Should I Try ECV or Not?

Is ECV worth a shot? I’d love your analysis of the data — I opted to not try it based on the 50/50 chance of success. Anything other than desire to have a vaginal birth that’s important to weigh in the decision?
—Britt

External cephalic version, or ECV, is a procedure that is done late in pregnancy to attempt to turn a breech baby to be head-down. The procedure is literally hands-on, turning the baby from the outside. Basically, one or two doctors maneuver to try to get the baby to somersault.

The reason to do this procedure — really, the only reason — is to avoid a C-section. It is certainly possible to deliver some breech babies vaginally, but very few providers do so, after a large trial showed slightly worse outcomes for breech babies with planned vaginal delivery. 1 If your baby is breech at delivery, you will very likely have a C-section. As I have written elsewhere, there isn’t necessarily an issue with this, but in some cases a vaginal birth is a goal, for various reasons.

Whether or not to have the procedure is, for most people, a complicated question. The success rate, based on many randomized trials, is in the range of 50%. Success is greater for some types of babies (for example, those who are lying horizontally rather than with their butt down) and for some groups of women (for example, women who have already had children). And it is a procedure that is not without small risks. These risks are hard to quantify precisely, since they are small, but they include stress on the baby, possibly leading to more serious issues.

During the procedure, infants are carefully monitored for stress, and the procedure can be stopped if stress is detected (in the data, about 5% of the time). This all makes it much safer, and it’s important not to overstate the risks: not zero, but limited.

This is a procedure with an uncertain success rate and that carries some risk. The reason to do it is to avoid a C-section. If that is not a significant priority, it may well make sense to skip it. If it is, it is something to discuss.