ECV for breech, and induction / ELCS for small baby(26 Posts)
I'm 35 weeks pregnant and have been having regular growth scans since 28 weeks due to small measurements. Scan measurements have been growing consistently along the 10th centile, doppler and fluid levels were normal. Because of the low predicted weight the consultant wants me to deliver by 39 weeks. This feels a bit over cautious to me, I can't see any sign that anything is actually wrong and I think she's just naturally small.
She is also breech and has been in the same position since 28 weeks. I'm currently booked in for an ECV next week, and if that fails and she doesn't turn by herself they want to deliver by c section at 39 weeks.
I'm not sure whether to go for the ECV. I'm concerned about the risks, and the chance of success is low as this my first pregnancy, it's an extended breech and I have an anterior placenta. Even if it does succeed they want to induce early, and I'm not sure I see that as preferable to ELCS. I think an early induction when my body isn't ready has too high a chance of a cascade of interventions, I'd refuse an instrumental delivery unless there was no other option, and could well end up with an EMCS after days of failed induction.
I could refuse induction and wait to go into labour naturally if she turns but I'd worry about going against their advice to deliver early in case something did go wrong.
Anyone else been in a similar situation? I just don't know how to make a decision!
I'm in a similar situation - I'm 35 weeks with a breech baby too! I'be decided not to have the ECV. For me it seems too risky, and the chance of it working too small, especially for first pregnancies. I also think that my baby knows what it's like in my womb better than any of us, and if he's breech it's probably for a good reason - maybe his cord positioning is better that way, or something. So I don't want to force him into a certain position. I've made my peace with having an elcs and am actually looking forward to it
That's just me though - I'm hugely risk averse. ECVs carry a small risk, as do inductions, of complications. I'm choosing the path of least resistance.
Good luck whatever you decide, it's a tough decision and I felt very stressed about it myself until I made my mind up about it all (which took me ages to do).
Also I think your concerns about ECV and early induction and the cascade of intervention are extremely valid. From all the reading I've done lately, an elcs is a walk in the park in comparison to a potentially long induced labour and the increased risk of intervention that goes with it.
I've had a successful ECV with nothing go wrong - just to dispel the negativity that goes with ECV!
I ended up with an EMCS anyway so I would say it's probably not worth it really.
Thanks Yorkie, I guess people do tend to focus on the horror stories, when it is actually quite a low risk procedure. I think I'd give it a go if I would then be left to go into labour naturally, but since all I have to gain is an early induction, unless I choose to go against my consultant's advice to deliver early, it makes me more reluctant.
Sanderling I'm also quite risk averse. From what I've read ELCS is the safest option for the baby. ECV comes with a small risk to her; the pessaries, syntocinon, possible ventouse / forceps / EMCS all carry some risks for us both. ELCS may have a longer recovery time, but is more predictable. If there was a high chance of a straightforward birth I'd take that instead, but I'm not convinced induction is likely to give me that. I'm glad you've managed to come to the right decision for yourself and I hope all goes well for you. I think I'm coming to similar conclusions.
Unfortunately I also have to consider the fact that my hospital has one of the most under-resourced maternity departments in the country. I've heard stories of women being told they're high risk and need to be induced, then being turned away to wait for several days as they don't have the resource to cope. In the current environment, I'm not sure I want to take the risk of needing EMCS at 3am with no experienced staff around.
I'm following with interest as we have been offered growth scans for a similar reason. We've been told that it doesn't matter if the baby is small so long as growth is steady. This seems to contradict your consultants advice about inducing early. Surely if baby is small they could do with another week or two to grow before birth. If there's a lack of growth that's much more serious but in that case I thought they would do tests to check if the placenta is working well before making a decision. Could you get a second opinion? I agree with you though about the risks of elcs vs induction. I don't think there's much difference risk wise. I've heard that induction isn't a very nice experience too. people seem much happier after elcs compared to induction.
That's interesting Bananas, maybe different hospitals have different policies? I'd originally thought they'd leave her to grow if she carried on along the 10th centile line, especially since the doppler shows no problems with placental blood flow. I did ask whether she wouldn't be better off with more time to grow, since there are no signs of distress, but was told that the scans wouldn't always pick up problems and that the stillbirth rate increases the longer she's left, so better out than in by 39 weeks.
I might talk to my midwife about being a second opinion, as I'm unconvinced. Think I'm probably going to cancel the ECV regardless as I'm not happy with the risks for such a low success rate. I've got a bit more time to decide on the rest.
Do you have other stillbirth risk factors then? Otherwise I guess he must suspect an issue that's not showing on the tests.
Please let us know how you get on as this is exactly the scenario I'm worried about with the growth scans: Being told we have to intervene without any evidence to suggest there's anything wrong other than a small baby. DC1 was small (10th percentile) and 2 weeks late so we've been offered the scans for DC2 as DC1 'was small for gestational age'. However, I was the smallest kid through most of primary school and secondary school until I suddenly shot up to average height in my teens. Husband is slightly below average height and was also tiny as a child. So I wouldn't expect us to produce big babies. DC1 is still only on 10th percentile now, he is naturally small and not a big eater. So im sure that 'small for gestational age' was absolutely normal for him. I'd expect DC2 also to be small and I don't want unnecessary concern about it unless there's a lack of growth. That said elcs would always be done at 39 weeks as they don't want you to go into labour so this will only affect you if baby turns head down. I just want to wish you a lovely birth whichever path baby takes.
No other risk factors that I know of. Original growth scan was because I'm hypothyroid, but that's been well controlled since before pregnancy and I don't think is linked to stillbirth. If they're suspecting some other problem I'd really like to know. Midwife and sonographer have both been reassuring, saying it just looks like she's naturally small, she has been since the 20 week scan and there's no sign of distress.
At our NCT class we were told our local hospital had become extremely cautious in the last year and were doing a lot of interventions that I think she deemed unnecessary. But then NCT are big advocates for natural childbirth, so it's hard to know whether they're too against intervention.
I'm quite tall so they're expecting a bigger baby - predicted to be 6lb13 by 40 weeks on her current centile line, which doesn't seem that small! My partner is shorter than me and obviously they don't take that into account in their custom centile lines.
TBH I'm starting to hope she doesn't turn, then the decision is out of my hands. I hoped everything goes well for you, I'll keep this thread updated.
It does sound like there's no evidence of any issue so a second opinion sounds like a good plan. I hope you get the information you need from the midwife
Personally I'd go for the EVC - I just had a c-section for my third baby and and it's been much, much harder than my two previous vaginal births (both inductions, one with many interventions and 2nd degree tear). The recovery from a c-section is pretty brutal. My first two were transverse breech, one until 37 weeks and one until 39 weeks, and both turned head down by themselves. The third was an unstable lie, would change from head down to transverse a couple of times a day. They wanted to do an EVC with an immediate induction, but couldn't due to low fluid, large baby and anterior placenta. I went in for a c-section, and I told the midwife I thought baby was head down. They did an u/s and said I was right and so they let me eat something then wold start an induction....by the time they tried to induce an hour later, he was transverse again. Consultant then said his lie was too unstable and we had to proceed with a c-section. It was the right decision, but I would have preferred a long induction over the recovery I have now.
Shanster can I be nosy and ask what things in particular you're finding hard about your recovery this time?
At this stage I'm like you Utini, hoping my baby won't turn so that the decision is out of my hands. Because the decision itself is something I'm just so conflicted about. Late pregnancy and labour are so full of uncertainty anyway, and having a breech baby who may or may not turn at the last minute is adding to that massively. I'm finding it quite stressful. Hope you're doing ok
I personally wouldn't consent to an ECV. There can be physical reasons the baby has not turned such as uterine shape, a short cord, or the cord tangled around the baby. There's a risk of cord compression, placental abruption and also of damage from the amount of pressure used. The risk is too high in my opinion, when there's a reasonably low risk alternative in the Elcs. I would not consent. That's just my opinion, of course but it's a reasonably informed one (scientist.)
I had an elcs (no choice in the matter, I had various placental and cord issues) and although I had a bit of a tough time, I'd still go for another elcs. The risks were managed. The complications dealt with professionally as they arose. It turned what could have been a very dangerous birth into an OK experience
It took me a bit longer than normal to heal due to the things they had to do but from talking to several friends who had tough vbs and birth injury I healed faster, and have been left with less damage, than they.
I have a hip-to hip scar and lost a lot of blood plus various other complications that I won't go into because it's quite outing.
But... Although the recovery was painful, long term I think it was preferable to a difficult vb. Again, just my experience and opinion,
I healed very easily after my EMCS, whilst I was cautious for six -eight weeks I actually felt entirely comfortable (and entirely unmedicated) within a week, with the scar healed fully within a fortnight.
You hear about the terrible discomfort and recovery etc of c sections, but it isn't always like that.
I was 41wks, with back to back position, I refused induction, wanted a natural delivery, but after much pressure from midwife had a sweep which broke waters, but didn't result in active labour, I still refused induction, and ended up with cs.
I wanted a planned cs if natural labour didn't occur, instead had 36 hours of early labour and no sleep before the cs. The cs was the best part of the process and faultless recovery.
My - limited - understanding is that in some cases, small babies can indicate limited growth caused by problems with the placenta. Placenta failure is more likely after 38 weeks and that could be why induction at 38 weeks is being discussed.
I think the success of ecv depends who does it so you might want to ask who would be carrying it out, how frequently they do it and what their success rates are.
I wasn't in a similar position but an identical one! Weekly growth scans and dopplers for a small baby who was also breech at 35 weeks. I decided to refuse the manual turning because of the risks but was going to have an elective section instead. As it transpired she turned herself at around 37 weeks and had a mini growth spurt which inched her just over the 10th centile line so I went from potentially elective section due to breech or induction early due to growth to any birth options available. Dd was born at 40+ 4, 5 hour labour and quick easy recovery, she was 6 lb 11 oz so small but not a very low birthweight. I was always slightly dubious about the growth scans, dd grew steadily and along her centile, she was just small.
I understand about the uncertainty sanderling, I was feeling much the same way this time last week. You asked what I'm finding difficult about the recovery - I have really ,ow blood pressure and it kept dropping during surgery, which meant loads of drugs to stabilize it and me just feeling very dizzy and sick. The first day I felt pretty out of it. I had extremely painful trapped wind for 2 days, and in order to feel functional now I have to take pain meds which cause awful constipation. I have two older kids and I'm always on the go - I find it really difficult that I can't unload the dishwasher, put the washing on, make dinner without taking pain medication. Also, just being able to take care of the baby in the middle of the night for feeding and changing- get in and out of bed while holding a baby are quite hard. All of these things I could do even after a difficult vaginal delivery. Probably made worse as I hate asking or accepting help from anyone. It sounds like others have different experiences however, so I could just be unlucky. For the EVC - my baby also had issues with having the cord wrapped around him twice from about 32 weeks, but they do a full u/s immediately before any EVC (at least they do here in the US) to be able to identify any issues that could put the baby at risk.
Good luck with whatever happens, there is no right or wrong way to have a baby and the decision probably isn't in your hands anyway. In spite of everything I just moaned about with my c-section, I'm eternally grateful to have a healthy safe baby boy home with me.
I cancelled the ECV this morning. Still not 100% sure that was the right decision, but if I went ahead I'd probably have spent the rest of the pregnancy worrying it'd done some damage.
Shanster I asked at my last scan about cord position / length and was told they could only view parts of it. Maybe that's due to having an anterior placenta, that probably makes it harder to visualise the whole thing. Congratulations on your little boy and I hope you recover soon.
Nicky wow, how lucky, I can only hope the same happens to me!
for you too Sanderling, I'm finding it all quite stressful as well. I'm not really happy with any of the options open to me now and there's just no obviously right answer. I'm pretty nervous about the idea of the surgery and recovery, and keep wavering a bit, but ultimately coming back to the decision that an ELCS is the safest option.
I have had the exact same problem. DD was born at 35÷6, EMCS, because of a premature aging placenta, pre eclampsia and low birth weight. She was born 4lbs3.
Knowing the problems I had with DD, they kept me under strict observation with DS. Instead of monthly checkups and scans I hadon't them every 14 days from when I was 9w. Everything was fine and DS was growing normally until 30w, I had a CS at 37+6 because my cervix had suddenly shortened by 75% and DS was fully engaged. He was born at 3lb6
If they want to do a ELCS at 39work it's normal for 2 reasons. 1) DC is small, probably not fit for a VB which could cause her distress and 2) the ELCS at 39w to avoid you going into labour naturally.
Don't worry if baby is small, they grow after birth and normally grow better than 'normal' weight kids.
Keep calm aso stress isn't good for you or baby xxx
Baby hasn't turned (currently 37+4) so I'm booked in for ELCS.
Despite saying I wanted to wait until 39 weeks due to risks of breathing problems etc, I got booked in for 38+3 rather than the one remaining 39+0 slot, as the consultant had said she wanted delivery before 39 weeks.
Argued with the registrar as I feel the growth issues are so borderline. She eventually agreed to book me in for 39 weeks only to find the one remaining slot had just been taken. Assured that 38+3 is considered term and it's perfectly safe.
Then had my pre op today where they did a surprise steroid injection due to delivering before 39 weeks, to mature the baby's lungs. Ouch, and no one ever mentioned that was necessary so I never had chance to read about it. Now I find there are potential links to mental health issues later in life, e.g. journals.plos.org/plosone/article?id=10.1371/journal.pone.0081394
So cross as I wouldn't be worrying about any of this if they'd booked me in for 39 weeks like I initially asked.
Watching with interest as am in a similar position (breech and no signs of turning yet!), just waiting for growth scan next week at 37+1 as dropped off the "normal" range for fundal height a couple of weeks ago. But, it was a different person measuring me...
I've also declined an ECV, risks to DD are too high for a 50% success rate and there's nothing to stop baby moving back after the procedure. As PPs have said, baby is in their chosen position for a reason and I do not want to cause her any unnecessary distress.
Thanks for the link to the study re steroid injections and MH issues OP, I have a history of anxiety/depression as do my folks and naturally want to minimise any risk to DD. If I have to have an ELCS I will decline any slots before 39+0.
Just for anyone reading this considering an ECV (not OP), I also had a successful one and am now awaiting natural labour. First baby too but it worked first try. They are very thorough with checking the baby's exact position by scanning beforehand, and they monitor the heartbeat before and after.
I also had a successful ECV - took about 40 seconds and had no discomfort at all. Agree they are super cautious and had close monitoring throughout and theatre prepped just in case (although the consultant said in 30 years he has never seen anyone go to theatre). I was also really unsure and almost declined but so glad I gave it a try
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