External cephalic version (ECV) for a breech baby in Hong Kong

At around 32 weeks, most babies are positioned headfirst in the womb to prepare for delivery. Sometimes though, the baby might be positioned to come out feet-first or bottom-first — this is commonly known as a breech baby. 

As you get closer to your expected due date, your doctor may suggest ways to turn your baby with an external cephalic version (ECV) procedure. 

What is an external cephalic version?

External cephalic version (ECV) is a process to help carefully turn your baby in the womb manually until they are facing-head first. The whole procedure is performed at a hospital and closely monitored by staff to avoid harm to the fetus. Within a few days of the procedure, there will be a follow up to determine whether the baby has turned and whether or not you can continue with vaginal birth. 

Generally, the procedure is safe. But the studies in its success rate vary anywhere from 30 to 80%. As the procedure is delicate, we recommend it should only be done by a specialist obstetrician experienced in ECV. So they will not force an unwilling turn. 

ECV in Hong Kong

In Hong Kong, ECV is offered in both the public and private healthcare systems. Mothers will usually need to carry out their own research or get referrals about the obstetricians available to her. 

How does the ECV procedure work?

ECV is usually performed after 37 weeks of pregnancy.

Steps before the version

1. Prior to doing the ECV an ultrasound scan is done to confirm that your baby is still breech, and a fetal heart rate trace is performed to check that all is well with your baby.
2. Your obstetrician will usually perform another ultrasound scan to confirm that your baby is still in the breech position. The ultrasound will also help check the fetus position, where the placenta is, and the amount of amniotic fluid. 
3. The fetal heart rate is checked to make sure the fetus is doing well. The heart rate may also be monitored during the procedure to observe the status of the fetus during the version attempt.
4. You might also be given tocolytic medicine to relax the uterus and prevent contractions. 
5. In some cases, you can be given an epidural to help relax and reduce pain.

During the version

1. While the uterus is relaxed, your obstetrician will try to turn your baby by pressing their hands gently on the outside of your belly. 
2. One hand will be by the baby’s head, and the other by its bottom. 
3. The obstetrician will push and roll the baby to a head-down position. 

Most women feel discomfort during the ECV procedure, but the pain usually depends on different factors like tolerance, abdominal sensitivity, etc. If the fetus shows distress the procedure is immediately stopped. 

After-care

Generally, most women rest as needed. You should follow your obstetrician’s directions and guidance. 

ECV is a safe procedure, but complications can happen on rare occasions. This is why the procedure is performed in a hospital where you can have access to an emergency C-section delivery. 

You should seek emergency care immediately if you feel contractions, bleeding, or you feel that your baby isn’t moving as before.

There are a few circumstances when ECV cannot be performed, these are when: 

• the amniotic sac (bag of water) has ruptured
• the mother has an underlying health condition that prevents her from receiving certain medicines needed to perform an ECV
• fetal monitoring shows that the fetus may not be doing well
• the fetus is known/suspected to have a birth defect 
• the mother is carrying multiple fetuses, like twins. 
• the uterus does not have a normal shape

External cephalic version help at OT&P

If you’d like to learn more about external cephalic version please feel free to reach out to us at OT&P! We have trained obstetricians who’ve had experience performing ECV in Hong Kong. We can help you learn more about the process, the risks and answer any questions you may have specific to your pregnancy. Together, we can work out the best possible options for you and your family.