Wanting to tell 44 weeks and breech friend she's risking her baby?

[scottishlass43]

My friend is 44 weeks pregnant with a footling breech. She's determined to have a natural birth at home with another friend of ours who's a midwife. She's been declining all intervention till now and has no cut off point - she wants to let the baby come naturally and doesn't want scans or any monitoring. She refuses to consider a c-section.

She's older (late thirties) and has been waiting for several years for this baby. I have no idea why she'd risk it now.

AIBU wanting to tell her what I think? Am I (and other worried friends) overreacting? Does anyone know of anyone who's done this, and how it went?

Won’t she even consider an ECV? Sorry if it’s been asked and answered.

I was considering declining induction at 42 weeks and moving to expectant management, so I do understand where she’s coming from to an extent. But the breech presentation and being this far over IS a concern as frankly there must be a biological reason as to why she’s not gone into spontaneous labour.

The trust I delivered at state that there are 6 still births per 3000 at 43 weeks, they don’t have any info for 44 but it seems to be increasing by one per week from 40 weeks. So there is clearly a risk, but it is still relatively small. A concern again would be that she’s declined expectant management so the size of the baby, or the function of the placenta are all unknown, so she can’t say she’s made an informed choice because the current health of the baby is unknown.

That being said I don’t think you’ll be able to change her mind OP.

If she goes into spontaneous labour she will be invariably be looking at an emergency hospital transfer and probably an emergency section, I’m surprised that they’ll support a breach home birth this past due dates, but I guess the hosptial and midwives have made her aware of the risk and she’s accepted them, so it’s either have a medical professional there who can act quickly or risk her go it alone.

I’ve seen a stillborn baby and felt the grief of the parents, I’ve never seen a grown man weep like that. It’s stayed with me and frankly traumatised me for my own pregnancy, i really hope that’s not the ending your friend is heading for, she’ll never forgive herself.

@SickofCovid

Please correct me if I'm wrong but I thought you were induced after 2 weeks past your due date as the placenta stops working....

Only if you engage with medical professionals.

Selfish fucking idiot. I would have severe doubts about the abilities of this woman as a parent - if the poor baby survives.

@SickofCovid

Please correct me if I'm wrong but I thought you were induced after 2 weeks past your due date as the placenta stops working....

They offer induction, they can’t force you. You can opt for expectant management.

The placenta doesn’t automatically stop working at 42 weeks, it’s not on a timer; there is a slight increase in still birth and 42 weeks is the line drawn in the sand by most trusts.

For instance

www.swbh.nhs.uk/wp-content/uploads/2012/06/Induction-of-labour-ML5105.pdf

The midwife is risking her career. I had a private midwife turn my baby in my own house and my then NHS midwife was livid and the private one got into a lot of trouble. Haven't heard of her since so she might have even been struck off.

Honestly, I don't know if I'm even going to stay on this site after reading through these comments, I'm absolutely disgusted.

Off you pop then

@SickofCovid

Please correct me if I'm wrong but I thought you were induced after 2 weeks past your due date as the placenta stops working....

Thats medical advice but they dont strap you down and force you. Placenta will be deteriorating significantly at 44 weeks and even with a normal head down presentation it is high risk. If the body hasnt spontaneously started labour by this stage and baby hasnt even turned, id be highly concerned about why. Ive had two unmedicated homebirths and am all for them with uncomplicated births but I would have asked for elective C section for a breech. No brainer

Both mine were footing breach. Had ECV with DD (worst decision of my life should have had an elective) and ended up EMC at bang on 40 weeks. DS also footling - I was desparate for a VBAC after the horrific experience with DD. I was allowed to go to 42 weeks with my consultant because everything was fine. Couldn't be induced because of previous EMC, had 3 sweeps but nothing happened so I had to have an elective. It was fine and DS is a happy and healthy teenager. Your friend is an idiot who may find out why a third of babies used to die in childbirth.

Sorry should have added DS turned at 41 weeks which is why I agreed to the sweeps. Had he still been breach I would have had a CS immediately.

I was going to say I didn't think hospitals would allow you to go over 42 weeks but I guess that they can't actively force someone to have a c-section or induce birth if the person isn't in contact, or turning up for routine appointments. I'm surprised the midwife is going along with it although maybe they have advised and the patient has ignored their advice.

Women due during childbirth. As well as babies.

She’s an absolute fool. Is she of sound mind?

@Namechangetimes100

Won’t she even consider an ECV? Sorry if it’s been asked and answered.

I was considering declining induction at 42 weeks and moving to expectant management, so I do understand where she’s coming from to an extent. But the breech presentation and being this far over IS a concern as frankly there must be a biological reason as to why she’s not gone into spontaneous labour.

The trust I delivered at state that there are 6 still births per 3000 at 43 weeks, they don’t have any info for 44 but it seems to be increasing by one per week from 40 weeks. So there is clearly a risk, but it is still relatively small. A concern again would be that she’s declined expectant management so the size of the baby, or the function of the placenta are all unknown, so she can’t say she’s made an informed choice because the current health of the baby is unknown.

That being said I don’t think you’ll be able to change her mind OP.

If she goes into spontaneous labour she will be invariably be looking at an emergency hospital transfer and probably an emergency section, I’m surprised that they’ll support a breach home birth this past due dates, but I guess the hosptial and midwives have made her aware of the risk and she’s accepted them, so it’s either have a medical professional there who can act quickly or risk her go it alone.

I’ve seen a stillborn baby and felt the grief of the parents, I’ve never seen a grown man weep like that. It’s stayed with me and frankly traumatised me for my own pregnancy, i really hope that’s not the ending your friend is heading for, she’ll never forgive herself.

It’s not ‘relatively small’ from their (the NHS’s) perspective though.. is it?

Because they delivered in 2013 roughly 778800 babies and 23% (again, according to 2013 figures) of those were induced, so using those stats as a blunt instrument:

23% is 179,124 babies that year who could have gone to 42+ weeks’ gestation. So those 3000 babies would be one baby dying every 6 days if they all reached 43 weeks. It’s within their skill set to avoid that death. They are of course going to advise women to take that option since there isn’t a good indicator as to who will be that 1 in 3000.

Induction has risks, it’s just less than 1 in 3000.

Risks of still birth* that last sentence should say

Tbh OP you'd be better off talking tot he midwife friend. If you can convince her that continuing with care like this, especially if she isn't from the right trust, is going to end her career, and their friendship once she delivers a dead baby, that might force pregnant friend into seeking proper care.

Worst thing that happens is you loose two friends.

Personally I would have allowed myself to go to 42+4 ( but I’d have had expectant management and acted if something did look off) as my trust start the induction convo bang on 42, so in my mind the increase from 41-42 isn’t astronomical. The lowest risk is 39 but they don’t routinely offer induction then. I never needed to speak to a consultant as I went into spontaneous labour at 41 weeks exactly but the midwives I spoke to were fairly favourable to my plan of 42+4 and a whole ton of sweeps lol.

But I understand why it’s offered at 42 weeks, as from a medical point of view it’s a preventable risk and those are preventable deaths. So women are presented with facts and then can make an informed decision based on risk. I don’t think consultants or medical professionals should be coercive but I do believe they should be frank and evidence based. Ultimately clinical guidelines exist for a reason.

Yes induction has risks but as you point out not to the same extent still birth wise but there are other risks, the cascade of interventions and a traumatised mother and I think that’s where this woman’s focus is. Unfortunately home births, doulas and the free birth movement really milk this fear and make doctors out to be the big bad boogie man.
However in this case, the friend is being pig headed, prioritising natural above safety. She’s not had scans or expectant management so she has no clue as to the function of the placenta or the size of her baby, and there is obviously a reason spontaneous labour hasn’t occurred.

-^home birth fb groups that should say

All the 'freebirthers' need to read their history. The talk so much rot! It was never easy - as previous poster said, nature does not care for the individual, only the species as a whole. My DH said that as a teenager he first discovered this while walking in the Scottish hills; he came across the decaying body of a beautiful mother deer who had died giving birth, with the dead fawn stuck half in half out.

The stats of maternal and child death around birth in past centuries are well known. But there is also evidence - perhaps less publicised - showing how scared many women were to find themselves pregnant; most women pre 1700 would have know one or more of their local community who died in childbirth or after a miscarriage. No one thought of childbirth as a pleasant or empowering experience; many anticipated horrible pain as "God's punishment for sins".

The following is just one example of many. Very sorry for the massive URL, but just scroll down and read a few pages of this:
books.google.co.uk/books?id=UT8Q4gPJcOcC&pg=PA56&lpg=PA56&dq=ralph+josselin+wife+pregnancy+fears&source=bl&ots=Nd2FEU-myu&sig=ACfU3U1BZwBeg0EcQ4r9I5TlaH7GIuxLag&hl=en&sa=X&ved=2ahUKEwj9zvinht_0AhX1mFwKHYmdDZEQ6AF6BAgLEAM#v=onepage&q=ralph%20josselin%20wife%20pregnancy%20fears&f=false

Re miscarriage:
uhra.herts.ac.uk/bitstream/handle/2299/15315/Women_Men_and_Miscarriage_submitted_version.pdf?sequence=4

what i want to know is why youre mutual friend the midwife is going along with this she should be telling her its not right and to go into hospital at this point

If she hasn't had any scans including doppler flow scans to check the blood flow to the placenta, she has no idea if her placenta is still functioning and if there is adequete oxygen flow through the cord. What she is doing is incredibly risky, if this goes wrong it is likely to be catastrophic. I don't understand why she would take the risk. With a complex breech presentation, she would have been safest to have an elective c-section at 39 weeks (if you have had a previous c-section, the NHS guidance says that there is a lower risk of stillbirth having an ELCS at 39 weeks, this is part of the guidance to help you make a choice between ELCS and VBAC).

My husband is upstairs reading our daughter a story. If I had done what your friend has done, she wouldn't be alive today.

The midwife is hopefully liaising with the hospital and documenting all the advice she's giving, its better to have a professional involved and "on side" than to have everyone shut out which is how this could go.

I wish I had spoken my mind to my friend instead of hoping someone else would.

She ignored the pleas from her consultant and NHS midwife.

Her baby died.

It was totally avoidable, watching her live with the pain and grief that followed has been heartbreaking. I can't believe independent midwives are allowed to encourage such risks.

I don't think they're allowed to encourage it, more that they can't force a woman not to be a thundering fool and it's better they stay by her side doing what they can rather than leaving her to "freebirth".

Freeeeeeeee-dumb!

I’ve just done some reading online and one thing I’ve learnt is that actually it can be hard to know you’ve had a stillbirth because the baby is still in the fluid and can still feel like it’s moving a little. Just to say because if your friend isn’t having scans etc she might still think baby is alive/moving and perhaps it’s not 😔

Personally I would have allowed myself to go to 42+4 ( but I’d have had expectant management and acted if something did look off) as my trust start the induction convo bang on 42, so in my mind the increase from 41-42 isn’t astronomical. The lowest risk is 39 but they don’t routinely offer induction then. I never needed to speak to a consultant as I went into spontaneous labour at 41 weeks exactly but the midwives I spoke to were fairly favourable to my plan of 42+4 and a whole ton of sweeps lol.

My trust now offers induction from 40 weeks routinely (or certainly did 4 years ago and I don’t believe that’s changed) because that was what was demonstrating the best outcomes for mothers and babies. It’s very, very strongly recommended by 42.

My dc2 was a footling breech, I had planned a homebirth, it went out of the window when the scan confirmed footling breech and I had ELCS. Not sure anything you say will change her mind but I'd give it a go anyway.