Amber Watters, MD, on emergency preparedness and building a version program

Emergent delivery is an uncommon complication of external cephalic version (ECV) and is exceedingly rare, falling within existing labor and delivery protocols, while establishing a version program requires stakeholder alignment and patient-centered counseling, 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's remarks on integrating anesthesia into ECV protocols.

Watters noted that the need for emergent intervention during ECV is low, consistent with the ASA statement.

“Emergent delivery in the setting of or after an external cephalic version is very uncommon, 0.2% to 0.7%, so exceedingly, exceedingly low,” she said.

Applying existing emergency protocols

Watters said units should rely on their standard escalation procedures rather than build new ones for ECV.

“Like everything we do in obstetrics, at any moment something can transition from being routine to being emergent. I would just adhere to your unit's typical policies, being able to perform emergent delivery within 30 minutes, which is what is set out as a priority for most labor and delivery units,” she said.

She noted that anesthesia collaboration may actually streamline readiness.

“Especially when you're collaborating with anesthesia to perform these procedures, you may already have your anesthesia team present,” Watters said, adding that the scenario “falls within the standards already applied on most labor and delivery units for escalating to delivery as needed.”

Building a program and honoring patient choice

For centers new to ECV or those performing it without anesthesia, Watters recommended convening stakeholders first.

“If you're in a center where version has not been done previously or has been done without anesthesia, getting your key group of stakeholders together to develop that process and to ensure that everyone's aligned and understanding the potential benefits of this collaboration for success of the procedure and for your patient population would be a really good place to start,” she said.

She emphasized that neuraxial anesthesia remains a patient choice.

“There may be situations in which patients decline neuraxial anesthesia or wish to undergo external cephalic version without it, and that still remains an appropriate and valid choice,” Watters said, adding that with appropriate counseling, patients will hopefully understand that the collaborative obstetrics and anesthesia relationship offers their best chance of success. Aligning teams on why practice is evolving, she said, precedes coordinating the logistics of how.

Reference:

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 11, 2026. https://www.asahq.org/standards-and-practice-parameters/statement-on-anesthesia-management-and-support-for-external-cephalic-version