If you've had an ELCS for breech, when did they advise it?

[diyqueen]

I'm currently 34 weeks and my baby has been breech all the way through and still is (had a scan yesterday for other reasons that confirmed this). I'm aware of the different ways of persuading them to turn, thanks to reading other threads, and am giving these a go, but no joy so far. I have an appointment for a presentation scan then review with a doctor straight afterwards at 35+6, and want to be prepared for what they may suggest. I'm undecided about ECV at the moment, but presuming that doesn't work (the baby's extended breech and seems wedged in tight, it's my first and I have strong stomach muscles and a tiny bump!) I know they'll advise the baby be born by ELCS (which is OK, would be equally worried about the risks of breech birth).

My question is really, if you've been in this position, whether they wanted to operate before your due date (e.g. at 38 or 39 weeks) or would consider letting you get as far as early labour then operate if still breech? The reason I ask is that my mum says I was breech and only turned head-down the day before I was born, more than a week overdue, and I hate the thought of my poor baby being wrenched out before it's ready if it can be avoided and it might still turn. I'm getting quite anxious about being put under pressure by the hospital if they push for early CS, and at the prospect of a CS full stop (I've never been in hospital or had even a minor op so a major op while awake is a bit of a scary prospect). In your experience, would the doctors be happy to 'wait and see' til I went into labour (and are there any reasons this wouldn't be a good idea?)

I do know that whatever you and they decide, make sure you get rescanned before going ahead as babies can turn all the way to labour and even in labour. My 9lb nephew flipped to breech during labour and had to come out through the sun roof. Just to say that your baby may well still turn. Have you investigated the optimal foetal positioning sites? There are things you can do to encourage the midget to turn. They might not work but I think they're work a go if you'd like to avoid a CS.

A CS incidentally is not anywhere near as scary as you might think. I thought they were until I had one for my 4th child.

Good luck, whatever happens.

Hi, A CS will be recommended as no one really has the skills for a breech vaginal delivery these days.
They usually plan for CS at 39/40 and in my experience always scan to double check just before going to theatre on the day.
I'm sure if you wanted to wait until you go into labour they would support you, my only concern would be what if it is in the middle of the night?
An unplanned CS is obviously and emergency and if it is in the middle of the night I would worry that the staff may be busy, theatrea may be in use, waking up a doc to do the Cs etc etc. Whereas a planned Cs is during the day with a dedicated theatre team who do cs day in day out.
Just my experience. Good luck whatever you decide.

CS became standard practice for breech after the Term Breech Trial was published in the Lancet in 2000 - which seemed to find that CS was much safer for mothers and babies. Unfortunately the study was poorly designed, executed and analysed to the point that most people (including the authors) now think the conclusions are invalid.

More recent research has shown that vaginal breech birth is no more risky (as long as certain criteria are met) - but one of those criteria is a skilled attendant, and those are getting much harder to find.

If you want to investigate the possibilities, get an appointment with the Head of Midwifery at your hospital (in addition to the consultant) as she should have a much better view of the breech skills of the MWs in the department. All MWs have breech birth training (they have to - something like 1/2 breech babies are undiagnosed until labour, and there isn't alwasy time to do a CS) and in some units there is more support for them using those skills such that breech is included under the banner of "normal but unusual".

DD1 was breech all the way. We declined an ECV and were offered a CS. I think they generally schedule them for about 39 weeks. You are, of course, free to decline a CS at that point. (We actually went for the alternative, and had her as a planned breech homebirth with IMs - that way we could be sure of the breech skills of the MWs attending the birth. By then we were so fed up with the way the Obs team were handling things we didn't investigate the skills of the NHS MWs)

I'd suggest talking to the consultant and finding out just what the situation would be - meedsatrim raises valid points about staffing levels over night, but it would be worth checking how these apply to your hospital before making decisions on those grounds.

If you want any reading on vaginal breech birth, "Breech Birth" by Benna Waites, "Breech Birth: What are my options" by Jane Evans and pretty well everything by Mary Cronk are all well worth reading (this is a good start).

What we came to realise is that there isn't a universal right answer - just the answer that is best for you and your family at this time. Good luck :)

My dd was breech from about 26 weeks onwards. After a consultant scanned me, she was not a candidate for ECV, and my section was booked for 38 weeks. She is nearly four now, and when I scheduled my section for ds in 2009, I was told that the guidelines had changed to 39 weeks.

Although he decided to come all by himself at 37 weeks. Best laid plans, eh?

Thanks, I'll stop panicking then and think I'll probably push for as much time as possible to give the baby chance to turn. I'm going to get myself mentally prepared for a CS and a stay in hospital as well (was secretly hoping that I'd be one of the lucky ones who could escape from hospital after a few hours and be back to normal after a couple of weeks, being fit and healthy and all that - yes, naive first-timer, I know!). Puts it all in perspective - all that time thinking about water births and third stages etc., now just want it all to be over and baby to be safe. Am a bit sad I may miss out on the experience of giving birth, but that's a bit pathetic I know as it's just a means to an end and I suspect plenty of people would swap their birth 'experience' for a planned CS!

DIY I'm 38 weeks tomorrow and breech, have an appointment later this afternoon. So I'll let you know what they suggest for me. Have a funny feeling it may of turned.

However I have a friend who was on the op table ready for CS for a breech baby, and the wee sod had turned, so they sent her home...to wait.. this must be very rare.

Thanks Highlandgirl - will be really interested to know but keeping fingers crossed for you that the baby has turned.

I was gutted when the MW said 'it' had turned. As a first timer I found myself really stressing out about the birth and just when I get my head round 'it' coming out of my well...fanny...it sodding turned!

You still have plenty of time (as do I) for it to turn several times before EDD!!!

Hi, I am 38.3 weeks today and my baby is in breech. I went for ECV yesterday and all I can say is that I would not recommend it to anyone. The chances of it working are too slim for the discomfort you have to go through. I ended up bleeding after and was kept in last night in case I baby got distressed and had to have c section. They have booked me in for Monday, I will be 39.1 but would have liked even earlier I think.

If I was you I would book yourself in for CS at 39 weeks but before that try moxibustion, homeopathic remedies, acupuncture etc, they all seem to have just as high success rate as ECV but do not hurt!! Then if baby has turned by 39 weeks great, if not you have the safest CS possible, i,e, a planned one.

Good luck.

PS try not to feel too down about it, we had a home birth planned using hypnobirthing and water so obviously huge disappointment but on positive note I get to meet my baby earlier than I had thought, which is really exciting!!!!!

DIY..I'm fully engaged..so I'm no help at all!!!!

My ELCS for breech DD was at 38+3, but she was very low on fluid. For DS, who wasn't breech, I had an ELCS at 38+6.

I think I was 37 weeks when I met with the consultant and was booked in for my ELCS. He made a feeble attempt at turning her at that appointment (and I mean feeble - a bit of a prod and a poke and that was it - I think it was more for box ticking purposes than actually trying to achieve anythingO). He also forgot to book me a pre-op appointment.

My ELCS was scheduled for when I was 39+3. I turned up on the alloted morning, they looked at me blankly and sent me home because their list was now full and I was no longer on it (?!) got home, waters broke, went back, they discovered I was fully dilated with a leg presenting and I had an EMCS.

I think it is fair to say I am less than impressed with NHS admin and would recommend booking your ELCS for earlier than 39+3!

Having said all of the above (and re-read the original post) I am quite glad that I did actually go into labour and therefore know that DD was fully cooked and ready to come out and that she was then born on her proper birthday. I know this seems a bit bonkers but, when I thought I was having an ELCS on a randomly picked date, I felt a bit sad that her birthday would be sort of artificial. She had other ideas, obviously.

That's only a small bonus though and I would try and avoid the EMCS route - that was a bit scary and unpleasant. Instead of a calm ELCS, I was being undressed as I was being rushed down the corridor to theatre, I was being prepped for a GA while they were trying to get the spinal block to work (in case it took too long), there was no opportunity to set out any kind of birth plan wishes (such as skin to skin, seeing the baby to see its sex, rather than just be told etc) and it was generally complete panic stations. Everything gets taken out of your hands at that point.

Good luck!

Mine was a footling breech, and they did the C section at 39 weeks. They scanned to check the baby was still breech before doing the C section. (They might have delayed it for one day if I was delayed too long by an emergency C section.)

Admittedly I was additionally complicated as I had Chicken pox at about 35 weeks. So they didn't want the baby coming too soon either.

DD1 was breech had a failed ECV at 36 or 37 weeks and booked in for c section at 39+3 (with strict instructions that any sign of labour I was to go straight to hospital) they scanned on the morning and said if she had turned it would be my choice whetehr to go ahead or not. Stubborn child was still firmly breeched and born at 4.19 that afternoon!

DS was breech from the start pretty much. I had an ECV at 37 weeks, but I really shouldn't have bothered, as DS didn't budge an inch and it was really quite uncomfortable. I had my ELCS at 39+2. It was supposed to be at 39 exactly, but my gynaecologist had an emergency on the day I was scheduled. By the time I went into hospital for my ELCS I was having contractions, and they were worried I wouldn't make it through the night!

I was soooooo obsessively worried about having a CS before I had DS. He was my first and I was desperate for a "normal" birth. In the end, the CS was really fine. The operation was fine, DS was placed on me as soon as he was born (one of the things I was most concerned about), and I had no trouble getting bf established. My recovery was really quick - I was up and about the next day - and my scar although noticeable is vey neat.

I'm now thinking about number 2 and not sure if I'll be able to go through a "normal birth" as my CS experience was so easy compared to other friends who've given birth naturally!