breach / unstable lie at 38+6 given until tomorrow am to decide

[lickencivers]

baby number 4 - previous 3 were all spontaneous vaginal deliveries with no complicatins at term. Was breach before but confirmed cephalic at 37 weeks, so has turned and I haven't felt it.

No other health concerns, no PMH

Saw MW today who sent me for presentation scan as due for a HB, baby is breach / unstable transverse.

Saw the Dr this evening whos basically scared the crap out of me and said dead baby at least twice. I don't want a C section, an ECV sounds crap too, a stable induction sounds hideous. I wanted my uncomplicated HB. FFS Any advice gratefully received as we need to call at 8am and tell them if we want the C section or the ECV on Friday.

I too would go with what’s best for baby (and your safety of course!) why take the risk! If the doctor has said “dead baby” multiple times I don’t think he’s taking this lightly and I would be inclined to do what was recommended even if it didn’t fit in with my own plans.
Whatever you opt for I hope it goes smoothly OP.

You've had three very straightforward births, OP, so I absolutely understand that this has caught you off guard. But that's three more than some women get - my first birth had every complication going and my second is likely to be similar.

It's a lot to process, I know, but from my perspective you've won the bet three times, so maybe it would be best to start making your peace with the idea that this time might start differently but end just as well - with you recovering well and a healthy baby.

Personally I'd go for a c section rather than an ECV but everyone has a different opinion on this.

Have you made a decision yet?

I would go for the c section especially now you've said your last labour was 20mins. If baby is transverse/ unstable lie it could be dangerous and I'd be very concerned about cord prolapse.

I'd be very concerned about cord prolapse

Indeed. A friend of mine had a VB with a breech baby, his umbilical cord prolapsed and his oxygen snuffed out. She was rushed for an emergency c section but it was sadly too late.

Not want you want to hear op but it happened.

going off what the consultant has said I’d be going straight for a calm, planned section.

My son was breech until he turned at 38 weeks, I declined the ECV and wanted the c-section that had been scheduled for 39 weeks. Had awful labour so was gutted I didn't get the section. ECVs are risky, I would not entertain one. Why risk your baby's life?

Totally appreciate it's a shock and you're probably feeling very out of control and confused. I would do some reading on the risks on all options and decide what's best for you. The trouble is of course, it's all unknowns. So for me I'd take the road with least risk.

Im a control freak and prior to having kids didn't want a section at all. I ended up having two sections, one crash, one elected. Crash was terrifying and it took me a long time to feel normal. Elected was really calm and I felt pretty good after a couple of days once the pain subsided. In the scheme of things the recovery is not that long when it's planned.

Good luck

I'd be queuing up on Friday morning for my c-section. Absolute no-brainer.
That's not to say I don't feel for you, and the shock and disappointment you're experiencing right now, and the loss of agency over your body. However you've had three straightforward births and you need to make your peace with the fact that this one is different and just get on with doing the right thing. Good luck with whatever you decide.

I would try to get some acupuncture - moxybustion - tomorrow if you can. Anecdotal obvs but worked for me and does no harm if you can afford it. Then book in the ecv. But in your position even if the ecv works I wouldn't have a hb just in case, esp as you are an hour away from hospital.

My first was a EMCS due to a cord prolapse (not breech, but breech increases the risk for it). It was terrifying and I was very glad to have been in hospital for it as they ran me down the corridor to the theatre.

My second was breech up until the morning of delivery. He flipped while we were waiting to go in for an ELCS and surprised the doctor by coming out head first instead of feet first. I was aiming for a VBAC, but due cholestasis, I needed to deliver early. I wasn’t a candidate for induction or an ECV due to the previous CS.

Having had both an EMCS and an ELCS, I would recommend an ELCS all the way over a potential EMCS. I would also HIGHLY recommend being at a hospital if you have an unstable lie and thus risk of needing a CS and increased risk of prolapse. Babies do flip late, but dealing with the risks just doesn’t seem worth it to me. I would have loved to have had my VBAC, especially after the mess that was my first delivery, and I totally get being sad/frustrated about not getting the birth you wanted or expected (twice for me), but in the end I have 2 healthy babies and I don’t really care how they got here now.

A few things here: everyone, but especially OP, would do well to read the relevant medical literature on risks. There seems to be a perception on Mumsnet that an ECV is an extremely risky procedure. It is not. There is a 1 in 200 chance of it leading to a crash section, which is why it will only be carried out if an operating theatre is available.

I believe you should do what is recommended by the medical professionals. Under no circumstances would I entertain the thought of having a home birth with an unstable lie - as a PP mentioned, you will need constant monitoring of the baby's position. An umbilical cord prolapse (which is a risk with transverse and certain types of breech, and I imagine with an unstable lie too) results in fetal death in 10% of cases.

Now my personal experience. DS was head down from 30-36 weeks, then transverse, then breech. The obstetrician recommended an ECV. I had this, it was uncomfortable AF and failed. I was given an explanation of the options. For me, only one thing mattered: safe delivery of the baby. In my case (footling breech) this meant an ELCS.

Just take a moment to visualise your DC in 10/20/30 years time. Imagine you decide to have no ECV and opt for a home birth. DC sustains permanent injury. How would you feel about this? Could you imagine saying "I'm sorry you have a brain injury, but mummy wanted to have a vaginal delivery"? Hideous, isn't it? So you go for the safest option.

I am familiar with the bluntness of obstetricians when it comes to explaining risks etc, but for them to mention fetal death more than once suggests that the risks are severe.

In your circumstances, I'd enquire about the risks of DC turning again after ECV. I would base my decision on the answer, but the three options would be:

• successful ECV + hospital birth
• unsuccessful ECV + ELCS
• no ECV + ELCS

I understand your disappointment and your reluctance to be railroaded into a decision you're not happy with. I struggled with needing a caesarean, feeling like I'd been cheated out of experiencing labour etc. However, I can't even bring myself to think of all the things that could've happened had I attempted vaginal delivery. DS's head is mega and I believe it would have ended badly, if not catastrophically.

Try to get your frustration out of your system before tomorrow and plan questions using the BRAIN acronym. Then you decide.

FWIW, I did not find the recovery from a section nearly as bad as it's made out to be. Yes, it is major abdominal surgery and yes you will have a newborn to look after, but there's no general anaesthetic and you can take good pain relief even if breastfeeding. I have a lot of shitty memories of the first few weeks after DS's birth, but pain isn't really one of them.

To the PP who went against medical advice and still had healthy babies: your stories are the maternity equivalent of "My aunt Elsie smoked 30 a day and lived to 103". Just because it worked out well for you doesn't mean it's not an inherently risky option. To suggest otherwise is irresponsible.

I wanted to add something. I also worried a lot about things being done "to me" by medical professionals whilst I was in labour. I did the online hypnobirthing course by the positive birth company, which made me feel a lot more empowered. I rocked up with a birth plan in rainbow felt tip on the morning of my section. I largely got what I wanted. I would urge you to let go of the feeling the doctors are motivated by cost and/ or control. They want the safest option (if for no other reason than maternity incurring the most clinical negligence claims of all specialisms). The obstetrician's relief when I agreed to an ELCS was palpable. This is not control in the sense of limiting your freedom, it is control in the sense of putting everything in place to maximise the chances of a successful delivery. If it were about cost we'd all be having home births, definitely not caesareans!

Aargh, also wanted to mention that I believe that the "a caesarean is major abdominal surgery, don't underestimate it" line is trotted out to discourage women from demanding them when they're not strictly speaking necessary medically speaking. It really isn't that bad - my friend struggled a lot more with an episiotomy than I did.

OK not me my DD, tried for a vaginal delivery started seizing after 26 hours, rushed into theatre, baby distressed mother nearly died, baby and mother would have died, post natal mother very ill for days, it was a bad time which I would not want any family to go through. They said afterwards because of the babies position it would never have been born vaginally.

Echoing others calling for the C section. I get that you're scared but if your attitude here is the same as in front of midwives & specialists, I'm not surprised they are giving you the worst case scenario. I should've had a c section with my son; I ended up asking for a 40 week induction (suspected v large baby) I ended up with an episiotomy, 2 second degree tears and thrombosed piles. I couldn't walk for 2 weeks and was still wearing standing up at 6 weeks. I lost 2l of blood and my kidneys failed.

And that was just me. My son was in distress due to a 50 hour labour and had to be resuscitated at birth.

Have the c section.

NC as this is outing - sorry for what will be a long post!!!!

I feel for you OP. Hearing someone tell you that your baby may potentially be at risk is scary as hell. You have the good fortune to be told this now, and not at the last minute, so that you're able to make an informed decision. The reason they will have mentioned the worst possible outcome to you is because they have to. If they don't make you aware of the possibilities and you make an uninformed decision and the worst happened, the fingers would be pointed at them immediately!

So you asked for experiences.... Last year, I was told I would be induced at 39+1 because my baby had stopped growing. I spent a week in hospital while they repeatedly tried to induce me, and it didn't work. So I was sent home to wait for a space on the labour ward where they planned to break my waters. I had a call the next morning to ask me to go in for monitoring, where they told me baby had moved. He was transverse. This is something that had been happening all week while in the hospital, and each time I told them, nobody listened. Within 10 minutes, I had senior consultants in the room performing a scan, and they confirmed that my waters were on the verge of breaking, and the cord was in a position where if they did, it would mean a cord prolapse. They wouldn't even let me stand up off the bed in case my waters broke. I was in surgery within the hour.

I hadn't planned a C section, it was my 3rd baby, with no previous issues and relatively straight forward deliveries. I'd hoped for a nice, relaxing water birth, not an EMCS. There were complications after which meant baby was in SCBU, and quite frankly, the whole day was one of the worst in my life. But if they hadn't acted as quickly as they had, my baby wouldn't be with us today.

If I'd been given the opportunity, and told this had been a possibility days before, I would've chosen a C section. As it was, I didn't get that choice, and I'm still struggling now to deal with the events of that day. Please, please, please make the choice to keep your baby (and you) safe

My DD was cephalic at 39wks.

At 40wks my waters broke and the MW discovered that DD was now transverse. I had absolutely no idea.

Once it was discovered, I wasn't allowed to do anything other than lie very still on a hospital trolley. The MWs and doctors were great but it was clear that there was a fair bit of panic happening behind the scenes.

DD was delivered by c-section and fortunately was fine. It was only afterwards that it hit me just how close a call it had been. I absolutely would not have wanted to have been an hour away from the hospital when the transverse lie was discovered.

If I were in your current situation, I would go straight for a C-section. Having gone through it myself I don't think it's worth taking any unnecessary risks.

I really didn't want a C section with my 4th. All the others had been vaginal births.
But having had a failed ECV which is the most unpleasant experience of my life, I was told in no uncertain terms that due to baby being breech I had to have a c section. ( they gave me paperwork for an elective c section- which I crossed out and wrote 'you forced me').
It was only after she'd been born I realised how awful it would have been if I hadn't had a c section which in fact was really calm and controlled. I healed well from the section and now have a healthy 6 yr old.

my 4th was unstable lie, then at 37 weeks they said he had turned so was ok. I went into labour few days later, he moved during labour, old midwife sent scan machine away saying she could tell where he was.
She couldn't, he was transverse and stuck hard. I was having a c-section anyway because I had previous sections, because he was stuck it ended up being traumatic section, I was cut in a J cut and he was lifeless and bruised but we are both ok now. I really wanted to have a homebirth, but there's no doubt we'd be dead if I had.
This is obviously not the norm, but I know from first hand experience that it is a risk.
Good luck OP with whatever you decide x

My baby was breech, and had got himself into a weird position. I declined the ECV and went straight to the c-section without a second thought. It was a great experience - very calm and relaxed. The recovery was easy and I never felt serious pain, I was just very achy. Having the cannula put in was by far the worst part of the whole experience

You do whats best for baby, you refuse to listen to medical advice, then its your burden to carry should something go wrong. Sick of hearing its my body bullshit. Put your baby first.

All 3 of my kids were transverse, but the first two turned head down and stayed down by 39 weeks and I was able to have straight forward births. #3 however was turning several times a day, and at 38 weeks my fluid levels were low and they said it was time to get baby out. I had stated weekly scans at 30 weeks after a routine scan showed he was transverse with the cord wrapped twice around his neck. Every week the position and cord issues were different. Anyway38 weeks and my OB recommened a c-section due to unstable lie. When I was in pre-op they noticed he was head down so they put me on the ward for an induction. An hour later, after i’d been allowed to eat something they came in with a pessary for induction and the baby had turned again...so no induction. Ended up with a c-section the following morning. Baby was actually head down in the morning but my OB said the unstable lie was too unpredictable and wouldn’t allow another induction attempt. I’d have preferred a vaginal birth, the section was painful and recovery much worse than a vaginal birth. However, given the risks I think it was the right thing to do.

If you live an hour from hospital with a baby that is transverse/breach and your last labour of 20 minutes then you absolutely should be having a csection or managed induction at the very least. There is no question.

I know it’s a shock, but when do babies or children ever do exactly as we want? You need to think calmly and rationally about this, and not let anger or annoyance cloud your judgement.