Breech at 36/37 weeks - should I have ECV?

[TippetyTapWriter]

Hi all

Just wondering if anyone had been in similar situation and had any experiences to share, as I can't decide what to do!

I'm currently 36+6 with my first baby. A scan yesterday showed baby is breech, although he was facing away so they couldn't see his legs or feet. I'm guessing this means he's not footling breech, but they didn't really tell me anything other than "breech". Baby's current weight is estimated 7.1 lbs.

Had a fairly useless appointment today with a consultant who just whizzed through options of ECV (manual turning) or planned CS in about 3 minutes flat and asked me to decide on the spot (she didn't examine me or anything)! I didn't decide, but she still went ahead and called the hospital to get me an ECV date. They also took a load of blood tests for liver function as I've been itchy recently (could indicate obstetric cholestasis). I should get those blood results tomorrow.

I was originally planning to birth in the MLU, as intervention free as possible as my pregnancy has always been low risk and straightforward so far. I'm not really an advocate of natural birth for any particularly deep reasons, other than it seems more pleasant for both me and baby and means we get to go home from the hospital as soon as is possible!

Other than a long stay in hospital and painful weeks of recovery, I don't have any major worries about having a planned CS. To be honest, I've heard a lot more positive stories about it than negative. I've also heard lots of negative stories about ECV. Basically I don't like the thought of it. or the potential risks. I find having the midwife try to feel the position of the baby very painful and keep imagining an ECV will be 10x worse. Plus I have a very small and hard bump - could that make any different to the success of the ECV? It seems like the midwife has to dig really hard to feel anything at all! Baby is normally very active, always pushing and stretching and moving from side to side. I wonder if that is him trying to turn?

I can't decide what to do. Should I refuse the ECV? But somehow that feels like giving up, not even trying. I worry that I'm talking myself out of the ECV because the CS seems preferable to the pain and unknowns of a vaginal birth. Basically it is the "unknowns" that scare me. If I knew the ECV would work, I might think it worth the pain and risks. If I knew a vaginal birth would be reasonably straightforward, I would try really hard to make sure I could have one. I just hate not knowing! It also seems weird that they haven't properly assessed my chances with the ECV before booking me in for one. I thought they would need to do a more detailed scan or feel my stomach or something?

Sorry this has ended up so long! Would love to hear from anyone who's been in a similar situation.

Thanks in advance.

My second baby was breech at 37 weeks. I was due to go in for ecv at 38 weeks, and basically spent the time in between doing movements/positions to encourage him to turn. (Have a look at spinningbabies.com for details)
I went in for the ecv convinced he was still breech as I hadn't noticed any movement, but he'd actually turned without me noticing! Ended up with a home water birth a few weeks later.

I'd definitely consider the ecv if I were you, at worst it'd be a short time of discomfort.

I wouldn't, personally. For a start, they are pretty brutal, and I'm always inclined to think that babies are breech for a reason - such as being tangled in the cord. That's why they can send babies into distress necessitating an emergency section.

You need to be a lot more informed about what the ECV will entail, and the person doing it's success rates before you can make a decision. Poor that you didn't get to discuss this in your appt.

My local unit have a good record with ECV and I trust them, so if they recommended it for me, I'd give it a go. I don't want a section as I'd need a GA. However, your team and situation are different.

Perhaps go along to the appt with a long list of questions - you will have to sign a consent form before they do the procedure, so they have to give you all the info and time to ask questions. If you decide it's not for you at that stage you can always decline and book in for section.

Thanks for the replies everyone. Been doing little but trying to decide for last few days, but had another appointment today at the hospital this time rather than my local antenatal clinic. They were so much better there. Really took the time to explain things to me and dh and let us go away for a coffee to think things over. They also scanned me again - baby is in extended breech, feet by head. Seems uncomfortable but they assured me it's not!

After lots of talking and thinking, have decided to decline ECV and will have cs in about 2 weeks time. Feel sad that this isn't the end to the pregnancy I had in mind. Also worried about what cs might mean for future pregnancies, but I know that all that matters is that baby gets here safely.

I can't really give a reason for declining ECV ... normally I'm fairly rational, but I just can't get beyond "I don't want to" as a reason!

Personally, I wouldn't even consider an ECV. I'm quite adamant that I wouldn't have one and would always choose a c-section.

Glad you have made your decision, OP.

Good luck, I hope it all goes well for you.

I wouldn't have an ECV either, from what ive read they have low success rates for the risk involved

I could have written this myself, although bub is transverse rather than full breech - I had exactly the same meeting with a consultant yesterday. I also feel exactly the same way about a virginal birth vs C Section - happy to go with whatever keeps us both safe.

But, we have decided to go for an ECV at 38 weeks (I am currently 36+2), for a number of reasons. The risks to baby itself are incredibly low, yes there are associated risks, but no more than the risks that you face from a C Section, which of course is major surgery. The risk of an ECS following the ECV is approx. 1/200 which is lower odds than we were given for the risk of miscarriage following an Amnio, which we have also had this pregnancy. The chances of it turning with the ECV is 1/3, which whilst fairly low, but are slightly increased in my case due to it being 2nd baby and therefore everything is a bit more stretchy and as it's only transverse, they only really need to move it 90degrees.

We have also been offered Moxibustion the week before to try and encourage a natural turn, and I will be bouncing on a ball whenever I am at home!!

Good luck with your C Section, pleased you were given an opportunity to make a more informed decision and one that's right for you all.

DS1 was a breech and the obstetrician said he wouldn't try an ECV because my womb was tight(!) How did he know?

When DS1 arrived by lovely planned c-section, his cord was exceptionally short. I'm glad we didn't have to find out whether that would have caused problems with the ECV.

Good luck - out of 3 births, my breech c-section was the best.

I was in the same boat and opted for a cs, rather than an ECV. My baby had been breech for ages and I just felt that there must be a reason for that. The cs was fine, although I was a bit disappointed to have missed out on a natural birth.

Good luck!

I decided not to. The consultant said it only had about 10% chance of working as he was sitting on one of his feet and because it was my first baby (success rates are lower for first babies). My ds had been breach since about 28 weeks and so I had a long time to get used to the idea of a section. I think in fact I may have been a bit disappointed if he had turned as having certainty over the date of his birth was really comforting and I was desperate to get him out to stop the heartburn! For other reasons it was highly likely that I was going to have to have a highly monitored birth if I went down the natural route which was pretty unappealing so worked out well in the end.
Good luck

I was a breech baby myself. I turned without any prodding at 41+5. Labour started at 41+6 and I was born at 42 weeks. Back then, they didn't immediately talk section when the baby was breech. They would have tried vaginal birth first.

With regards to subsequent births, I'm a positive good news story!

Dc1 was footling breech, failed ECV then ELCS. I then went on to have 3 VBACs without any complications other than speed of labour/delivery.

One of my babies was breech from 30 weeks. He didn't turn and I had a vaginal birth and we were both fine. In hindsight it seems like madness but felt the right thing to do at the time. Those hormones can mess with your head.

year was it your first? I think I'd have attempted a VB if my breech baby hadn't been my pfb.

DS1 was breech, I had an ECV at 37 ish weeks - can't remember exactly. It didn't work and I had an EC at 38 weeks. The ECV was awful, think of someone putting their hands around your bump and pushing them together whilst trying to twist round at the same time. It was really painful. They did say just speak up if you want to stop. I felt that I had to give it a good go and lay there with tears in my eyes. The nurse kept looking at me asking me if I was ok. I should have stopped it sooner.

EC a walk in the park in comparison -even got to choose the music they put on in the theatre. Next birth was twins with one breech so another EC.

No, Roly, previous CS and VB.

My first was a breech that wasn't discovered until 39 weeks. I tried for an ecv at 39 1/2 weeks anyway as we hadn't seen a consultant by then at which point she told me that chances of success were low due to the dates, being my first, and the fact that her feet were by her head (same as you OP).

As it turned out we didn't get that far as baby's heart rate spiked for a few hours until the doctor had gone home but I'm glad it didn't happen as it turned out that due to being breech dd had a hip problem that was only picked up as they routinely scan breech babies after they are born. They don't do this after they are successfully turned so if anyone does have a ecv it might be worth asking for the scan.

I have heard of a case where the baby was turned and the hip problem wasn't picked up until they were trying to walk at which point treatment is much harder.

MIL had twins who were breech and transverse and delivered naturally at about 40 weeks. I'm very glad I didn't have to do that tbh.

Glad you've made an informed decision, OP. Good luck :)

FWIW, I would refer all babies who were breech at 36w or at birth, whichever came first, for a hip scan. Easy, cheap scan and big impact if you pick something up. Lots of units don't, but ours did and so should every one.

Thanks everyone for your responses, it's really reassuring to read them. Glad you all seem to have had good outcomes in the end. Had a slight wobble the moment I walked out of the hospital after making my decision but think I'm starting to come to terms now with having a completely different birth to the one I'd planned. Keep reminding myself that even if baby had been head down there's no guarantee anything would have gone to plan anyway!

Thanks for the advice about the hip scan, purplegiraffe and ChatEnOuef. I've been reading about hip problems in breech babies, so it's something I'll definitely ask for if they don't do it as standard. Also been reading about frank breech babies keeping their feet up by their head for days or weeks afterwards (and also having dented heads?!)! Not quite the mental image of my newborn I've had in mind! I wonder how much it will affect dressing, swaddling, baby-wearing etc ... Although I guess I won't be up to using my sling for a while afterwards. I think the first few weeks not just the birth are going to be quite different to how I'd imagined! Oh well. I'm getting used to nothing going to plan ...

Tippety dd was frank breech and held in that position very tightly, hence the hip problem. She did come out with her legs around her ears, to comical comments from the staff like " that's not very lady like" but it didn't last long at all and it certainly didn't affect anything.

One thing I would say though is be careful with your choice of sling until you know baby is ok. In our ignorance we bought a baby bjorn (luckily not used much before we knew) that is known to be bad for babies hips. I am due in July and definitely won't be using it this time. Lots of slings are good for hips though, which we still need to look into.

Sorry meant to say there was no dented head either so it could be absolutely fine.