ECV – The Art of Flipping Babies

I’ve been there. You’ve gone the distance and arrived at the end of the third trimester. You have your birth plan in hand, you’ve grown a perfect little baby, and you’re eager to finally see that tiny face. Your primary care provider palpates your uterus, or maybe a scan was ordered. Your stubborn baby is making sure you stay on your toes up to the very last minute. They’re breech!

At 36 weeks, my daughter was one of five babies in our OB practice who hadn’t flipped head down. By the time I went in for my ECV at 38 weeks, my baby was the only one of the five who hadn’t flipped spontaneously.

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This gal was a little too comfortable in my rib cage

Breech babies can and do flip on their own, all the way up to labor itself. For some parents, a vaginal breech attempt is a great option that should be thoroughly explored with your care provider. For others, the choice is between scheduled cesarean or attempting to turn your baby. There are several methods for encouraging your baby to turn, but today we’ll talk about the nuclear option of baby flipping, ECV (external cephalic version).

What To Expect

Before your ECV you’ll have the opportunity to chat with your care team about what to expect. You will have options. You can indicate your preferences about when to perform the procedure, or whether or not to have an epidural in place. Just over half of babies respond well to ECV and remain head down. If your procedure is unsuccessful you may opt to try again. Sometimes, when attempts to turn are unsuccessful, it’s not just a matter of luck. There are physiological reasons why a baby may remain breech, like a short cord, or simply mother and/or baby’s physiology meshing better in a breech position. If this is the case for you it is absolutely not a failure, just an opportunity to move on to discuss vaginal breech vs planned cesarean.

The planning stage is a great time to chat with your doula. You may want to discuss informed consent, and comfort measures. Whether or not you opt for the epidural, you can expect some discomfort. It is not overwhelmingly painful by any means, but having good coping mechanisms in place will make for a more positive experience. If you’d like professional support, ask your doula if they’re available to attend the procedure.

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My ECV was performed by a high risk OB and a nurse at the Ottawa General hospital. Talk to your care team about a referral to a skilled provider. I did not opt for an epidural. You’ll be brought to an exam room and made comfortable on the bed. First an ultrasound will be performed to assess your baby’s positioning and ensure the procedure can be performed safely without creating cord compression, etc. Enjoy this opportunity to take a peek at your little one! The ultrasound will remain on throughout the procedure, to help guide the OB. The OB will palpate your uterus, getting a good grip on your baby’s head and bottom. Now for the fun part, you’re about to watch someone pick up and move your baby before their birth. Using ultrasound imagery the OB will carefully rotate your baby’s body. For me, the most difficult part was navigating her head under and out of my rib cage. However it was nothing I couldn’t handle with careful breathing control and excellent care team support.

Once your baby has successfully turned head down, they’ll once again assess position via ultrasound. For me, I felt a tremendous feeling of relief. Not only emotionally, but also an immediate sensation of lightness with the removal of all that pressure in my ribs. You can expect to be sent for a non stress test afterwards. They’ll be monitoring baby’s heart rate, along with checking kick counts and contractions. This is a precautionary measure to ensure your baby tolerated the procedure well. You may find, like I did, that your baby is tired after the procedure. I ate crackers and drank juice, and alternated positions to wake her up. Once awake, she met the kick count standards, and we headed home one hour post ECV.

Once home, it’s wise to continue noting kick counts and timing any small post procedure contractions. You’ll be reassessed periodically for the remainder of the pregnancy to ensure your baby remains head down. My baby did, and seven days after my ECV I had the spontaneous, uneventful delivery I had hoped for.

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Miss Stubborn Breech, safely earth side.
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