Doctor suggests I may need a C/S - what would a midwife say?

[Leogaela]

I am 35+ weeks with my first baby. I live in Switzerland where we see a doctor (ob/gyn) not midwife for our ante-natal care.

I saw the doctor today who is concerned that although the baby has dropped a bit its back is facing mine and the head is bent to one side. He is suggesting that the head position could be an indication that the head could be too big to pass through the pelvis and that I may need to have a c/s. He says to wait 2 weeks and see if the baby's position changes and the head descends properly, if not then he will send me to get the baby's head and my pelvis measured up using a radiograph (???) to make a decision whether I should have a c/s or not.

It had never entered my thoughts before that I may have to have a c/s and I feel very disappointed at the possibility.

Does it sound as if the doctor is being premature/overcautious in his warnings or could it be possible that a c/s is my best/only option?

It might not be that the baby is too big, it could just be that the baby has to move its head so it can engage - if it's looking up so to speak then it won't fit - I think waiting 2 weeks sounds sensible, it might give it time to move.

This sounds like what happened to me with ds, although they didn't pick it up until just before term when he hadn't engaged at all. I had an elective section just after my due date because he was showing no sign of engaging at all, in fact they had to fish him out with forceps as he was so high up still.

Just from my own experience, what they said to me was that with the baby so high up I was unlikely to go into natural labour because no pressure on the cervix, if my waters broke it would be a problem because the cord could get in the wrong place or the baby could just get stuck, and for similar reasons they couldn't induce me. So I suppose I could have waited for another week or so over my dates, but it actually looked unlikely that anything would happen and that if it did it would all be very unpleasant. But as I say, I was right at term when all this happened, and you still have a month to go, so time on your side, maybe. Good luck.

I would think the baby still has time to move and engage properly. However there are some OB/Gyns who will take CS as an option rather than go through an awkward delivery. Friend of mine switched from delivering at Spital in Horgen to Sanitas quite late on because her 2nd baby was breech and at Horgen she'd have to go straight to a section whereas at Sanitas they gave her the chance to try to deliver naturally, successfully. No experience of head/pelvis size afaik but ds was a back to back labour and ventouse delivery as his presentation was awkward and labour long. Keep an open mind until your next appointment and read up on the pros and cons.

Hi there,

I think a midwife would say that there's plenty of time for the baby to move - and so would many British obstetricians. In fact you often cannot tell how things are going to progress until labour commences.
Type "Optimal fetal positioning" into a search engine as there are exercises you can try to tempt the baby round to a better position.

Mandy

Mrs FP - the doctor is worried what you experienced may happen to me. He wants to monitor it so that he will know if i will need a c/s as he would prefer that I don't go into natural labour and have to have an emergency c/s. he would prefer to know before and plan it.

I hope you are all right in saying that the baby just isn't getting into position and its not the size of the pelvis & head. I will check out the O.F.P. websites and try to do some of the exercises. I just hope the head is not too big! It may be that I get really cramped hips at night and sometimes wake up on my back. That would encourage the baby to lay with its back to mine. also I am still at work, maybe the sitting at my desk all day isn't the best thing to get the baby in a good position.

Lizs - i think you are right, my doctor tends to be on the side of cautious rather than risk a difficult delivery which could possibly damage mother or baby unecessarily. I will talk to the midwives at Sanitas and see what they think before i make a decision if i am faced with it.

Mrs F.P. ... that didn't make sense, as in your case he said that I would not go into labour naturally if the head isn't far enough down.

What the consultant said to me was that I was very unlikely to go into labour ie with contractions, but that if my waters were to break, which might sometimes happen without labour proper starting, then that would be a problem and they wanted to avoid that.

But again, that was at full term, so time wasn't on my side at all.

Agree with Mandy. Far too soon to say. Here is alink to optimalfetalpositioning

Thanks everyone, I have had time to think about it and read up a bit and feel much better about this today. I feel sure that it is only the baby's positioning that isn't the best at the moment, I am not that small and instinctively I don't think that size will be a problem. On reflection I think that the doctor is just not keen on doing a natural delivery if he thinks there may be any complications or difficulties at all. If I have another baby I think I will try to find a doctor that has a more natural rather than medical approach to things (or see if I can just see a midwife). When I asked him if there was anything I could do to help the baby get into position he said no, I asked him the question because I had seen comments on MN about it before. I feel a bit disappointed in his answer, even if he doesn't believe the exercises work at least he could have told me about it and said he didn't think it helps but.... or maybe he just doesn't keep himself informed.

In the meantime I will also talk to a midwife at the hospital.... and I spent quite a lot of my evening down on all fours last night!

Do you think that the baby not dropping down yet could also be indication that the baby may not want to come out until after my due date? Should I be planning for a late arrival or is this not an idication at all?

Leogaela - it is not abnormal for the baby not to have dropped down yet. For a first baby the head does not engage until 36-38 weeks. It will only be a problem if the head has not engaged from 38 weeks onwards so there is still plenty of time. Definately consider the exercises for optimal fetal positioning. Sadly doctors do not have a clue when it comes to this type of knowledge.

Thanks again Mears! So at my next appointment at 37+ weeks if the head still isn't engaged I should wait another week before pressured into making any decisions about having a c/s.
Do you know anything about the radiograph measuring techniques he has mentioned? He seems to think it is an accurate way to measure the space inside the pelvis for the head to go through and the size of the head. Is this something that would be done in the UK? Is it necessary?

No it is not recommended in the UK. Page 10 and 11 of this guidance mentions it as not being useful. It will take a minute to down load. It is the national guidance on C/S.
If the head was high and free at 40-41 weeks then a C/S would be indicated. If the head was stable at the entrance of the pelvis, then labour would be allowed to continue or be induced to see if the baby will pass through. A close eye would be kept on progress and if the head did not come down in labour then a C/S would be performed. Labour is really the only true test.

I really appreciate your advice! I will definitely feel more confident in standing up to the doctor if nothing changes and insisting that we wait as long as possible to see what happens. I feel that my doctor has worried me unecessarily (its not the first time either!) and realise its too early to be worrying about this yet.

I will read the document at home this evening.

My SIL lives in CH and as she pointed out to me.... in CH if you get a section it's far more ££££ for the doc and the hospital.....
SHe had (IMO) 2 unncessary sections.... she is still very upset at the care she got at one of Geneva's best hospitals too!

pupuce, I have to say that had crossed my mind too. You have to pay for 2 OB/Gyns in attendance for a section here as well as a paediatrician - so can be seriously expensive, although the costs are regulated. They would probably rather plan it in advance than upset their schedules with an emergency one. However that is not to say that all CS's are unnecessary - friend recently had her 4th in 5 years as she gets pre-eclampsia and was monitored carefully throughout her pg's.

The £££££ had crossed my mind as well and another reason that I wanted other opinions on whether or not it is necessary. Not only that, the doctor has to come to the hospital especially for the birth. If its a c/s then he can plan it with his assistant. What happens if I have an emergency c/s? where does he get the assistant from then?

Lizs - according to my dh costs are not actually regulated and it is one of the discussions going on here at the moment that doctors charge what they want and the insurance companies are required to fork out for it.