Breech at 35+5... all options slightly unappealing!

[katiegolightly]

Hi mumsnetters. I've been for a scan this morning and baby is happily in breech and I'm told not all that likely to move by herself now (but possible). I'm going to discuss options tomorrow at the hospital, which my midwife says will likely be an ECV or an ELCS. Or both if the first doesn't work/she turns back again.

I'd been hoping that I could put all my lovely hypnobirthing into practice and had been looking forward to using the birthing pool (I know I know... but I'd felt quite strongly about this :-/ Whilst I fully understand a birth cannot be planned I feel as though I'd rather attempt as natural as possible or the other extreme of an ELCS. Anything in the middle is not appealing!!

I'm worried about trying the ECV and then her reverting back or not being able to attempt a natural delivery and ending up going into labour and having an EMCS when I could just make the decision now to go for an ELCS and be done with it.

I know it's a very personal preference, but has anyone else found themselves in a similar quandry? I'm not sure what I should be asking the obs tomorrow but my head is spinning and I'm not sure what I need to know to make a decision about the next step .

Hi,

My daughter was cephalic right the way through, so obviously not quite the same, but I had a low-lying placenta meaning that I had a risk of haemmoraging if I had a vaginal birth. I attempted a vaginal birth (and managed not to use any pain relief for the time that I was in labour so I definitely think that you can have a natural birth if you want) but ended up with an EMCS.

I think it's best if you weigh up which seems worse to you. Would you rather attempt a vaginal birth and accept the possibility of it failing or book an ELCS and not experience the labour at all?

If I was in your position, I would attempt the ECV and give it a chance to see whether or not it works. If it does, great, and, if not, then a c-section isn't the end of the world.

Have you looked into having a vaginal delivery even if the baby remains breech? It's much harder but it is possible to do. I don't know what the chances of increased intervention are though, but it might be something to look into it.

Good luck.

If I was in your position, I would opt for an ELCS. But that is because of my previous experience, and so I am very much swayed by that.

In my first pregnancy, DS was breech throughout. I had an ECV at 38 weeks, and it was successful on paper in that he turned. But it was incredibly painful (not 'uncomfortable'), took absolutely ages and felt very invasive and traumatic. But well worth it at the time to me as I felt that I had given myself every chance of a successful vaginal birth - better prospects for the baby, better recovery for me etc.

I went into labour naturally, and was in labout for 3 days and only got to 7 cm. At that point, baby's heartrate plummeted and I was taken for an EMCS. Turns out baby was back to back (I didn't know that), with his chin very much up (I didn't know this either) and had the unusually short cord wrapped round his neck and legs. Obstetrician said there was no way he would ever have been able to come out vaginally.

I have no way of knowing whether the back to back and cord thing was done during the ECV or whether thats the way he's always been. But having had a long labour and then an EMCS at the end of it, when there was no way he was coming out naturally, I said I'd never put myself through that again, and if I had anotehr breech baby, I woudl go for an ELCS.

I am pg again (36 weeks) and until a coule of weeks ago, baby was breech. I was intent on not having an ECV and then an ELCS would ahve been the norm (consultant said they woudl not consider delivering a breech baby naturally). As it is, baby is now head down (moved at about 34 weeks), so I am going to try for a VBAC.

Sorry for the essay. My view is clouded by my own experience, but if I were you, I'd go for the ELCS.

Thanks Fondle & Happy. I've ruled out any attempt at vaginal breech - I know it's possible but I just wouldn't want to raise any chance of an EMCS and to be honest, it simply frightens the bejesuz out of me, it's so far from the water/hyponbirthing I'd prefer. The scan today was actually to see that the low lying placenta at 20w had moved (which it had) so didn't expect this. Especially as I've been convinced she was head up for so long, and the midwife palpated (extensively) at 35 weeks exactly and said 'don't worry, baby is definitely now head down'. Phew, I thought! until today.

I'm wondering if I book in for an ELCS and then she moves come the day, would they likely cancel the ELCS and make me wait (after getting my head around the new plan) or do they just proceed as the arrangements have been made?

I'm not so good at 'impulse' so if I plump to go for and ELCS I'd at least like to know that that's that then - no 11th hour wait & see... I guess I'm just expecting too much!

If your baby turns before the ELCS then you'd be sent home to await spontaneous labour as the reason for surgery would have gone. They scan prior to the op to check presentation one last time.

hmm, just as I feared - still unpredictable until the last minute! Thanks Flisspaps.

Thanks QT, that's good advice and glad to hear such a great turn of events in your case, especially with successful breastfeeding!

I agree with doing what feels right for me (Luckily I don't care a jot at all what others think ) I think the hardest bit would be having to be prepared mentally for two quite different paths. I feel like given some time to prepare, I could cope and be content with either, it's just the last minute change of plan that is quite un-nerving, I'm a bit of a planner...

Maybe I'll write a list of 'good things' about both and give to DP to re-iterate the appropriate one over and over depending on whichever situation we find ourselves in in any given moment!

katie just wanted to say thanks for this post, my DD has been breech all the way through pg and as I'm 33 wks today I find myself wondering if I should book for private positioning scan closer to my dates (no reason for me to get one on NHS). Both gp & mw couldn't really tell which way up she was at last visits and like you I don't fancy the sound of an ECV or labouring away for hours/days and then having to have emcs anyway... I understand your frustration as I've planned a homebirth & DH doesn't cope well in hospitals (gets very squeamish!) so any cs could be interesting, although I think we'd both cope better if it was el as I'd be worried about him otherwise! :o

Good luck with the birth however it turns out, sounds like you're preparing for all possibilities, which is the best you can.

My DS1 was breech from the go, and remained firmly breech right up to the end! I tried an ECV at 37 weeks, but I definitely wouldn't recommend it. It was really painful, felt really wrong (as if I was trying to force DS to do something), and didn't work! I had an ELCS at 39 weeks and it was a fantastic experience. I had skin-to-skin stright away, no problems breastfeeding (although it took 5/6 days to get it established), and no problems recovering. In fact, I recovered better than some friends who had natural births. Like you, I was really disappointed not to have a natural birth and it took me a while to come to terms with having a ELCS as I felt I'd failed in some way. But, I now know that it was the best thing to do, and really didn't matter in the end. The most important thing was/is having a healthy little baby.

I'm now 33 weeks with DS2 and he only just turned head down last week. I'm a bit disappointed as I had psyched myself up for another ELCS, but now I've got to get my head around actually giving birth!

Hi all, just thought I'd update since this morning's appointment. It could still go either way!

They briefly explained the ECV process and ELCS. They said ECV around 50/50 success rate, and small chance of baby moving back to comfy place again but unlikely in my case as there's not lots and lots of fluid.

I could book in for an ELCS as the situation stands but the frustrating part is if the baby is in the right position on the day they cancel the op and send me home to wait - they won't just do the op anyway. Either way they won't make me attempt a vaginal breech birth (well perhaps if I insisted I wanted to try, but I don't).

Whilst both options were clearly on the table, I felt that they were quite clear on letting me know 'ELCS is not the easy option, don't make that decision lightly' - and didn't seem to understand why I wouldn't want to try the ECV. I must admit I'd rather rather she decided to be the correct way up on her own without having to take drugs to relax the uterus, be painfully manhandled and risk (as she put it) 'being rushed into theatre there and then if we do detatch the placenta or somehow induce labour through the procedure'. !!

I wasn't rushed to make a decision today, there's still 'plenty of time', but I think I'll pass on the ECV and get them to book in the ELCS (which they would do at 39w), and if we are sent home on that day to wait for her to arrive in her own time then there's nothing I can do about that. At least if that does happen there is no reason I can't try to continue with the original plan anyway of trying for a hypno & water birth.

Unfortunately, as ever, the appointment was somewhat rushed and there wasn't any hope of making time to discuss ways I can encourage her to turn on her own. But I've also heard that reflexology and acupuncture can be effective - so maybe I'll have a look at those.

I'm trying very hard to take certain things out of the equation (i.e. the excitement of potentially meeting my baby sooner, in-laws over from overseas for not much time at all and which option helps me recover quicker to get into shape quicker for the wedding dress in September! LOL) I know these shouldn't influence at all so am trying my hardest to put those aside!!

My baby was breech and I was also told by the consultant that 95% of babies do not turn themselves. I was booked in for the ECV but prior to that I spoke to my yoga teacher who recommended that I got myself on all fours as much as possible, or lying on the side with my leg raised on a high pile of cushions. She also recommended taking pulsatilla. I duly did all this and when I went in for the ECV, the scan showed the baby had turned and I had a homebirth. Best of luck, whatever happens.

You might want to look into to Hypnobirthing as they offer a session to turn breech babies. It might not be your thing as some people are a bit funny about Hypnotherpy but thought I would suggest it in case you did not know it could help.

Hypnobirthing

spinning babies

I suppose you have tried the kneeling posistin with head down and bottom up to persuade baby to move?

This is the conclusion of a research study on ECV but might be a bit late as you have probably seen the consultant now - hope it went well.

"The intrapartum cesarean delivery rate after successful version is 2 times that in pregnancies where there is spontaneous cephalic presentation. Pregnancies after successful version should not be considered the same as a normal pregnancy."

Thanks Ushy, that's interesting - do you have the link to the study?

Have been doing lots of yoga/hypno cds at home, Piplysmelie, some resting on all fours (but not too much floor scrubbing!)

Next step... Moxibustion!

Just to add - I tried al sorts to try and get DS1 to move - hangin upside down, being on all fours, headstands in the pool, etc etc. Nothing worked. Some babies just don't want to move, so don't be too dissappointed if our DC doesn't move either...

I was going in for an ECV on Monday at 36+5 weeks...which in retrospect seems a bit late to have left it...but after a weekend of yoga & bouncing on a gym ball, the baby had turned by herself.

We think she is still head down now but it's so hard to tell! I am still not sure if it was misdiagnosed in the first place but the earlier scan definitely showed head up (she was transverse not breech) and now her bum is exactly where her head was!

I was starting to feel a little excited at the thought of an ELCS on the grounds that I would get to meet her in only around 2 weeks, whereas now I'm back to waiting for perhaps another 4-5 weeks.

But overall I was very glad to miss the ECV, it didn't sound pleasant.

When I do go into labour, though, surely if I tell them baby was transverse previously they will check positioning first before letting me labour on for hours: if she moves again and I do need a CS on the day, they may as well get on with it...

DD2 was breech at around 32 weeks and I did a lot of bouncing on my gym ball, being on all-fours and finally lying upside down on a board with my feet in the air several times a day (easier said than done - especially the getting back up bit!). She had turned by my final scan at 36 weeks. No idea if she'd have done so anyway of if any of my shenanigans did the trick but it is worth a try.

My DD was breech till 36+4, she turned the night before the scan to confirm presentation prior to lining me up for a c section... I sat on the ball, tried the torch at the bottom of the bump thing, kneeled on the sofa with my hands on the floor (with dh on standby to help me up), crawled about on all fours when moving room to room! She finally took the hint and moved.

Anecdotally I have heard so many stories of babies not turning - then when a section's done it turning out that there's a good reason why the baby hadn't turned. If I were you I would go for the ELCS and explain that given an ECV only has a 50% chance of success you'd rather have just the one invasive procedure ...and know that when you come to hospital to have it done that you'll definitely be meeting your baby that day! Good luck

Marshmallowpies - I would be insistent, if it got to this I think I would go in at the first signs to double triple check. I personally think it would be quite traumatic to labour away for a day at home, go in and be told you are quite far along and, oh whoops, still breech - EMCS. Argrgrgrghhh! Looking forward to following your progress

blondieminx, impressed with your late turn!

Thanks for the good wishes katie.

I will certainly be trying to get as clear a picture as I can beforehand of where the baby is positioned, if she did go back to being transverse I would be needing to go into hospital as soon as I was sure I was in labour (the doctor I saw last week said something v ominous about not wanting the umbilical cord to come out before the baby...)

For me the ECV was very painful and scary but it worked ... But I ended up with a EMCS anyway which seemed really unfair after everything I'd gone through. Everyone tells me that a ELCS are much better which I believe . Mine was definitely not a good experience but very traumatic and took a long time to heal even though had no complications other than anemia .
Now We're about to have a baby girl in a few weeks by a surrogate who's having ELCS and although she's offered I'm not sure I can be in the room after having one myself . I think I'd have flashbacks so might have DH go in and wait outside with DS . I've waited for her so long that I can wait a bit more to meet her...

Hey, just a quickie to say that I've just had my twin boys who played silly buggers with their positions all the way through my pregnancy. One was breech, then the other, then both and finally neither. In fact they changed positions 4 times in the last 5 weeks and that was with TWO in there. They were born at 37.6 weeks.

Just to say, anything is possible and I prepared for every eventuality which meant when I did go into spontaneous labour I was ready for it. Similarly, I'd had a good read around c-sections and all other options too so wasn't too scared of what could happen.

Good luck all those with breech babies - they certainly are a special bunch!

Katie, have you asked your HypnoBirthing Practitioner to help? I'm a practitioner and I am always very happy to help. I had a mum very recently who was aiming for a home water birth whose baby was breech and a quick 1 hr session was all it took to turn him. It's worth asking.

read a bit here

Good luck!

My DD2 was breech from about 28 weeks... had no intention of moving, even though everyone was saying most did but my gut instinct said that she wouldn't turn. I tried ECV at 36 weeks, but no luck - consultant gave it some welly too!! It was painful, but I'd had a text book birth with DD1 and the thought of a CS terrified me.

However... DD2 came earlier than my ELCS, waters broke at midnight and she was born at 2:22am. It was a lovely experience - so calm, joking all the way through, I was lucky to have skin to skin in theatre, back up on my feet 12 hours later.

Now pregnant with DC3 and happy which ever way he/she comes out!!

Good luck whatever happens!

Like you I had Placenta Previa which luckily moved up around the 20 week mark. at 40 weeks plus 1 baby got caught up in her cord and it pulled her into transverse lie.

After 2 days in labour MW'vs eventually noticed that she was in wrong position and tried to turn her. Unfortunately weren't able to.
After 50hrs she was eventually delivered vaginally. I tore badly and needed lots of stiches, blood transfusion and was catheterised. Was so traumatised after the birth that caused all kids of bonding problem with DD.

Really wished I'd had an EMCS.

OP good luck + try not to worry too much.