External cephalic version as an alternative to breech delivery and cesarean section

External cephalic version (ECV), the transabdominal manipulation of a breech-presenting fetus into a head-down position before birth, is common in traditional ethno-obstetric systems as well as in the modern scientific obstetrics of Europe. In the United States, this practice has fallen out of use and is no longer taught in medical schools or obstetric residencies. The currently standard American management options for breech are either breech delivery or, most frequently, cesarean section. This paper examines the historical and crosscultural distribution of ECV, describes the various methods for effecting version of the fetus, and assesses the risks of the procedure. It is concluded that the data available are inadequate to either condemn the practice or to advocate it without reservation. It is suggested that ECV may constitute an attractive conservative management strategy for breech presentation in scientific obstetric systems as well as in those developing countries where the skill to do versions is part of the traditional inventory of midwifery skills.