Experiences, please ... home birth with breech; potential ECV; or did your breech baby turn late?

[MayfairMummy]

Sorry about the long post; a bit confused and could use a sounding board...

DS1 and DS2 were successfully born at home. Am hoping DC3 will also be. Have a history of miscarriage (first trimester) and also antiphospholipid syndrome so have only finally been transferred to midwife (from doctors) at about 34 weeks. First actual appt with midwife (36 + 2) and apparently baby is breech. Am spending the week trying to turn her naturally :) If that doesn't work, I have appt with midwife on tuesday when i think she will try/organise ecv if baby hasn't turned. I unfortunately seem to have read a load of horror stories about ECV in the last few days.

I'd rather have a home birth still, but my risk factors are stacking up (age - I'm 42; history of hemorrhage (lost 3litres of blood after one miscarriage); my babies generally go late (DC1 41+3 and DC2 41+6) which they don't like in older mothers, antiphospholipid syndrome (though i'm not concerned about this one), and now baby potentially breech still. I can still insist on a HB, even with breech, but i'm not sure that's sensible. My HB midwife has said she can 'find someone' with breech experience for the HB, but basically has said that a generation of midwives / docs have no breech experience as for so long they've just gone automatically to CS.

If baby turns I'll happily still go with HB. ECV may turn baby, but i've got the willies a bit having read some of the ecv threads on mumsnet. I've also got a mildly arcuate uterus, which is a factor against ECV, though i don't know how much 'mildly' affects this, and am waiting to hear back from midwife.

Anyone have actual experience? Did your baby turn after 36 weeks without ECV? Did you have a good ECV experience? Did you have a home birth with known breech? Do you have an arcuate uterus and still, or not, have ECV? No need to 'warn' me to get a CS please unless you've got experience.

Can't comment on home birth but gave ECV a go at 38 + 4. Had known she was breech for about 10 days, obvs she didn't shift! Very uncomfortable procedure but Dr great & didn't pressurise at all. Unsuccessful had ECS. Next day. Would have liked it to work to avoid c section! Best of luck x

Read here for a very inspiring breech homebirth story. (Scroll down to 'second time around')

Had a frank breach baby and ECV (unsuccessful). From what I read it depends on the type of breach whether ECV would be successful or not. Frank breach (straight legs) quite difficult because there's nothing for the baby to kick itself round with once it gets half way. Bent leg breach might be more successful. Footling I don't know.

Ecv not pleasant but was ok. Suggest listening to your relaxation cd or whatever if you have one to keep you calm. I didn't go into labour or anything. I wouldn't have had another though. Quite happy with Ecs.

Effing ... thanks; somehow your experience is what seems stuck in my mind as a likely outcome...

CityDweller; I can find some really lovely home birth breech stories, but my first site of reference, which helped me start on this whole home birth thing years ago (homebirth.org.uk) expresses caution. This was my first 'go to' site when i had to (first decide and then), ahem, express my opinion that i could have a home birth despite being a first time mother, and then again later when i'd had a major hemorrhage and i had to repeat the risk assessment process for myself for HB no 2. I cannot imagine i would ever forgive myself if i gave birth at home by choice and caused damage/death to my daughter...

Stubbed; thanks for info on ecv; never thought about how 'which' breech would affect ECV. I can feel kicks very low down so suspect complete or footling breech. Here's hoping i can turn her on her own !

I had a failed ECV for frank breech with an arcuate uterus at 36 weeks.
No horror stories to report, DD was just totally stuck. It wasn't pleasant, but I'm glad we have it a go.

Had a CS at 39+5, where her head was well and truly wedged in my ribs -apparently an attempt at natural breech birth was unlikely to have ended well.

Good luck, and congratulations!

Thanks, Egog; that's really interesting to hear. How did they decide on 39+5? My doctor would have wanted to induce me at 40 weeks anyway because of my age; i'm wondering how far they would want me to go if they don't want natural labour (can you tell i'm not very patient!)...

I haven't had a home birth but I did have a vaginal breech delivery last week in hospital for my third baby. . My baby had been in a footling breech position from about 28 weeks and like you I was debating the merits of ECV followed by a home birth if baby had turned . In the end I went into spontaneous labour at 36 weeks and had a very quick delivery although I did need some forceps applied to flex baby's head at the end. He had a very short umbilical cord which was around his neck making his head quite extended . I don't think he would have turned successfully.
Personally after experiencing a breech vaginal delivery, it is not something I would choose to do at home( although I would have another hospital one). I was glad that there were medical staff on hand to sort the problem with delivery of the head out. I also felt reassured that if things started to go wrong then I could have urgent c section. I would also be a little cautious if I felt baby might be on the large side.
Obviously you will come to your own decision, I think a big factor for me would be the experience of the person delivering you as this has quite a large part to play in how successful your attempts will be. Anyhow those are just some things to consider. Good luck with whatever you choose!

Mayfair It was supposed to be at 39 weeks exactly, but my sister was getting married that day so we asked if there were any alternatives! 39+5 was the next free ELCS slot. I was under strict instructions not to go into labour before then!

As it was, labour started the morning of the section, so we jumped the queue. Contractions were 4 minutes apart when they were prepping me for surgery!

Egog; what a lovely reason not to take the date they give you :-)

flyingchick; if she doesn't turn, I'm very likely against the home birth, but it's good to hear views from someone who has a similar mindset (ie actually contemplating HB)... I'll see if they can give me some size indicators on tuesday, though as my two have been 8.5 and almost 9.5lb respectively, i can't imagine she'll be small.... It's good to hear that you'd do a hospital breech again, though - somewhat reassuring!

My 3rd baby was breech until more than 38 weeks. Still a bit 'off' by the time labour started (12 days overdue) but early labour sorted that and he was born very big but without a single scratch to me.

Mayfair - have you looked on spinning babies.com?? Some great advice on positions to aid baby to turn?? Google Mary Cronk, Shawn Walker and Joy Horner they are experienced midwives in breech and host study days, write articles etc.... So maybe able to reassure you. As a third year student midwife we are taught breech is a variation of normal and really really hope I can experience supporting a woman to have a breech one day!!! Good luck I hope you have a fabulous birth experience

Twothirds, Starlight.. thanks for the posts.

I spent the time between first post and yesterday doing all the spinning babies, inversions, reflexology, yadda yadda i could manage with 2 kids in tow, and still ended up breech yesterday when we went to check (although i had a LOT of movement going on in that week). On the plus side, had the ECV, which was an absolute breeze, despite my fears, and baby turned easily.

I'm not entirely sure she's still correct way around, i have to say - she was hugely active last night and i'm getting some knocks (feet or hands?) this morning that are about midway between bellybutton and pubic bone, but i've got a positional scan again next tuesday so i guess i'll just wait until then and see.

My original (pre breech) plan was to start all the 'natural' methods to get her out; now that i'm not certain which way up she is, i'm thinking i'm better leaving her until she's 100% ready. Hopefully this will be sooner rather than later :-)

I was adamant that for the baby to have the best chance of turning I had to avoid interference. That meant no sweeps or anything that might trigger labour before baby had found his optimal position.

When in labour is when I made absolutely certain I was in the best position possible (lying on my front in a deep bath, MNing for 3 hours is what did it).

I was breech myself. I turned at 41+5 (not the most pleasant feeling for my mum, having a fully grown baby turn around). Labour started at 41+6 and I was born at 42.

3HBs here
2nd two were breech at 34 weeks and both turned (unbeknownst to me! clearly absolutely NOT in tune with my body...)
MWs on both occasions said fine to have VB in hosp, but really really unhappy with the idea of a breech birth at home.
There's an amazing video somewhere (maybe linked on the HB website) of a footling breech HB.

I have to say, I was scared of the idea of breech delivery, but more of CS.
I would definitely have tried ECV if necessary.
Acupuncture is said to help?

Am hoping she'll be/stay right way around, now, after the ECV. I'll probably try another ECV on tuesday if she has turned back, but I'm considering trying to get a positional scan as labour starts, if I can .... if she's head down, or probably even frank breech, i'll try a home labour - i can get home quite quickly from the hospital (MW says she can probably find me someone who has some experience with breech). If she's footling or complete, i think i'd rather not take the 20% risk of prolapsed cord....

Thanks again, all, for all your help/experiences!

I was breech at 36 weeks and had a week of acrobatics I refused ECV because quite frankly it looked barbaric, and I hated my bump being touched anyway! A friend had it and she was literally black & blue

I went at 37 weeks to be booked in for a CS as I didn't feel comfortable risking a natural breech birth. Asked for a quick ultrasound to check if he's moved (though I hadn't felt a big swirl!) and despite the registrar insisting that he couldn't have because I would definitely feel it, LO and behold he'd turned! So the acrobatics from spinning babies may have been what did the trick!

My DC1 turned a lot through the pregnancy, and was breech for a lot of the time. I actually had a section booked (scared of ECV) but then DC1 turned. "What a good baby," we all said. Section cancelled.

My consultant (private not for any complications) scanned me 3 days before due date head down. I went in for an induction the day after due date, had all the checks and procedures -- at the last possible second, he scanned me and cursed. DC1 had turned breech in the 40th week without me noticing!

Any further news mayfairmummy? I'm planning a HB with my 3rd and have just been told at 33+6 that baby is breech (probably footling) at the moment. There are some practical issues with my HB at the moment (outside anyone's control), but with a history of fast labour I risk not getting to hospital either. Does anyone know if they ever induce for a known breech birth?

thelovecats .... it's been a dodgy time, actually. I went back the following week after my ECV (having noticed that i'd had a lot of movement that week too), and she was transverse, with lots of cord sitting between her and the cervix - and a generous amount of amniotic fluid. I was told that if my waters went, i would almost certainly have a prolapsed cord immediately as they would flood out (no head/bum to block the exit), and it was extremely dangerous in that circumstance .... and i should stay in the hospital. I declined to stay in, on the understanding that if i had any signs of potential labour, i would go straight up. I went up 2.5 days later as I'd had back pain (my only sign before waters burst with DS2), and they kept me in until Saturday, when she went cephalic (head down). Unfortunately she's not staying there at all, she's just in an unstable lie, and goes transverse most days for a while. I've always got adult company, just in case, and if she goes transverse for any length of time, i head back up to the hospital (though have managed to not be admitted by having her go cephalic again).

Having now researched the death out of all these options, and variations on the issues i've been having, if I were you, I would...
a) wait until 37 weeks. Most babies turn before then anyway. Look at spinning babies website for good ideas to help her turn before then.
b) consider an ECV. I had a really easy ECV, but then that's probably because she can move so freely. If s/he can't move as freely, it might be a little more effort to turn him/her, but she'll much more likely stay there! Personally, i would do an ECV and hope she stays there for your HB. Probably at 37 weeks ish, but midwife will advise. You'll need a consultant experienced in ECV to do the turn.
c) consider an ECV followed by an ARM (artificial rupture of membranes). Baby will be head down, on no. 3, an ARM should send you into labour fairly quickly if it's far enough along, and head should descend into pelvis with the waters going. they'll only do this in hospital in my area, but if you have a quick labour maybe that's a good thing?
d) probably aim to not have HB if you're still footling breech at full term. 20% chance of cord prolapse, though not as dangerous as if transverse, as you will likely have more time to deal with it after commencement of contractions/ waters breaking. Personally, i'm staying in hospital if she's like that when my labour starts (though i have the advantage of being close and being able to get to the hospital in time!)
e) consider c-section if she's breech at term. Most midwives and consultants have basically missed a generation of experience of vaginal deliveries as the default is to do c-section; as such unless you find someone experienced you may find it more stressful than it need otherwise be. I'd personally much prefer to avoid c-s, but I suspect most people would rather go for the 'elective' c-section and have an easy op on a known date.

Best of luck with whatever you decide; hopefully you'll be one of the majority whose baby turns cephalic before you're full term!!

That's really helpful, thank you for writing that reply. I am concerned that this baby is somewhat unstable, as she has been at various times head down, transverse and oblique, and moves a lot. I will keep my fingers crossed that she turns on her own in the next 2 weeks and stays head down. I can't take the risk of home birth, or indeed going into labour naturally if lie is at all unstable because of the timing issues with help arriving and expecting a fast labour.
Good luck with your birth, will you come back to let us (me!) know how it goes?

I'll do my best to update, thelovecats...

From what i can tell, unstable or transverse lie is the most dangerous, but no need to stress for a while unless you have a history of early labour.... they don't seem to mind until 37 weeks or so. If you are indeed unstable at 37 (or transverse); they're likely to want to admit you to hospital at that point. They'll probably try and induce you at 39 weeks if they're like my hospital. I suspect they would have been more agressive with wanting me to induce if they hadn't been particularly busy at the time (shortage of beds)... but i made it out at 39+1 (but did have a sweep on monday).

I've been chatting with my HB midwife, and it looks now like i'll go in for hospital birth, if i have a breech during labour. Whilst she could find a midwife for me who had some breech experience, she wasn't experienced enough to want to do a home birth, and that doesn't give me a great deal of confidence, so i've bitten the bullet and said that i'll only do home birth if she's cephalic.

Hope it all goes/went well for you OP :)

Still waiting, lovecats! Have been head down and stable since last Sunday, but now 2 weeks overdue. Induction tomorrow if she doesn't want to join us today...

I was sure you must have had your baby by now! Good luck with it all. Friends who have been induced with 3rd had a quick labour so hopefully you'd be the same :)