ECV – External Cephalic Version

Babies sometimes require help to settle head down in the pelvis.
Sometimes just being reminded what we want of them is enough; bodywork on the pregnant body helps to remove barriers, but sometimes as we near the due window, it’s smart to help them move head down before they run out of room because of their growing size and the normally decreasing fluid volume.

Here’s a great example of the midwifery model of external cephalic version. This mama was almost 37 weeks and her baby was still breech. She had done ‘all the things’ and was beginning to get worried about her birth plans. We discussed her options (planned c-section, planned vaginal breech birth, an ECV with a physician or an ECV with me, her midwife), She researched all her options and decided that she would prefer to try to turn her baby with the care provider she already knew. We talked about risks, benefits and gave her our protocol for the most successful version. 

The night before her appointment, she did a lot of inversions. Then the day of the appointment, she went to her chiropractor for a ‘turn encouraging’ adjustment. When she arrived at the clinic, she spent another 20 min in the ‘knee-chest position’.

Finally, we were ready to ask and encourage baby to move.

For all the providers out there, it’s not ‘woooooo’ to involve the baby in the process. Why shouldn’t we treat baby with the same respect we treat our adult friends? Ask, communicate, encourage, speak nicely, listen to them!

When I do a version, I approach both mom and baby and ask them both permission to touch and move their bodies (not in this video), once I receive consent, I tell them what to expect and then move forward knowing that either could change their mind at any moment – consent is a verb y’all.

We physically listen to the baby’s heartbeat throughout so that we can clinically tell if they are tolerating the experience. But we also listen to the energy in the room, to the silent and subtle changes. Midwives develop a skill to ‘read the room’; we calibrate our intuition and learn how to communicate telepathically. If you don’t believe this – you don’t spend enough time with midwives.

The hardest part of a version is moving through the transverse. Before you push a baby into this space, ask them if it’s ok, literally pause and ask the ethers. A NO is clear – they push back against you, their heart rate goes down, or your body gets nauseous or cold sweat or chills – let the higher self guide in these moments. A YES feels easy, like butter, your hands just start moving without your control, baby moves into the space themselves, or your body stands up and leans in. LISTEN to these clues. In 20 years of providing versions to families that request them, I have never experienced a baby in distress because of my hands. I have, however, listened to my ‘holy no’ and stopped, ordered another scan or checked in with mom and discovered a real contraindication to ECV.

This baby turned and the mama was so happy! Such a relief – she did go on to have a beautiful, al be it, long homebirth.

A quick note on pressure – ECV should not hurt. The touch is deep but slow and steady – something you can get used to. The communication flows both ways, I am as responsive as mama and baby, together we make a team.

A note on monitoring – bp;abies should be monitored before and after an ECV to risk assess fetal distress – but this can be done with Doppler, not just ultrasound. In this video, my student was doing her best to follow baby as I moved her. When needed, I was able to give her exact direction, and even though we were hearing echo and cord for much of it, we were assured of baby being happy throughout. We listen again with every maternal position change to determine baseline after the procedure.

A note on risks- the only real risk with ECV is fetal distress. Pressure from outside can compress the cord, placenta, vena cava, or uterine arteries. It is very unlikely for a term baby being touched by a sensitive provider with good FHT monitoring throughout, but it is possible. If baby says no, put them back where you found them, assist the birther to the left lateral position, and depending on the severity, initiate transport and begin the intrauterine resuscitation techniques of oxygen and bolus IV fluid.

A note on ultrasounds – my highest advice is to confirm position of baby BEFOFE attempting an ECV. Diagnostic US also confirms placenta location, amount of amniotic fluid and sometimes cord location as well. This can be very informative and helps the parents make a more informed decision.

A note on post-version protocols – getting up from the table with a baby still high (like in this video) is not recommended. So we bind before we rise. Rolled hand towels splint babies head and then an elastic, Velcro binder is placed around the abdomen for the remainder of the day and mom is instructed not to remove it till she is in bed for the night. This decreases the percentage of babies who flip back to breech and increases the likely hood of engagement after version.

If you would like hands-on training in ECV, consider coming to one of my summer workshops in the US – schedule on our website.

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