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External Cephalic Version

Medically reviewed by Last updated on Aug 31, 2022.

What do I need to know about external cephalic version?

External cephalic version is a procedure used to move your baby into a headfirst position in your womb. This is usually done at around week 37 of pregnancy. A rear-first or feet-first position is called a breech position. This position can cause problems for the baby during pregnancy or delivery. Examples include a hip dislocation and nerve or brain injury. Babies in a breech position may need to be delivered by cesarean section (C-section). External cephalic version may help prevent problems during delivery.

What will happen before an external cephalic version?

  • Your obstetrician will tell you how to prepare for this procedure. You may be told not to eat or drink anything for 8 hours before this procedure. This is because external cephalic version can sometimes cause problems that may an immediate C-section necessary. Arrange to have someone drive you home from the procedure and stay with you for the rest of the day.
  • An ultrasound will be done to make sure your baby is in a breech position.
  • Your baby's heart rate will be watched closely with a monitor.
  • You may get medicine in your IV or injected into a muscle to help prevent contractions. Medicine may also be given to help the muscles in your uterus relax.

What will happen during an external cephalic version?

Gentle pressure will be used to prevent problems for you or your baby. An ultrasound or other test will be used several times during the procedure to check your baby's heart rate.

  • You will lie on your back. Your obstetrician will put his or her hands on your abdomen to find your baby's head.
  • First a forward roll will be tried. Your obstetrician will use one hand to lift your baby's buttocks out of your pelvis. The other hand will move your baby's head down toward your pelvis.
  • If this does not work, your obstetrician will try a backward roll. This means one hand will hold your baby's buttocks, and the other hand will push your baby toward your right hip. The baby will also be moved upward. His or her head may be moved down toward your left hip.

What will happen after an external cephalic version?

  • Your baby's heart rate will be checked again. If it is normal, you may be able to go home.
  • If the procedure worked, your obstetrician will help you make a birth plan if you want to have a vaginal delivery. Plans for a C-section may also be created, in case your baby has problems or turns back into a breech position. You may also need or want a C-section if the procedure did not work.
  • Your obstetrician will tell you when to return for more tests before you deliver. He or she will also give you instructions on what to do at home until labor begins.

What are the risks of external cephalic version?

You may feel some pain or discomfort during the procedure. You may also have nausea, and you may vomit. This procedure may cause labor to start, or cause premature rupture of the membranes (PROM). PROM means fluid leaks from your amniotic sac before labor begins. The placenta may pull away from the uterus, called abruption. You or your baby may also lose blood. Your baby's heart rate may become too slow. Your baby may turn back into a breech position even after a successful external cephalic version. During delivery, your baby may have a dislocated hip. His or her shoulder may get stuck in the birth canal (called shoulder dystocia). You may need to have a C-section to deliver your baby if he or she is in distress.

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