Experiences of unstable lie and birth options...

[mummabubs]

Hi all,

Not sure if this post is better here or in childbirth but it technically spans both so here goes. I'm 36+4 with my first child. I was told at my 12 week scan that I have a mild bicornuate uterus so I was transferred to consultant-led... then at 20 week scan the uterus had stretched to a normal shape so I was back to midwife-led. Jump to now and I've been to pregnancy yoga, planned a very calm and minimal intervention labour on the MLU in a birthing pool (I know experienced mums will be saying my first error was making a birth plan given that these often go out the window- and mine has spectacularly!)

I was advised to have a presentation scan at 36 weeks when the consultant discharged me at 20 weeks just to check for breech. Baby has been head down when midwife checked at 32 weeks and also at a 29 week growth scan they were head down. Grand. So I went to the scan today by myself fully expecting to be in and out in less than 5 minutes- turns out baby was transverse and then flipped to frank breech in front of the doctor and sonographer's eyes in under 20 seconds. Cue conversations about being admitted today, EVCs (which I've always said I don't want) and probable c-sec. I managed to convince them to let me go home as I'm still a way off due date and it was just so overwhelming to have all this info at once. (Plus I'd left the dog at home and only parked my car for 2 hours!) They've booked me for an ECV on Friday despite me saying I don't want to have one- they say I can refuse on the day but they may choose to admit me for the remainder of pregnancy at that stage due to risk of cord prolapse.

I'd never been particularly pro-ECV and to me it doesn't make sense if the problem is that my baby can move themselves too easily then what's to stop them moving out of position 10 minutes after the ECV? (Consultant did agree this is entirely possible). I had really wanted to avoid a c-sec but I'm starting to think that might be the better move rather than ECV and induction?

At the end of that massive unload (thank you for reading and I think I'm still in a bit of shock) I was wondering for those who were told they had an unstable lie- what was your experience? Were you admitted early and if so what was this like staying in hospital/ how long for? How did you deliver baby in the end and is there anything you wish you'd known or would do differently? Sorry, many questions but think ultimately I'm just trying to work out what my decision is from an informed position... or as informed as you can be! Thanks all xx

Anyone? I know it's not wildly common and have now found some previous threads that have been helpful but I thought I'd do an optimistic bump? X

Morning,
I had unstable lie with my second child, who is now 7 weeks. He was oblique for much of the pregnancy, wedged down by my hip, and at 37 weeks I was sent by my midwife for a scan and doctors advice on whether to admit in case of prolapse.

The baby moved while I was sitting waiting for a scan, I felt him move into my pelvis (maybe uncomfortable metal hospital chairs are good for something), and his scan presentation was therefore ok, and no further intervention was required.

He definitely shifted back between oblique and cephalic then for about another week and a half, and I went back for another presention scan, where he was (amazingly) head down. He came at 39 weeks in a good position.

I was worried about prolapse, and did all the 'right' things to help positioning; I walked, sat on the ball, got on all fours, and didn't lie or lean back. Night time seemed to be the time where he'd shift back to oblique, usually while I was asleep. It was stressful. He was a perfectly average sized baby btw, and I wasn't terribly big, so I'm not sure where he got all the space to move from.

I knew what to do in case of labour starting (for prolapse risk), and I live very near a hospital. In the event, my waters did break first, but head was engaged by then.

I read a lot about ECV, and was pretty sure I didn't want it, but I didn't want other birth interventions either... I think I might have tried it, given that he only had a few degrees to turn, but I was definitely scared about it.

Good luck, I hope your baby shifts into position soon. There's still time!

I'm in a very similar position- baby flipping between frank breech and transverse at 35. Also hate the idea of an ECV but have one pencilled in for 37weeks

The potential negative health implications for me and baby after c section are making me think I have to try an ECV. If it works and baby stays then I get my natural birth. If it doesn't then c section is the only option. Without the ECV, section is the only option unless baby turns.

Feel very backed into the corner which is making me miserable. Trying not to over think it and doing every possible natural trick to turn baby - yoga, aquanatal, side lying stretches, pelvic bridges, sitting on birth ball not sofa, have booked acupuncture.

Consultant has told me that it is very obvious very quickly which babies will turn with ECV and if they don't look like they'll go they don't even try.

Good luck with whatever you choose - keep thinking those head down thoughts!

I didn't have an unstable lie but DD2 flipped to frank breech just before 36 weeks. I had a failed attempt at an ECV - apparently frank breech is the worst position for ECV because of the legs being extended, so it's a lower success rate than the other types of breech, which would have been nice to know beforehand!! I was then booked for c section at 39 weeks and told to go in if signs of labour for an emergency c section. There was no talk of admitting me though.

The consultant said one reason a vaginal birth is advised against for breech babies is that staff have little to no experience of it anymore which makes it more unsafe than just the physical risks - cord prolapse, compression etc

Hi I had an unstable lie in 4 pregnancies. I would be examined baby would be breech, at scanning 5 minutes later baby would be transverse and I would be admitted as we live rurally and over an hours drive to hospital.
In the first unstable lie I was induced under very close scrutiny. Normal vaginal birth, with epidural.
The next unstable lie we attempted the same procedure, waters broken by consultant, induction and very close monitoring. This saved my DDs life. I suffered a sudden prolapsed cord and was immediately rushed in for an emergency c-section with GA. We were lucky!
Next two pregnancies I opted for an elective c-section as I really wanted to avoid the GA.
In my experience, my pregnancies became more unstable the more I had.

Hi OP, if there is any chance of you having a bicornuate uterus at all they should NOT be offering an EVC. The risk of uterine rupture is high when EVC is carried out with bicornuate uterus. X

Your uterus will have stretched to a normal shape as your pregnancy progresses, that's generally what happens with BU. However there are still stress points in the uterus as some bits have stretched more than others. Search for bicornuate uterus on Facebook and join the group that pops up. Ask them for advice - it is full of professionals that work in this area and specialise in BU.

Thanks so much everyone for your responses, it makes me feel much less alone than I was yesterday.

@Callamia So glad you got the natural birth you wanted. Did you also have a bicornuate uterus out of interest? (From my understanding this is what makes my baby less likely to stay put as my womb is more stretchy (I.e crap muscles!) compared to a 'normal' shaped womb). Baby was cephalic at 29 and 32 weeks but during the scan they completely flipped and I know from the movements I feel every day there's no way the stay in the same position during any 24 hour period!

@NotAUserNumberSoNotATroll Sorry you're experiencing this as well, it's not exactly the stress-free final few weeks that a lot of us assume we'll have eh! I would say if you really don't want an ECV stand your ground. I've been going to antenatal yoga classes for the last 6 weeks and they've made me feel much more confident and empowered to own my birth experience as much as possible, which includes your right to refuse certain interventions if you don't want them. I also didn't ideally want a c sec (had planned a water birth on the midwife led unit which they told me yesterday is now absolutely not an option... both the MLU and using a pool so I really empathise with feeling trapped and backed into a corner).

@MustBeThursday I think it's the unstable lie that necessitates the admission as if your waters break and the baby is transverse there can be serious risks for little one. Not keen on hospitals at the best of times but accepting this is how it maybe needs to be right now.

@Izzadoraduncancan Thanks for sharing your experiences, I've also assumed that subsequent pregnancies will likely end the same way now too. Your experience of EMCS under GA has made me resolve a bit more than an elective c sec might be best for me. I've worked so hard on all my techniques for having a calm natural birth, but how I feel now is I could manage the pain in a calm-ish manner but I'd be so worried about whether baby was staying head down throughout.

@FruitCider Completely after. Truth be told I was pretty miffed that despite me saying very clearly three times to both the referring consultant and the consultant I'll be seeing tomorrow that I've already made my informed decision that I don't want an ECV they still booked me in for one and told me to show up and refuse on the day if I still felt that way having read the RCOG guidelines for ECV. So even though I knew I'd made up my mind I thought I'd do my bit and read the guidelines last night and was just a bit fuming to read that ECV is not appropriate for people who have a bicornuate uterus or have had bleeding in late pregnancy... and the doctors yesterday knew I have both but have still tried to push me into this. I'm an NHS professional myself and certainly don't feel that they embodied person-centred care or even basic respect for my right to consent/decline interventions as an adult with capacity!!

*Completely agree

mumma I'm glad to hear you had read the guidelines and knew already this is not a suitable intervention for you. Just ring them and cancel your appointment stating RCOG guidelines. You have agency over your own body, don't let them take that from you! PM me if you want to talk about BU more x

Thank you so much. I think I still need to go tomorrow as it's when they've talked about admitting me and discussing the next steps so I can at least use the time to help create a plan moving forward. What that'll look like at the moment who knows?! I get the sense that there aren't too many of us with both BU and unstable lie, I thought before conceiving I just had a really boring normal body but clearly not!

The admission process can happen separately to the EVC appointment if it needs to happen. You can just ring your midwife. Obviously it's your choice but if I was in your shoes I would be worried about being forced into a high risk EVC once there. The fact they have suggested it means they don't understand the risk and may try to minimise.

Very true, FruitCider, although as I'm sure my husband would attest to once I know my own mind I can be pretty stubborn, so I can safely say there is no way they will be performing an ECV on me tomorrow. !! They wanted to admit me yesterday and I declined so I know admission is realistically on the cards, and I do agree with them it's the safest place for me to be as due date gets closer. Equally I wanted 48 hours at home first to get my head around it and properly prepare so I do feel that we've reached middle ground on that one. (I'm genuinely not an intentionally difficult patient I promise but as someone who works in the NHS and does capacity assessments as part of my role I'm so aware of my rights and the need to be informed of all potential risks of any proposed procedure which they neglected to do so it just really frustrates me).

I was admitted one day before the EDD. It was coincident that the date of admission in hospital was same with child labor date. As they admitted me, I got labor pain after 5 hours. I had no need to ran in emergency. They admitted me earlier due to a c-section. I couldn't deliver it normal. They asked me if you want to wait for normal or c-section. I chosen c-section. Too much difficult to bear pain in normal delivery. Scared. C-section was smooth for me. I didn't suffered too much even after operation. It was good decision for me. The only disadvantage is, it has long term side effects like back pain and you can't afford many c-section. You have limited choice.

That's really interesting @Suzi763 that you weren't admitted, can I ask if they knew you had unstable lie and whether you had a bicornuate uterus long before your admission date? I'd much rather not be admitted until later as I'm only 36+5 but think husband is now very scared at the idea of me not being in hospital :/

Sorry, meant that you weren't admitted long before your EDD x

I've been looking at other articles and studies into the possibility of successful vaginal delivery after a successful ECV and there is a higher risk of EMCS, and higher risk of meconium in the waters (indicates fetal distress), plus more likelihood of induction. A successful ECV doesn't mean your pregnancy becomes the same as a normal head down presentation

None of this was mentioned by my consultant which again makes me feel like the ECV is pushed because hospitals are still keen to reduce ELCS numbers and promote "natural" birth. I'm still sitting on the fence but I'm worried that baby has chosen this position for a damn good reason and I need to listen to that and not someone who is considering their statistics.

Good luck with your baby and birth OP

My gp sent me for a scan at 37 weeks as she wasnt sure she could feel head down. The scan just showed the cord sitting right over my cervix then a pair of feet above it. I knew he had been head down 2 days before as my sister is a mw and had had a good feel!
I was admitted straight away and was told I'd have to stay in until they could book me for a cs at 39.5 weeks.
I kept saying that he was flipping about but they didn't scan again until 2 mornings later - and he was head down - phew. They let me home but said to come back again if I felt him on the move - I had 2 more scans but he was head down each time (but was definitely moving about in between). There was no mention of ECV - I don't understand why they would if the baby can move around quite well by themself!
My ds never engaged his head, even during induction and I ended up with emcs at 42+5.

Thanks @NotAUserNumberSoNotATroll, hope yours goes well too. I also read similar research findings re ECV and I think for me whilst I know elective c secs aren't as "good" as a natural birth I think for me it still outweighs the risk of natural birth that turns into emergency c sec. My consultants certainly didn't give me the full picture either, I wonder if it's partly as an ECV if successful is also a lot cheaper in terms of resources compared to a 3 week hospital stay and then c sec + recovery. I know that as a frontline member of NHS staff we are often sadly away of how tight budgets are and what the lower cost treatment options are. 😕

@Hummingbird15 Thanks for sharing and I'm glad you were discharged home after a relatively short stay. I'd like to think I'll experience the same, however I know I feel baby doing big movements every single day so I reckon even if they scan as head down and I'm discharged I'd be back within a day! 🙈

Hi all! I'm sorry to resurrect an old thread (not quite a zombie) but I'm in the same position right now (minus the bicornuate uterus).

How did it all go, @mummabubs?

My first son was breech at 38 weeks, they tried to get me to have an ECV, by after reading up on it.. I declined.

Instead, I went for a type of acupressure, was going to try moxi sticks (I think it was called.. it was 12 years ago!).

Basically the outside of your little toes, level with the vase of the nail is the pressure point that is connected to your uterus. I massaged that every day and he turned himself.

No idea if it helped or if he’d have turned himself.. but either way, I ended up with the birth I wanted with no intervention.

*base of the nail

www.rcm.org.uk/news-views-and-analysis/analysis/turning-the-breech-using-moxibustion

Thank you, Not! I was hoping to try the moxibustion but the mic Chinese medicine place had no idea what I was on about, and looking online, I can't get delivery soon enough.

I have been put off the ECV for a number of reasons, one of which being that navy has gone from ceph, to oblique, to transverse, to breech...hence thinking it's an unstable lie and the ECV wouldn't work.

Thanks again

I'll try the nail massaging