Transverse at 36 weeks - risks if go into labour

[Zimbah]

DD2 is currently transverse at 36 weeks and has been for weeks and weeks, sometimes she seems more oblique but never head down (or bum down for that matter). I had an ELCS with DD1 who was breech, it was booked for 39 weeks but my waters broke at 38w5d so I had an "emergency" section. I was really hoping for a VBAC this time but it's looking unlikely.

I've got a consultant appointment this week and I'm going to ask for a scan so we can tell exactly what position the baby is in. Ideally, if I do have to have another section, I'd like not to book it in until 41 weeks as there's a chance the baby could turn at any point until I'm in labour, and I really hate the idea of springing the baby out before she's ready. If she was still transverse when I go into labour then of course I would have an emergency CS. However, while I would be 100% set on that decision if DD2 was breech, what scares me with transverse is the risk of cord prolapse. Some info on the web says there's a 20% risk of this if you go into labour with a transverse baby, which is shockingly high, but there isn't any research cited to back that up. The RCOG guidance says the risk is 1%. I really don't know if this is 'high' or not - the risk of scar rupture in VBAC is 0.5% but that's something I'm prepared to accept, and it's only twice as much as that. However, I think the scar rupture risk of actual serious harm to mother or baby is considerably lower than 0.5%, whereas if the cord prolapses I imagine the risk of serious harm or death of the baby is pretty high. The last thing I want to do is put my baby at risk but nor do I want what may be an unecessary CS.

Obviously I'll need to wait and see what the consultant says later this week but does anyone have experience of this, or thoughts about the relative risks? The other issue is an emergency CS for transverse would probably be more of an actual emergency that my one for breech - which was very calm. So it could turn out to be way more stressful both for me and DH and the baby, rather than the possibility of a nice calm CS if I booked it, plus the concern about how quickly I could actually get to the hospital if I was alone with DD1 for example. Aaargh!

I can't offer advice about the statistics but my waters broke when my baby was in an undiagnosed transverse oblique position.

In my case it turned out to be surprisingly calm and relaxed. The cord was checked for signs of prolapse but everything was fine. As I wasn't having any contractions they decided to leave it for as long as possible to minimise possible complications with the anaesthetic. I was given strict instructions to push the emergency buzzer if contractions started but otherwise it was just a case of being monitored at regular intervals. My c/s was even put back a couple of times because of other emergencies.

The consultant told me that it had all caused "a bit of a stir", and one of the medical studentsasked permission to write it up as a case study, but otherwise you wouldn't have guessed it was anything out of the ordinary. The c/s took place 10 hours after my waters broke so although it was technically an emergency c/s it wasn't rushed or stressful.

I think that even though it turned out fine in the end for both me and the baby, I'm not sure that I would want to risk leaving it to chance if I knew in advance that the baby was likely to be transverse.

OTOH though, in a previous pregnancy the baby was breech up until 37wks, then turned into a transverse position, before turning head-down by the 38wk scan so there is still time for your baby to turn. I had been warned though that if the baby hadn't turned by that 38wk scan that I would be asked to stay in hospital until I either went into labour or it was decided that a c/s was needed.

I have a baby who likes to twiddle between transverse, oblique and head down at 39 weeks.

I, like you, want to go for trial by labour (although this is my first so not a VBAC).

If I'm fairly certain baby is head straight down and I have contractions I can stay at home and see how they go for up to 6 hours, then they want me in to see how I'm going (am having hospital birth anyway), unless contractions are regular and 2-3 mins apart before then. If I'm not sure then we apply the precautionary principle and go in.

I have to go straight in if my waters break, even if I think baby is head down. I must not drive (!) and if DH isn't here/a neighbour can't take me between waters going and getting to hospital I'm supposed to lie down with hips elevated to reduce risk of cord prolapse. Also supposed to keep seat reclined in car to avoid being vertical as much as possible.

It's then a case of presentation scan etc and, if contracting, CS ASAP for transverse/oblique. If not contracting then monitoring and CS as and when assuming no signs of distress.

Oblique is riskier for the baby than transverse because the risk of cord prolapse is higher, transverse had a marginally increased risk of uterine rupture, even in primaparous mothers.

Have you been offered an ECV?

I second the spinning babies recommendation btw - but your baby may not stay there!

Sorry thats really waffly! Personally I've gone for trying rather than a straight ELCS but if I go in at least it's a planned EMCS rather than a proper emergency and unless there are signs of foetal distress it shouldn't be any different to an actual ELCS beyond not having the date in advance.

Dd was transverse at 37 weeks and I also had slightly too much fluid. In my case i was admitted straight away (because of the high risk of cord prolapse) and sat there for 2 weeks awaiting a planned section.

On the morning I was due to have the ELCS I had a scan and she had gone head down, and they sent me home. I ended up with an EMCS after induction 10 days later. With the benefit of hindsight I would have pushed for the ELCS - and I think I would also do that if I was in your situation.

Can I ask where you feel movements with transverse lie? I am not convinced baby is properly head down. I get kicks mostly on right side but quite low down( eg belly button ) and sometimes on left too. This is 3rd pregnancy and I'm 34 weeks tomorrow. Prev 2 have been LOA and kicks were definitely under my ribs then
Thanks

It depends whether baby is sunnyside up or not where the kicks are. Mine are in my ribs but more to the right hand side when baby is oblique/head down. It's more reliable to feel for the head or bottom and follow the hardness of the spine than to try and map kicks.

I've had tranverse and oblique baby apparently for weeks (on and off with cephalic/oblique the last 2 weeks) -am due today -and am feeling movements in all the same places in all positions - high up under ribs, low down in groin and all in between as well.

OP, I had a successful ECV at 37 weeks but it seems baby had stretched uterus into apple shape through being transverse for so long, so hence the continued mobility. Last week, was head down oblique, was told if waters break to go straight to maternity to assess for cord prolapse etc but not told not to drive myself there.

My lower twin was transverse and I was admitted on the spot at 34 weeks. ECV isn't an option with twins and the way it was explained to me was this: We lived 30 mins from the hospital, min, with no traffic. Say 15 on a blue light. My Cons Obs said that if the cord slipped below the baby, as was likely, and then the cord prolapsed, they had 10 minutes to get the baby out. Fully out. So that was that - I had to just sit and wait. She said I could have a section at 37 weeks if I hadn't gone into labour beforehand and that I had to alert the staff if I thought anything was happening, on top of additional monitoring. Her point was that although the risk of the cord prolapsing was low, the consequences of that happening were likely to be disastrous.
After it was all over (I had an ELCS privately at 36 weeks) I talked it through with a very natural-focussed midwife friend of mine, who then told me about her dealing with an undiagnosed cord prolapse, sitting in the back of an ambulance with the woman face down with her bum in the air, and my friend with her hand up holding the cord in place. (They were fine, btw.) In your shoes I'd have a very low tolerance for anything unexplained happening. My ELCS was lovely, calm and a really positive, pain free experience, I'd highly recommend it, and both my babies were absolutely fine. Very best of luck. X

My dd2 was transverse until 37+6 (the day before my planned section!). My consultant was not prepared to let me go beyond 38 wks despite #1 being born at 41 wks due to our journey to hospital being 35+mins.

Having now had another and another due in July, if I was in the same position again I'd be signing the dotted line for a section at 38wks. I'm not risk averse in any sense but that was too scary for me.

Incidentally, I was a breech birth and my mum was told if her waters broke she should think about getting to hospital as soon as she could. When I was told by my consultant that if the same happened to me with #3 I was to call an ambulance if alone or get in the car immediately she was totally [shocked] as she'd had no idea why and was v blase about the whole thing!

Thanks for all the replies, it's really helpful to see others in the same boat or with previous experience. Got the appointment tomorrow so will see what happens. I would be keen to try ECV and will ask for it, but it seems that most hospitals don't do that if you've had a previous CS because of the risk of rupture - despite the fact that there is no evidence that it increases rupture (any more than the tiny risk of rupture with any ECV), and that in any case if I go for a VBAC I've already accepted there's a risk of rupture. I'm so worried that they'll want to admit me around 37/38 weeks as it would be really difficult with DD1, but equally scared that they won't and my waters will break at the start of labour, as happened last time, putting my baby at risk. Although we are only 10/15 mins from hospital, or 5 mins by ambulance. I'll post again tomorrow after my appointment.

Quick update and thanks again for the replies. At my appointment today the registrar said DD is head down. I asked for a scan but the scanner wasn't available unfortunately. I'm really not 100% convinced about the position unless the baby is a contortionist, so when I have a midwife appt next week I'll ask to be referred for a scan otherwise I'm just going to keep stressing out about it. But fingers crossed the Dr was right and DD is in the right position.

Good news and fingers crossed. Try not to stress about it too much this week, stay mobile and vertical(ish)