ECV or Caesarean ?

[Hobnob76]

I'm 35+4. My MW appt the other day confirmed my suspicions, my Little Miss is indeed breech, and according to the scan, is curled into almost a 'C' shape.

She's got 2 weeks to move into a head down position (got another hospital appt for 2 wks time), if not then they'll most probably give me a date for a caesarean section at 39 weeks. The MW gave me a leaflet on a procedure called an ECV, where I'll have to go in to delivery after 37 wks and they'll try and move her round. The MW seemed quite positive that she'd move on her own or that the ECV might work, but also said that sometimes there's a reason why she's not head down such as I might have an odd shaped uterus. I just know that she's not going to move, she's been breech ever since we had the 20 wk scan, and she still is.

I have to say I'm totally shitting myself at the thought of having major surgery just to have my baby, I never even gave caesarean's a thought, I always thought I'd be able to deliver naturally, naively! I've been in tears at the thought since, I just can't cope with it. I'm worried it might ruin my chances to be able to breastfeed too, as I desperately wanted to be able to try and breastfeed as soon after the birth as possible.

I've done lots of research in the last 2 days and found the success rates for ECV's at my hospital are only about a 15% chance of success and from what I've read its more unlikely to work due to this being my first pregnancy too. Even the MW was negative about the ECV working, due to the position that my baby is in in the womb.

I feel like I'm stuck between a rock and a hard place, I don't want the ECV (heard it can be painful and result in an EMCS in a lots of cases)but I equally don't want an CS!

Wondering if anyone has any useful advice ?

Hi there

I vote ECV all the way, cos it worked for me 2 weeks ago. Mine is also a first pregnancy and my little sod darling had been breech all the way from 26 weeks onwards. Scan confirmed extended breech at 34+5 weeks. My MW also advised they may not be able to turn him due to his position. Have a look atthis thread for my experience on 11/08/10.

My hospital leaflet gave a 40% success rate, it also suggested a 1 in 1000 chance of emcs or waters breaking due to the procedure. The consultant obstetrician told me she had never known it happen in my hospital though.

I'm glad to say he has stayed the right way round, and there were no lasting effects once the sore stomach muscles recovered by the next day. And now I am on course for a astraightforward delivery in the MLU rather than surgery which suits me fine.

It is possible to deliver a breech baby vaginally - and, depending on your individual circumstances, the risks can be comparable/lower to having a CS. However, key to a safe vaginal breech birth is a MW/Dr confident and competent in vaginal breech - and that is often where the sticking point comes. Due to the Term Breech Trial (Hannah et al, published in The Lancet in 2000) NICE guidelines recommend CS for breech babies - the study has since been widely discredited but the guidelines remain and vaginal breech skills are being lost.

That said, it doesn't mean they are non-existent. There are pockets of breech expertise within the NHS and Independent Midwives often have experience in this area. They may well have insight into how the hospitals in your area handle these issues and most will be happy to talk through generic options and - even if you don't book with them.

If you're interested in vaginal breech birth, google Mary Cronk (this is a very good starting point), and try and get hold of either "Breech Birth" by Benna Waites and/or "Breech Birth: What are my options" by Jane Evans. Once you're clear on what you're trying to achieve, talk to the Supervisor of Midwives and/or Head of Midwifery (I'm not sure the terminology is completely consistent) and discuss how they can support you in this - they should have a much better overview of what breech skills their team have than the CMWs.

I'm pretty sure you can also ask to be referred to a different hospital/consultant for an ECV if that would be your preferred course of action. You GP should be able to advise on that - or an IM may well have more information on what consultants in your area have better success rates (for what its worth, the national average is about 50%, and some consultants are much higher than that - possibly through only attempting cases that their experience tells them are likely to work). Before they attempt an ECV they should do a fairly thorough US to ensure that there isn't any obvious cause - such as a bicornate uterus, placental position, cord length or baby/cord in a big tangle.

All that said, elective CS's aren't necessarily the work of the devil and don't mean that you will run into problems BF by any stretch. You can do a lot to personalise the experience (have a look at this and this) and maintain the feel that its the birth of a child rather than a surgical procedure. Also, if you plan to BF then you may want to talk about whether or not you take prophylactic ABs - I know at least one friend who didn't take them with a CS so they're don't seem to be a blanket requirement.

For what its worth, DD1 (DC1) was persistently breech. We did a lot of reading and thinking before deciding to have her as a breech baby at home with experienced IMs. She arrived at 41+3, foot first (not expected - she'd been a little budha 18 hours earlier on a scan) and weighing in at 9lb 12. But i was very calm and relaxed during the birth and quite enjoyed the whole affair. That said, its one of the hardest decisions I've ever had to make as there isn't a single right answer - all you can do is make the best decision you can for you, your family and your circumstances. Good luck with it - and if I can help with anything else please let me know :)

QTPie No I've not tried moxibustion, I had a quick look at the info today, would it still work as alot of the info I've read suggests its got more chance of working before 35 weeks ? Thanks for the info about your elective CS, nice to read a positive story about one.

Thanks for replying ethelina glad to hear about an ECV that worked! Was interesting to read about your experience.

Tangle thanks for the links, very useful info on them. I only wish I had the confidence to go for a home breech birth but being my 1st child I'm not so sure!

I also went for ECV to turn my little girl. She wasn't having any of it and I had an ECS a week later. It was very relaxed, friendly and there we're no problems. I didn't regret not giving birth naturally, in fact after hearing other mums stories I felt I was lucky to have a CS! I was driving within 3 weeks and had no problem looking after the little one whilst I was recovering. It is major surgery and is different for everyone but it is a common procedure and can honestly say that I'm glad i did it that way. Good luck either way x

Another positive CS story here. I had an emcs after failed induction (DS had been transverse most of pregnancy and just didn't engage properly). Was a very happy relaxed procedure, and we had no problem at all with BF. Had skin-to-skin in recovery room and he latched on fine as soon as we were back on the ward. Milk came in after 36 hours and he didn't lose an ounce in his first week. 10 months now and showing no interest at all in weaning!

Yes, I was uncomfortable for a few weeks afterwards, but that was just even more reason to sit on my backside and boss others around. :) Please don't worry too much about a CS if it turns out that's the best option for you.

And yet another positive CS story! Like you, my DS was breech from 20 weeks. He got comfy with his head up under my ribs. I was offered the ECV at 37 weeks. Gave it a go, as it was my first pregnancy and I wanted to give birth normally if possible. The ECV was very uncomfortable and the gynae couldn't get DS's feet to budge. So, I then had an ELCS at 39 weeks.

My CS was fine, no problems, and I was up and about the next day. I had a little pain for a few days, but was driving after about 2 weeks and had absolutely no trouble taking care of DS. My scar has now healed well (5 months on) and is very neat.

In my case, I was blooming glad I had the CS as DS turned out to be a whopper - 4.7kg (10lb 4oz)! They reackon he'd simply got stuck in the breech position. In any case, I had a far easier recovery than some of my friends who have given birth the normal way....

There is no medical evidence linking c-sections with lack of ability to breastfeed, so don't let that be a factor. The trigger for milk production is the removal of the placenta, and it doesn't matter how this happens.

Personally I would opt for an elective cs in your position, and wouldn't bother with an ECV as everyone I know who's had them has said how painful they are, and they usually don't work anyway.

Hi I'm a newbie here but in the same position - 37 wks and baby has been stubbornly breech for as long as I have been aware of him. I have tried everything - acupuncture, moxibustion, hanging upside down, gym ball, crawling on all 4s - you name it i've done it! Going for a scan and consultant's appt today and i'm guessing they'll advise a section next week or the week after. I'm pretty terrified about having surgery, mainly because I have a 3 year old and i live in a flat with lots of stairs so will struggle to get out with him when i'm recovering. and my DH can only take 1 week paternity leave so he won't be much help! I'm considering ECV (it's my 2nd so apparently more likely to succeed). I'm not too worried about BFing as I had an easy time of it last time and am pretty sure with perseverence (and support if necessary) we'll be fine with that. Am worried about how my body will look afterwards though :( i got my flat(ish) tummy back easily last time but I'm guessing that won't happen so easily when it's all been sliced open...

Feeling quite down about it all but I don't think i've got much choice if the ecv doesn't work, as i don't want to risk doing a breech vaginal birth - at the end of the day the baby's safety has to be most important. still, wish i could get excited about my baby's arrival, at the moment i'm just down and scared :(

ECV x2 and still c-section for my DD! Very stubborn she was...and still is! C-section by the way was absolutely fine and want another one this time around as it went so well. I definitely think ECV is worth a go though if you are keen on trying naturally.

Thanks for all the replies everyone

Thought I'd come back and update :

Well my scan today showed that our little lady is still breech, which I already knew. The doctor and I discussed the possibility of an EVC but I wasn't keen on having it done, I don't know, my gut instinct said no and the doctor said that it was unlikely to work as my LO's bottom is well and truely wedged in my pelvis. She also said that the positioning of my LO might mean that it wouldn't be easy to perform an EVC, that and the fact that its less likely to work on a first time mum to be.

So I'm to be booked in for a C-Section in 2 weeks time, our baby will be delivered on either the 21st or the 23rd September! shock Mentally I'm so not ready but physically I've had enough of the heartburn, cramps, carpal tunnel syndrome and not being able to get comfy in bed!

I tried ECV - it was extremely painful and distressing (4 docs trying to manually shift a small baby) - I had to hold onto the bed and was left with nail imprints all over my stomach. At no point did I feel in control/was I really give the option to stop. They carried on even though I was in tears.

would it have been worth it ahd it worked? maybe

as it was it didn't so i was left exhausted and shaky (they give you drugs to relax the uterus that made me feel v odd)

and then went on to have a v positive CS experience a week later - all v calm, with our music on the CD player, and DS suckled within an hour of birth.

realise this is not what you wanted to hear but in the name of balance, i thought it was worth sharing.

best of luck whatever you decide

Hi I wanted to come back and update on my situation...
Had ECV booked for yesterday but on Friday night our little man had other ideas and I went into labour at 37+4 wks.

They gave me the option of having a VB but we decided (on doctor's advice) to have the CS and I have to say it was the most amazingly positive experience - far better than my VB was last time. The op itself was pretty stressful as I was terrified but they stitched me up beautifully and I was so well looked after in hospital I came out feeling more rested than when I went in (even taking baby away for a couple of hours when he wouldn't settle so I could sleep!)
Don't want to scare anybody but when our beautiful boy came out he had the cord wrapped tightly round his neck twice and the doc said he would have been distressed by an ECV and pretty much strangled by a VB so I'd have ended up with a EMCS whatever we had decided to do, and probably a far more traumatic one than we ended up having.

I was surprised the cord didn't show up on the scan I'd had the day before - if in the same situation again I'd ask them to look at where it was if that's possible.
Good luck Hobnob - CS is nowhere near as bad as I was expecting. I'm 6 days on now and pretty mobile, healing well, stitches out - but enjoying being looked after by everyone while I cuddle my new baby :)

Have you thought of seeing a HypnoBirthing Practitioner? I am a Practitioner and I do a hypnosis that helps the baby to turn. I am sure that if there is a Practioner near you that they could do the same.

Otherwise, I'd go for a C-Section above an ECV. Electives can be very nice, recovery does not have to be long and/or painful and you can breast-feed whilst the operation is being completed.

Best of luck.

QT out of interest who is your consultant at C&W?

Great thanks. I have a friend who also used Gubby and also speaks highly. I am with Zoe Penn at C&W and thought you may have been with her too.