What if my baby is still breech near term?

Babies who are still breech near term are unlikely to turn on their own. So if your baby is still bottom down at 37 weeks, your caregiver should offer to try to turn your baby to the more favorable head-down position, assuming you're an appropriate candidate.

This procedure is known as an external cephalic version (ECV). It's done by applying pressure to your abdomen and manually manipulating the baby into a head-down position. (If your caregiver is not experienced in this procedure, she may refer you to someone who is.)

ECV has about a 58 percent success rate in turning breech babies (and a 90 percent success rate if the baby is in a transverse lie.) But sometimes a baby refuses to budge or rotates back into a breech position after a successful version. ECV is more likely to work if this isn't your first baby.

Not all women can have ECV. If you're carrying twins or your pregnancy is complicated by bleeding or too little amniotic fluid, you won't be able to have the procedure. And, of course, you won't have a version if you're going to deliver by cesarean anyway — for example, if you have a placenta previa, triplets, or have had more than one previous c-section.

What is an ECV like?

Having a version isn't entirely risk-free and some women find it very uncomfortable. You'll want to discuss the pros and cons with your caregiver.

Severe complications, while relatively rare, can occur. For example, an ECV may cause the placenta to separate from the uterine wall so that your baby has to be delivered right away by c-section. The procedure may also cause a drop in your baby's heart rate, which, if it doesn't resolve quickly on its own, will require an immediate delivery.

For these reasons, a doctor should do the procedure in a hospital with facilities and staff available for an emergency c-section in case any complications arise. You'll be told not to eat or drink anything after midnight the night before the procedure, in case you end up needing surgery.

When you go in, you'll have blood drawn and an IV will be started. Women who are Rh-negative should get an injection of Rh immune globulin for the procedure unless the baby's father is also Rh-negative. Your baby's heart rate will be monitored for a time before and after the procedure.

You'll have an ultrasound beforehand to check your baby's position, the location of the placenta, and the amount of amniotic fluid. The ultrasound will be repeated after the maneuvers are performed. (Some doctors also use ultrasound during the procedure.)

Some studies show higher success rates for ECV when uterus-relaxing drugs are used.

I am starting to get nervous about this whole version procedure. I hope it goes well. Have you or somebody you know have this done before? Please, share your thoughts with me.