an external cephalic version or ECV

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I don’t know that I posted much about my experience last pregnancy with Pixie. I felt very insular and private during that pregnancy. This time around I have faced many of the same dilemmas and realised that by speaking out about my feelings they become a whole lot easier to manage.

When my little Pixie remained firmly in breech position throughout my pregnancy, I could barely bring myself to utter the word: breech. I felt like if I said it out loud, she might hear me. At the cross roads between a home birth and a caesarean I felt an immense amount of stress. After much agony and research we went ahead with an external cephalic version (ECV). My little Pixie turned south and remained that way to be born, at home, in the water.

When the same thing happened this pregnancy, I couldn’t quite believe it. I felt much better equipped to work with the situation, given I’d had practice, but I still couldn’t help feeling a desperate panic for this baby to turn. Reliving history gives you the chance to reflect on how you might do something differently. I tried really hard to focus on that this time. So I called in all the stops – booked myself in for a few specialised counselling sessions with a very experienced independent midwife, got back on the horse with acupuncture, moxibustion, chiro, spinning babies – you name it, I did it. I also decided at the beginning of the pregnancy that I wanted to go back to the birth centre where I had my first baby Birdie, as one of the difficult things for me about having a home birth was not having easy access to additional support if it was needed – for example in my case, another ECV. My doctor has also semi-retired and is no longer attending home births, so the thought of replacing him on my support team and organising the whole caper just wasn’t what felt right. Turns out my instincts were leading me on the right path.

With my ECV date looming this time around I went through various phases: panic, depression, fear… until finally, the week before my appointment, I allowed myself to give up. I cancelled my last acupuncture appointment and while I continued to do all the spinning babies exercises and yoga and so on, it was without pressure. I resigned myself to the fact that I would be going in for the ECV. I accepted it. In my mind the ECV was the next turning point in this pregnancy. I just had to get myself to that date, and wait and see what would come next.

One mistake I did repeat was searching for other experiences on the internet. Unfortunately there are lots of women who have had difficult ECVs and I didn’t find many positive experiences. (In saying that I know there was apparently a really positive ECV video being passed around on Facebook a few weeks ago but I was too frightened to watch it at the time and now I can’t find it… if anyone has the link please let me know and I’ll add it here.) [*UPDATE – here is the link. I haven’t watched it myself, still can’t bring myself to but perhaps I will after I have had the baby!]

I want to share my ECV experiences for others who might be thinking about choosing this option. This time it was a no brainer, but I remember it being a difficult decision the first time, and as discussed in my last post, there seems to be a lack of positive stories floating around in the birth arena.

For those of you who don’t know, an ECV is a procedure which takes place in hospital by an obstetrician. During an ECV a baby is manually encouraged to turn from breech position to head down by use of the obstetrician’s hands on the woman’s stomach. My father in law asked me afterwards, “So they… use their hands to… go… up… internally and… twist the baby…” UP? NO! I had to stop myself from crying I was trying not to laugh so hard. Rest assured, it is all done from the outside people.

I have gone down the ECV road twice now during my last two pregnancies. It is not something I would like to repeat and certainly didn’t imagine myself having to do it again this pregnancy, but I would do it again a million times over before being bullied into a caesarean simply due to breech position, which is sadly what happens at a lot of hospitals in Australia. There are certain risks that go with getting an ECV. If you’re considering getting one I would do some research yourself and ensure that it is the right decision for you. Some people decide not to go ahead after they have read more about them, it is entirely your individual choice.

Onto the ECV. When I arrived at the hospital I was given a very brief ultrasound just to confirm that the hard round ball under my ribs was in fact a head and not a strangely shaped bottom. It was, so I was hooked up to monitoring for about 20 minutes. After that I was met by the consultant obstetrician who would be doing my ECV. She did a more thorough ultrasound to check that there wasn’t any obvious reason for the baby to be in breech position, and measured things like the baby’s estimated weight, checked where the cord and the placenta were, and basically made sure the conditions were optimal to attempt the ECV.

Usually women are given a drip with a medication that helps to relax the uterus during the procedure. Last pregnancy I was told that my stomach was relaxed enough to attempt the ECV without the drip. I’m terrified of drips so I was very thankful to my yoga breathing for getting me out of that one! This time, at a different and more stringent hospital I was really worried they would make me have the drip. I mentioned that I hadn’t had it last time and the consultant had a feel and was happy to attempt without the medication, and all went smoothly. I would definitely ask if this is a possibility if you are going for an ECV. The medication can make your heart race and make you feel a bit anxious, in a situation where you are probably already sweating it out a little. I was also told by the registrar that did my first ECV that he preferred not to use the drip if possible as while your stomach is relaxed under medication it is easier for the baby to flip back around afterwards. I have no idea if this is true so don’t take my word for gospel, but it does seem to make sense.

The consultant then explained that while I was laying on my back she would use both her hands to push underneath the baby’s bottom and try to encourage him/her to do a somersault. If this didn’t work she would attempt to encourage the baby to go the other way. She clearly explained that she would only continue if the baby easily moved. If the baby did not want to move, she would not push it. This was reassuring as I had read some stories on the internet which involved ECVs going on and on and on with a baby who obviously did not want to move.

She placed both her hands on my stomach and located the baby’s bottom. She pushed her hands quite deeply into my stomach in order to get them slightly underneath the baby’s bottom. This is the uncomfortable part. I closed my eyes and breathed in for four and out for four. Within about a minute the whole thing was over. Initially my heart sank and I thought when she removed her hands that it hadn’t worked. A quick ultrasound showed the baby’s head pointing south and a bottom up under my ribs. I couldn’t believe it!

I was a little sore in the days following, a little bit because I had been poked and prodded, but mainly because I could feel the blissfully uncomfortable feeling of a little (wishful thinking?) head nestling and nudging my pelvis.

I am now 38.3 weeks and the baby’s head is engaged.

I couldn’t be more thankful for having the opportunity to get an ECV. I will never know what might have happened if I hadn’t agreed to it both times. Perhaps my babies would have flipped. Maybe once labour began they might have looked for the appropriate exit. I will never know, but I know that for me, the ECV was the right decision. It has allowed me to spend the last month-ish of both my pregnancies relatively worry free. It has allowed me the time and the space to prepare for a natural birth, without the added anxiety of a potential/likely caesarean looming over me. It has allowed me to connect with my baby without the strain of frustration that I felt when they seemingly would not turn around. It was the right decision for us.

Some people believe that a baby remains in breech position (or other) because they want to, and that they might know something that we don’t. I don’t know if this is true. It is usually something I would believe in wholeheartedly. I think the important thing to do is weigh up all your options and go with your gut. For me, both times, it has been to go with the ECV and so far I have not regretted my decision. There are always a lot of variations to each pregnancy – not least of which including your location and whether or not you have facilities and support nearby to deliver a breech baby naturally. This weighed in heavily on my decision to have an ECV as my other options were very limited.

Do what is right for you and your baby.

My husband and my midwife accompanied me through the whole ECV procedure and I have to give them both special thanks for being there for me on the day (and during the lead up in which I was a bundle of nerves and tears – sorry to you both!). I was so nervous, and their talk of coffees, vampires and zombies made for some excitement on my baseline monitoring record as well as helped to distract me from the whole process. So thank you xxx

And I hope this ridiculously long post has helped give another perspective on the experience of an ECV. Good luck with your decision making!

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2 thoughts on “an external cephalic version or ECV

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