Transverse Baby -- Am I mad to avoid going into hospital early?

[Chaotica]

OK -- so LO is transverse (most of the time, occasionally breech and for a whole 3 days cephalic before he/she moved back) and my obstetrician wants to admit me to hospital if this doesn't change by 37 weeks. (Then she'll do a cs at 39 weeks if things don't change.)

They won't try ecv as the amniotic fluid is rather low and so is the placenta (probably what is putting LO off engaging). Am I foolish to try to negotiate not to be admitted at 37 weeks? (My last pregnancy ran to 41+3 and I'm not convinced the (scan) edd this time is right.)

The ob. is understandably worried about cord prolapse etc -- should I be? The hospital is 20 mins away... (And meanwhile DD is 16 months old and won't have a clue where her mum is and why, which is why I'm considering going against medical advice in the first place.)

Hi Chaotica

How many weeks are you now?

36+3 (So I haven't got long before term.)

yikes, you've worried me now. i am 36 weeks and mine is transverse too. is cord prolapse a risk in this situation?

Sorry, vitomum! worrying people wasn't what I was about! But even the rather calm midwives (the ones who have been saying if they think the consultant is being over-cautious) have said to call an ambulance if I go into labour (and to stick my bum in the air I wait for it to happen in the supermarket ). The reason, I was told, is that they don't know what will come first and it might be the cord. (Don't know whether that's the same for everyone though.)

no, not at all. i am glad you alerted me to this being a possiblity. i am seeing midwife on monday so it will be interesting to see if she raises it as an issue. hopefully some people who know more than i clearly do will be along to offer some useful advice. i will watch with interest

we didnt know ds4 was breech til i was 8cm dilated, but we knew he wasnt engaged. i was booked in for home birth and this didnt change because of risk of cord prolapse. i saw mw who warned me about it and told me to stick bum in air if waters went with a gush but i was told i didnt necessarily have to go to hospital. and this was when i was about 41 weeks and in labour and she said birth would be within the next few hours.

so dont know if my mw was less concerned than she should have been or if yours are too concerned, but i dont think i would wait in hospital for 2 weeks.

all was well with me btw, ended up with crash section but no cord prolapse

My DS4 was transverse, I had previously delivered three hefty boys naturally and just assumed my uterus was rather lax and so DS was having a hard time engaging and staying put. I was admitted at just under 39 weeks as I was advised that going into labour with a baby in transverse position (especially a 4th labour as might be quick)could be risky to baby and myself. I took the advice and spent a week in hospital befor ehaving him by cs at 39+6.( In my defense was in a great deal of pain, my bump was very tender on the inside as DS tried to turn and had bruised me, I was also exhausted from huge Braxton Hicks and caring for three under 4)

A good friend had same with 4th baby but although told she should, didn't stay in hospital, continued at home spending as much time up right and leaning forward as possible and had her 4th naturally and problem free. She visited me in hospital and was apalled to see me lying in bed. Her midwife had told her to sit up as much as poss, to spend time kneeling with bum in air and to use a birthing ball several times a day - I was never told any of this and spent a very hot week lying on my side watching Wimbledon on telly.

I have just had this experience with my 3rd baby. She was transverse and after failed ECV attempts I was advised that I should stay in hospital until they could do an elective c section or she turned around on her own. I was really against staying in as my elder 2 dd's were on Summer Holiday, don't have any family close by etc etc but the Consultant told me that there was a serious risk of cord prollapse and/or ruptured uterus. In the end I had the elective c section and there was no emergency but I'm glad I was there just in case. Good luck anyway with your lo !

amyclaramum, can i ask what stage you were admitted to hospital at? were there other factors putting you at risk of cord prolapse or was the decision made purely on the basis of the transverse lie? oh, and congratulations on your latest lo

Hi again Chaotica

Yes, you should be concerned about the increased possibility of cord prolapse.

If you choose to not be admitted (as is your right)then be aware of what to do if you have spontaneous rupture of the membranes.

This could still happen prior to 37weeks, and yes, even in Tesco's, make sure you have your AN notes on you at all times.

Assume a position on your knees with your head and shoulder as close to the floor as you can and ask someone to call for a 999 blue light ambulance to transfer you asap to the nearest maternity unit informing them of the possibility of cord prolapse.

Cord prolapse can occur when the baby is a head presentation and the mother in that situation does not have prior knowledge.

Uterine rupture in this situation would only occur if there was advanced labour and no medical assistance available for a prolonged period, so please don't let that thought cause you worry.

Obviously I hope you don't experience any of the above and that the baby turns spontaneously to a cephalic or breech presentaion and you progress to a normal delivery

Hope this helps.

Just how low is the placenta? Because if its over your cervix you won't have a cord prolapse - placenta will prevent cord coming out. Although you might have a haemorrhage, but at least that would be rather obvious, and 20 mins from hosp is ok (by ambulance).

Hi there - I was admitted when I was 37 +5 weeks and had c section at 38+5. I think they were concerned that she just didn't budge when they tried turning her and that I lived about half an hour drive from hospital (Kingston). I was also worried that if my waters went at home and I called an ambulance I would also have my 5 yr old and 8 yr old at home and would have to get someone to come and get them - they would also be really worried about me !I'm sure you can ask for scan to assess the position and ask to discuss it with the consultant. Hopefully your lo will turn round on their own anyway !? Have you tried all those positions to get the baby to move round ? I also went to an osteopath and know other people who have tried acupuncture .

Thanks for all the replies. (And congratulations to amyclaramum.)

The placenta is low, but not low enough to stop cord prolapse (2 sonographers have declared it too close to call on whether it's stopping LO engaging for a normal birth). So my maternity notes don't leave my side... (might regret getting them tattooed on my forehead though )

Now at least I can make an informed choice on what I'm doing. Meanwhile, I'll try all the tips to get baby to turn (and stay that way) before my appointment next week.

i spoke to my maternity unit today and they advised the following:

if contractions start, get myself to maternity unit

if waters break, don't panic but phone maternity unit and they will arrange for an ambulance to take me there

if waters break and cord is visible assume the bum in air position and phone 999

they seemed pretty unconcerned by it and i dont even have another appt with them until 39+3.

there seems to be a huge range of practices in terms of how this is managed. My hospital is clearly at the other end of the scame fromn yours chaotica. it's really hard to know what to think and do. best of luck to you with whatever decision you make.

i spoke to my maternity unit today and they advised the following:

if contractions start, get myself to maternity unit

if waters break, don't panic but phone maternity unit and they will arrange for an ambulance to take me there

if waters break and cord is visible assume the bum in air position and phone 999

they seemed pretty unconcerned by it and i dont even have another appt with them until 39+3.

there seems to be a huge range of practices in terms of how this is managed. My hospital is clearly at the other end of the scame fromn yours chaotica. it's really hard to know what to think and do. best of luck to you with whatever decision you make.

My ds was transverse (well transverse oblique - not sure if that's different) and no-one even noticed until my waters broke, as they all thought he was engaged, head down etc (this was three midwives, including one being trained, and two SHOs). When we finally got a scan (this was after threatening to leave the hospital when they started to say they wanted to induce me) the consultant appeared sharpish and I had a c-section within 30mins. We were supposed to be having a home birth, but I had meconium in the water. They did seem surprised that the midwife told us to come in at about 9 am but we didn't go into hospital until about 4.30pm. Were we very foolish? I didn't know that the position could have any risks.

My waters broke the night before I was booked for a scan and discussion of CS for DD's transverse lie. There was no cord in evidence but I was told to go straight in (nothing about position - just to go into hospital immediately). They did a scan and it seemed DD had been turning head-down of her own accord so we ended up with an immediate induction (iv drip) and a vaginal delivery. The impression I got was that the hospital took the risk of cord prolapse seriously enough to want to get the baby out before things developed - the MW I saw had spent a lot of time at an ante-natal class describing how stressful cord prolapse is for MWs and she got very firm with DH when he queried the decision that was made about inducing me. I suspect the team had had a bad experience recently , as they were so very insistent. DOn't know if this helps!

I'm not a health professional, but I've been researching maternity issues as a hobby for 10 years now.

It's my understanding that the main risk in cord prolapse is when the cord prolapses past the presenting part of the baby, and then gets compressed by the baby descending onto it. It's easier for the cord to prolapse if there is not a good fit between the baby and the uterus, ie if the baby is breech or transverse, but on the other hand, if the cord does wash down there, it is less likely to be compressed because there are plenty of gaps for it to fit through, IYSWIM.

The most dangerous situation is when the baby is head-down and the cord prolapses, because then the baby's head presses down on it and cuts off the blood supply to the baby.

Having an elective section for transverse or oblique lie before you go into labour is quite controversial and there are certainly other views amongst obstetricians and midwives - eg work on foetal positioning, as mentioned in this thread - see www.homebirth.org.uk/ofp.htm .

One approach is to go into labour and keep upright and active, while being carefully monitored, and see if the contractions and gravity get the baby into a better position.
If you want to get some other opinions on this, you could post to the UK Midwifery egroup - see www.midwifery.org.uk . Good luck.