External Cephalic Version (Version) for Breech Position

Treatment Overview

External cephalic version, or version, is a procedure used to turn a fetus from a breech position or side-lying (transverse) position into a head-down (vertex) position before labor begins. When successful, version makes it possible for you to try a vaginal birth.

Version is done most often before labor begins, typically around 37 weeks. Version is sometimes used during labor before the amniotic sac has ruptured.

A scheduled cesarean is used to deliver most breech births if a version doesn't work.

Fetal monitoring

To avoid harm to the fetus, a version procedure is closely monitored.

• Fetal ultrasound is first used to confirm the fetus's position, where the placenta is, and the amount of amniotic fluid. Fetal ultrasound is often used to watch the fetal position during the version attempt.
• Electronic fetal heart monitoring is used before, possibly during, and after a version attempt. An active fetus whose heart rate increases normally with movement is usually considered to be healthy. If the fetus's heart rate becomes abnormal, the version procedure may be stopped.

Version procedure

Before the version attempt, you may be given an injection of tocolytic medicine to relax the uterus and prevent uterine contractions. The most commonly used tocolytic medicine is terbutaline.

While the uterus is relaxed, your doctor will attempt to turn the fetus. With both hands on the surface of your abdomen-one by the fetus's head and the other by the buttocks-the doctor pushes and rolls the fetus to a head-down position. You will feel discomfort during a version procedure, especially if it causes the uterus to contract. The amount of discomfort depends on how sensitive your abdomen is and how hard the doctor presses on your abdomen during the version attempt. If your fetus appears to be in distress, as shown by a sudden drop in heart rate, the procedure is stopped.

If a first attempt at version is not successful in turning the fetus, your doctor may suggest another attempt, possibly with epidural anesthesia to help you relax and to reduce pain associated with the procedure. Epidural anesthesia may increase the success of repeated version attempts.^{footnote 1}

Serious complications are rare during external cephalic version. But they do happen. This is why a version is performed in a hospital where you can have an emergency C-section delivery if needed.