What is ECV?

During ECV, we try externally to turn your baby from a breech position (or unstable position) so that it’s lying head down.

Your baby has to play along, the midwife or doctor performing the ECV can’t force anything. The pressure used while pushing on your stomach on your stomach to turn the baby can sometimes feel uncomfortable. If you are in too much pain, you can indicate that and the person performing the ECV will stop . If your baby doesn’t want to turn, the ECV won’t work.

Sometimes the ECV works immediately, but often during an appointment several attempts are needed to make your baby turn. The baby can turn clockwise or anticlockwise depending on how it is lying.
An ECV is safe, as there are rarely, if ever, problems during the procedure.

Why ECV?

We recommend ECV because, if the baby is lying head down at the time of delivery, the chance of a caesarean is much smaller. With an operation (caesarean) you are more likely to have problems, which you do not have with a vaginal delivery of a baby in head-down position.

Even if you choose not to have ECV performed, we recommend that you discuss this choice with your midwife or the person you have been referred to. In exceptional cases, your healthcare provider may advise against attempting ECV.

When can the ECV take place?

If you are pregnant with your first baby, we will attempt ECV from about 35 weeks gestation, depending on the space in your abdomen. If you are pregnant with your 2nd or subsequent baby, the ECV can take place from 36 weeks or later.

centre locatedWhere does the ECV take place?

The ECV is carried out by an experienced ECV practitioner: a specialized midwife and/or obstetrician. The ECV takes place at a community centre located  in a midwifery practice (or an ultrasound center) or at the OLVG-West hospital.

After consultation with your midwife, you may choose where you want the ECV to take place. Your midwife or doctor will refer you to the ECV practitioner.

The practice of ECV

Before you are referred for ECV, an ultrasound will have already been made. The position and growth of your baby will have been looked at. It will also be checked to see if there are any obvious reasons why your baby is not lying head down. Usually, there is no identifiable reason for this. A breech position is not an abnormality; it is a variation in location.

When you come for your appointment it’s a good idea to come with someone and to wear loose, comfortable clothes.

The ECV practitioner will first explain what to expect from the ECV and there will be time to ask questions. The whole appointment takes an hour. This amount of time is required so that we can help you relax properly. This makes the ECV attempt easier.

We always listen to your baby’s heartbeat for a long time, before and after every ECV attempt. In a community setting, we do this with the handheld doptone, just like your midwife does. In the OLVG-West this is done with a CTG device (cardio-toco-graphy).

Both in the community-setting and in the OLVG-West there is an ultrasound scanner present. This will allow us to look at your baby before and after the ECV.

In the OLVG-West you can also opt for medication during the ECV. This medication allows the uterus,  to relax even more, making an ECV easier to perform. The medication can sometimes have mild side effects for you. There are no side effects for the baby. The side effects are short-lived and usually disappear after a few hours.
If your blood type is rhesus negative and that of your baby rhesus positive, you will receive an injection of anti-D at the end of the ECV, whether it has succeeded in turning the baby or not.

In the community-setting, there are one or two ECV practitioners present as well as you and possibly your partner. In the OLVG-West as well as the practitioner performing the ECV, there will also be a nurse or possibly a doctor.

The OLVG-West is a training hospital. Therefore, you may be asked whether a midwifery student or doctor in training can also watch the ECV.

Warning: film of actual ECV

When is an ECV not possible?

• You’re expecting twins or triplets.

• The placenta is low-lying (or over the cervix).

• There are other medical reasons why your midwifery health care provider advises not to try an ECV.

Have you made your choice?

Always contact your midwifery healthcare provider for a referral to the ECV team of your choice. If you haven’t been able to make a choice yet, the ECV team can also help you with this. Even if you choose not to have the ECV performed, you can make an appointment with the ECV team for further information.

How do I prepare?

• Bring your partner (or someone you feel comfortable with) to the ECV.

• You should rest before and after the ECV or take a shower or bath to relax.

• Make sure your stomach is not full at the time of the ECV.

• Wear comfortable clothing that allows easy access to your tummy.

• You don’t need to have to have a full bladder.

• Write down any questions and take them with you.

What should you do following ECV?

• Ensure adequate rest the day after the ECV.

• At the end of the ECV you can get muscle pain or a bruised-like feeling in your stomach. This can last up to two days and is harmless.

• Sometimes you can feel the baby moving in a different position following the ECV. If you have any doubts about the amount of movements (or way in which your baby moves), always contact your midwifery care provider.

• In case of blood loss, amniotic fluid loss or if you are concerned, you should always contact your midwifery care provider directly.

• If the ECV is successful, you will stay under the care of your own midwifery care provider for future care.

• Three months after birth, an ultrasound should be made of your baby’s hips. In babies, who have been in breech position for a long time, the joints which support of the hips may be less well developed. Therefore, this is checked with an extra ultrasound. For this you will automatically get an appointment.

What if the ECV doesn’t work?

Sometimes at the first attempt it is not possible to rotate the baby. You can then decide, together with your ECV practitioner, whether to have another attempt made. The next attempt is usually made with a second ECV practitioner in attendance. Again, you have the choice where you want to make this second attempt: in the community-setting or at the hospital.

If your baby is not lying head-down despite the ECV attempt, you will be referred to the outpatient obstetric clinic of the OLVG-West. During a discussion with an obstetrician, the different ways of giving birth and alternative possibilities will be discussed with you. Your own midwife arranges this appointment for you, in consultation with the ECV practitioner.