Amber Watters, MD, on counseling patients for external cephalic version

Clinicians play a central role in guiding patients toward external cephalic version (ECV), and counseling should convey that a successful version carries different implications than proceeding directly to cesarean delivery, according to Amber Watters, MD, MS, Assistant Professor of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, and Chief of Obstetrics, Northwestern Medicine. The discussion continues Watters' previous remarks on integrating anesthesia into ECV protocols, also published on Contemporary OB/GYN.^1,2

Watters emphasized that patients look to clinicians for direction on ECV.

"Patients are really looking to us for guidance when it comes to external cephalic version and, truly, when it comes to recommendations for what we think is in the best interest of them and their pregnancies," she said.

Encouraging neuraxial anesthesia where appropriate

Watters encouraged clinicians who believe neuraxial anesthesia will improve version success to counsel patients accordingly, consistent with the ASA statement's finding that neuraxial anesthesia increases the success rate of ECV (RR 1.37; 95% CI, 1.19-1.58).

"If you feel neuraxial anesthesia is going to improve the success rates of your versions, which does seem to be the case from the observational data that we have, think about how to counsel and encourage your patients toward that decision if you feel it is the right one for them," she said.

Framing version versus cesarean

Watters cautioned against presenting ECV and cesarean delivery as equivalent choices, given their differing consequences.

"Patients sometimes are given equivalent choices between version and cesarean delivery, and we know that a successful version has different implications for both this pregnancy and future ones than a cesarean delivery without attempting version," she said, urging thorough, comprehensive counseling to support the best possible outcomes.

She also shared her own experience as a patient who underwent a difficult but successful version.

"I did have a version with my second child, my second daughter, and it was a very hard one. I was so relieved when it was successful," Watters said, noting the procedure allowed her to avoid abdominal surgery and recover more quickly. "As a patient, it's a really beneficial procedure to allow patients to avoid abdominal surgery and to return to their families and their older children and recover more quickly."

She welcomed the ASA's emphasis on collaboration. "I really appreciate what the ASA is doing in making a statement like this to encourage closer anesthesia collaboration with obstetricians in the performance of this procedure," Watters said. Per the ASA statement, ACOG recommends ECV for breech presentation at or after 37 weeks' gestation absent a contraindication to vaginal birth.

References:

1. Statement on Anesthesia Management and Support for External Cephalic Version. American Society of Anesthesiologists. Committee on Obstetric Anesthesia. Approved October 15, 2025. Accessed September 15, 2026. https://www.asahq.org/standards-and-practice-parameters/statement-on-anesthesia-management-and-support-for-external-cephalic-version
2. Fitch J. Amber Watters, MD, on anesthesia in external cephalic version for breech presentation. Contemporary OB/GYN. Published September 8,2026. Accessed September 15, 2026. https://www.contemporaryobgyn.net/view/amber-watters-md-anesthesia-external-cephalic-version-breech