How to Survive an ECV
Third Trimester

How to Survive an ECV (External Cephalic Version)

So, baby number two is clearly hell bent on being upside down for the entirety of this pregnancy.

It is completely and unmistakably the wrong way up! It’s big old lump of a head is lodged under my ribs and its legs are fanatically kicking me in the bladder. Neither of which are particularly comfortable!

At every antenatal appointment the midwives calmly and confidently told me that baby will turn itself head down (cephalic) before too long. My gut instinct, however, told me in no uncertain terms that baby had other plans.

It was determined to stay head up (breech) as clearly that is the right way up to be ( I can’t argue with its logic really – who wants to be upside down all the time?!).

They kept telling me that baby would turn!

During my 37 week appointment, the midwife finally had to admit that it didn’t feel like baby had turned and that it was time to check things out.

I was swiftly sent off to my local Antenatal Day Unit for a Presentation Scan to confirm whether or not baby was the wrong way up or not!

As soon as the Sonographer touched my belly with the ultrasound probe she confirmed that baby was definitely breech.

One leg up, one leg down!

After having a closer look around at baby’s presentation she found that baby was neither extended (or frank) breech (with its legs up by its head) or footling breech (feet below its bottom) or flexed breech (with its legs ‘frogged’ and feet right next to its bottom) but a halfway between the lot.

Baby had one leg up by its head and the other down by its bum! It sounds like it’s bloody uncomfortable in there, constantly doing the splits!

It suddenly made baby’s movements make a lot more sense. I wasn’t quite sure how I could feel baby kicking me in the ribs and bladder simultaneously!

It’s breech, now what?

So, with baby’s position confirmed, up popped one of the consultant obstetricians to talk about my options;

  1. Elect for a cesarean section
  2. Try turning baby with an ECV (External Cephalic Version)
  3. Leave baby upside down and deliver breech naturally.

I knew I didn’t want to try and deliver my breech baby naturally..

Having already done my research on my options (see here), I decided to go for the ECV.

Trying to deliver a breech baby naturally wasn’t for me. Four in ten (40%) of vaginal breech deliveries end up as emergency c-sections. I didn’t fancy going through hours of labour to end up with an emergency section anyway!

Also, I knew that very few Midwives and Obstetricians will deliver breech babies!

I wanted to try for a natural birth.

However, I did want to try to have a natural birth before resorting to a cesarean section. So I decided that my best option was to give baby a chance to turn by undergoing an ECV. I could then hopefully have a natural cephalic delivery.

If baby was still hell bent on being breech after we had tried the ECV, then I would elect to have a c-section.

This is therefore what I told the obstetrician. I was then booked in for an ECV in three days time.

Don’t rely on Mr.Google!

Right; most people, including myself, spend the hours before having their ECV, googling to try and find and read real mums’ accounts of what an ECV is actually like.

I couldn’t find many and the ones that I could (good old Mumsnet!) weren’t brilliantly comforting or informative!

Honestly, I couldn’t find much information about the whole process at all! I didn’t receive all that much information when I was booked in for the procedure either. So here I will try and do both.

I will give you my honest account of what undergoing an ECV was like for me. I will then give you the factual answers to the questions you’re probably asking yourself!

What happened before my ECV:

On the day, I arrived at my local antenatal day unit. I had neither drunk or eaten anything all morning (as had been suggested as a result of my mornings ‘google-ing’!).

Nobody had actually advised me as to whether or not to do this.Oobviously other people on the interweb had.

Somehow, I figured it was better to abstain from food and drink just in case. I didn’t want to get there to have them say they couldn’t do the procedure as I had been eating and drinking. This was clearly unwise of me, but we’ll get to that later!

The staff checked me in, then I was sent to a monitoring room.

The midwife performed a very brief ultrasound to confirm, once again, that baby was still breech. I was then hooked up to a fetal heart rate monitor and was left to it!

I was hooked up to many machines..!

The specifics of it eluded me, but the monitor had a programme to run. It had to monitor baby for a specific time or for a specific amount of movements or peaks and troughs of its heart rate.

Once the machine was satisfied that baby was all OK, I was disconnected from the machine and was sent to the antenatal ward to await my ECV procedure.

How to Survive an ECV External Cephalic Version
Hooked up to the fetal monitor!

What happened on the ward:

Once I was admitted to the ward, I was talked through the procedure by the consultant Obstetrician.

She explained the potential risks; distress to baby, pre-term membrane rupture, emergency cesarean section etc. Then made me sign a consent form to say that I understood the risks, and was happy for the procedure to be carried out.

Relax those muscles please!

The doctors then administered an injection of a type of muscle relaxant to relax the muscles of the womb. This would give baby more room to turn. I was told that it can make your heart race. Apparently it can feel a bit scary, but that it would pass in a few minutes. I can’t say that I noticed anything much!

After the drug had been given time to work its magic (half and hour or so), the Obstetrician and two Doctors appeared to try and turn baby.

They gave it three goes, trying to turn baby clockwise twice and anti-clockwise once. After each attempt they checked with a ultra-sound to confirm if baby had turned or not.

So, here they are, the answers to the questions you have been waiting for:

What does an ECV feel like?

It literally felt like they were trying to grab baby’s head with one hand and bum with the other through my stomach. Then literally pushing and pulling to turn it round in my belly.

Does an ECV hurt?

I’m not going to lie; it wasn’t pleasant and it wasn’t pain free. But, it wasn’t anything compared to labour pains, so it really isn’t too bad!

They have to dig in pretty hard with their hands (and fingers – they were the buggers!) to get a hold of baby. That and pushing it into a position where it is lying horizontally in your belly feels like quite a stretch!

Knowing the pain won’t last for ever (in the same way that labour pains don’t last forever!) makes it all manageable.

Take deep breaths, really focus on your breathing and you will get through it just fine! Taking along someone who’s hand you can squeeze makes things feel better too!

Despite their best efforts, baby was still breech!

Unfortunately, despite their best attempts, every time they managed to get baby to turn, it slipped back. After the third go, they decided that baby was not going to move so they wouldn’t try anymore.

I therefore decided to go for an elective cesarean section.

If baby turned in the meantime, all well and good. Although the Obstetrician confirmed that if it hadn’t turned during the procedure, it was unlikely to turn of its own accord!.

I was then placed back on a fetal monitoring machine for an hour. Just to check that baby was well, happy, wriggling and not in any kind of distress.

Ketones are great for the diet, NOT pregnancy!

Baby was fine, but due to my ill-advised lack of food and drink, I was not.

We had been in the hospital for around 6 hours as they were particularly busy; a long time during a balmy July day to not have anything to drink!

They found very high levels of ketones in my urine, so I was placed on an IV drip, told to eat plenty and left until the ketones had gone from my urine and I was deemed safe for discharge.

How to Survive and ECV External Cephalic Version
High on cake (and McDonalds!) to bring down those ketones!

In hindsight, I should have phoned the Antenatal Day Unit and questioned whether or not I should have been nil by mouth prior to my ECV. I shouldn’t have just gone with what Mr.Google had created a consensus on!

If I had asked the question, I would then have been discharged following confirmation that baby was happy, not four hours later as my day actually played out.

As far as I can tell the only reason to be nil by mouth is just in case an emergency cesarean section needed to be performed.

Thinking back, this really isn’t a reason to have not eaten or drunk anything (unless I was specifically advised – which I wasn’t).

The rate of emergency cesarean sections required following an ECV is very low (1 in 200) and even if one was required, I don’t think they would be worrying if I had eaten or drunk in the last few hours!

It would make the procedure easier but wouldn’t stop them performing it!

I forgot my own rule; when in doubt, CHECK IT OUT!

I’m an idiot!

So that’s my experience; definitely worth giving a go if your baby is breech and hell bent on being that way.

The small amount of discomfort and pain far out ways the pain of recovering from a cesarean section. So, if there is a possibility that it will work for you and you can have a normal delivery, then give it a go!

Is ECV Safe?

ECV is generally considered very safe and has a very low complication rate.

There is a 1 in 200 chance that you will require an emergency cesarean section immediately after an ECV, if there is a change in baby’s heartbeat or there is any bleeding from the placenta.

What is the success rate of ECV?

ECV is successful for around 50% of procedures carried out.

It is more likely to be successful if you have been pregnant before and had a vaginal delivery as baby has more room to turn.

There is still a very small chance, if the procedure is successful, that baby may turn back to the breech position. This happens to less than 5 in 100 (5%) of women who have had a successful ECV performed.

How is ECV done?

An ECV is done by applying firm, but gentle, pressure on your abdomen to help baby turn in the uterus.

Both you and your baby will be closely monitored before and after the procedure and ultrasound scans will be used before and after the ECV to confirm the position of baby.

Can you eat before ECV?

Check with the clinician/ward/department/hospital that will be carrying out your procedure.

It is quite apparent that different hospitals have different requirements.

Don’t get this wrong like I did! Please don’t guess or ask Mr.Google; check it out with those in the know, in advance!

Can Breech babies turn after 36 weeks?

Some babies do turn themselves naturally in the last month of pregnancy (36 – 40 weeks).

If it is your first baby, the chance of them turning before labour is around 1 in 8 of all pregnancies.

If this is your second or subsequent baby, the chance of them turning naturally increases to around 1 in 3.

Does turning a breech baby hurt?

The official line is that turning a breech baby by ECV maybe ‘uncomfortable’.

Yes, I would agree that its very ‘uncomfortable’. Read my account above and you’ll get the idea!

Can you go into labour after and ECV?

It is very rare that complications will arise from an ECV, however they are performed in a hospital just in case any do.

Around 1 in 1,000 women will go into labour after an ECV.

What happens if my baby is still breech after my ECV?

If your baby remains breech following your ECV procedure, your Doctor, Midwife or other Clinician will advise you of your options following your ECV.

You may wish to try and repeat the procedure at a later date, go for a vaginal breech birth or opt for an elective cesarean section.

For further reading (UK based advice) the patient information leaflet published by the Royal College of Obstetricians and Gynaecologists (RCOG) is valuable reading.

Please find the link below:

https://www.rcog.org.uk/en/patients/patient-leaflets/breech-baby-at-the-end-of-pregnancy/

Remember, it is very rare that having a breech baby means that anything is wrong or will be wrong with baby. Sometimes they are just stubborn little buggers!

Whichever route you decide to take is just one step closer to finally meeting your little human for the first time!

Relax and remember it won’t be long now!

2 Comments

Leave a Reply

Your email address will not be published. Required fields are marked *