ECV or ELCS

[Stellarbella]

Hoping to draw on the collective wisdom of mumsnet to make this decision!

I'm nearly 36 weeks with my first baby who has been persistently breech throughout. A presentation scan today confirmed this, and so the consultant has taken me through the various options which are basically ECV or ELCS. There doesn't seem to be a huge amount of vaginal breech birth experience at my hospital and I'm not massively keen on that as an idea for a first birth anyway.

I've said that I don't want the ECV due to the low success rates and the discomfort of the procedure and potential to distress the baby, and I've therefore been booked in for an ELCS in a few weeks. However, the doctor said I could change my mind this week and have the ECV if I want to.

I've all of a sudden started to doubt my decision, and have got the terrors at the prospect of major abdo surgery involved in an ELCS.

Does anyone have any advice? Or good / bad experiences of either.

I was in your position two weeks ago. I was adamant I didn't want an ECV.. but when it came to the crunch I started to doubt whether I was resigning myself (and baby) to a surgical birth when there might be another way.

What swayed it for me was speaking to a midwife friend who said although an unpleasant procedure, I should try and maximise my chances of a vaginal delivery due to the recovery aspect and also to avoid being deemed high risk in future pregnancies - meaning I'd never get my lovely water birth in the midwifery led unit.

Anyway, I had the ECV and it didn't work! But it was very quick, I felt very well looked after and baby was monitored for an hour afterwards. Absolutely no distress to baby whose heart rate didn't change at all. Baby has remained very active and I've had no concerns since the procedure.

I'll be having a c section afterall but at least now I know I definitely couldn't have avoided it.

Thanks! Did the ECV hurt?

I've had 2 ECV's, with 2 different DC. One worked, one didn't. After the failed ECV I had acupuncture, and my baby turned at 39 weeks.

I would do all I could to avoid an ELCS, as you say, it's major surgery.

You have nothing to lose by going for the ECV, the hosp will monitor you very closely before and after for any signs of distress, or they will stop if it's too uncomfortable.

IME, it's slightly uncomfortable, but doesn't hurt. It's infinitely more preferable to the recovery from an ELCS.

Google 'spinning babies' for tips on how to get your baby to turn.

In this position and have my ECV booked for Thursday- was given the choice of elective CS but decided I couldn't bring myself to opt straight for major surgery if there was a chance to avoid. My consultant has said if baby doesn't turn easily then they won't keep trying but at least I'll have given it a shot and if it's a CS it wasn't going to be avoided,

Mine was definitely uncomfortable but they told me to say if it was hurting, and they'd stop straight away. It was pressure more than anything.

Speaking as a medic, ECV if you have been breech for a prolonged period of time in your pregnancy is unlikely to work and there is a small risk of placental abruption as a result or of foetal distress.
If it works, you still have a 50% chance of needing some sort of intervention for delivery, be that forceps or an emergency section.
I'm not sure I would take the risk to be honest.
Nearly 40% of babies are now born via section and the enhanced recovery programme means you are in hospital for no more than 48 hours.
Whatever you choose, good luck!

Jasper, are you a midwife or a hospital Dr, or a GP?

Hi I was in the same position months ago. I refused the ecv as I had read online about all the things that can go wrong and many friends I knew went into labour but ended up having emergency c sections for various reasons so I opted for the c section. The nurse said to me though that it was unlikely to work with me because there wasn't s lot of fluid.

It is a personal choice and no1 can really say what is the right one. The recovery for c sections are long it is longer than the 6 weeks they say, I am a healthy size 10 and it took about 6 months before I stopped feeling some sort of pain by my scar when I exercised as it's layers of tissue underneath the scar that takes months to heal fully.

Jasper, that’s helpful thanks. The consultant pretty much said the same to me, that whilst she would have the ECV, all of the other consultants at my hospital would go straight to c section. I agree that the prospects of the baby turning on an ECV are lower in my case due to persistent breech and being a FTM

Thanks Beckie. How long was it before you were up and about after your section?

I had an elective section a few weeks ago - best experience ever! I was walking around within five hours of the op and had a shower and I only had discomfort in the week that followed but never real pain. I feel fully healed a few weeks on and I would do it over a million times as it was such a pleasant experience. I should also add that I had a natural birth with my first and it was absolutely horrendous and I took months to get past the pain from a tear - do not fear elective sections as they are nothing like emergency sections which can be really horrible and with a long and painful recovery

Hi Stella I was also up and about within a few hours. Took pain killers and was out and about as normal within a few weeks. Just had to take it easy when exercising etc. Mine was semi-emergency tho, I was due to go in for an elective on the Friday but went into labour naturally on the Thursday so it was still classed as emergency. I would do it all again too. I know so many people who have had horrible labours. I guess I'm too lazy to push 😂😂

I was in exactly the same position 2 years ago. DS persistently breach. Tried the ECV didn’t work. The consultant said she almost straight away that she could tell it was to happen she couldnt get a grip and my stomach muscles were fighting her

They tried once but as soon as I said it was hurting they stopped.

She also said the chances of him turning back again were high.
The drugs they give you to relax the womb made me feel a bit odd and floppy all over

In the end I had an ELC and it was a lovely calm experience.

I'm in exactly the same boat, 35+5 and had concluded ECV was too stressful for baby but now getting closer and no spontaneous turning has happened I'm rethinking. I've been stressing myself out reading about the possible negative outcomes from sections and if I'm honest I feel quite heartbroken at the prospect. My first labour had many ups and downs but it was honestly the most incredible experience and I feel so sad at how different this could be. But like people have said, I've heard many positive section stories so I think I need to sort my attitude out. Be nice to hear how you get on whatever you decide to do.

I found this article about ECV helpful and the stats made me more inclined to want to give it a go. I've also been moxibustioning, spinning babies, handstands in the swimming pool so at least Ill feel I did what I could!

evidencebasedbirth.com/what-is-the-evidence-for-using-an-external-cephalic-version-to-turn-a-breech-baby/

I had resigned myself to an ELCS the 2nd time. In fact I was prepped and ready for theatre. A last minute scan showed head down, so I went home!

I swear it was the acupuncture (moxibustion).

The first time, the ECV was successful. My consultant says there was a 50/50 chance on success. She also said she'd been doing about 2 a week for 12 years and had never had to deliver a baby as a result of distress caused by ECV.

I personally really would not take the risk of the ECV. ELCS is so safe now, why take the risk? Unless you are planning a large family and want to avoid CS at all costs? I agree with Jasper that the likelihood of it working and you getting an uncomplicated vaginal birth aren't that great anyway.

Shoving leopard, I respectfully disagree.

I have had 4 uncomplicated vaginal deliveries. 2 ECV's (one successful and one unsuccessful, and one baby who turned at 39 weeks).

hallamoo I'm really glad yours all went well for you. Sadly, they do not always end well, and the results can be catastrophic.

For me the risks are just too high, given how safe CS now is. My own experience of ELCS was wonderful, though I do realise not everybody feels this way. I would rather have ELCS than an instrumental birth, even without an ECV, as statistically ELCS is safer than an instrumental birth. ELCS removes the risk for OP of breech birth, ECV and instrumental birth. For me, it is a no-brainier, but of course we all weigh up risk individual and what is a tolerable risk to some may be out of the question for others.

Hallamoo in response to your question I am a hospital consultant.

I would be interested to hear the views of midwives on the subject.

I did an awful lot of research on the subject (having had 2 babies who were breach). My consultant said she'd been doing about 2 EVC's a week for 12 years and hadn't yet had to deliver a baby as a result of distress caused by the ECV. She also said it was a 50/50 chance it would work, and the biggest risk was that the baby would 'flip' back to breach again.

I even considered giving birth vaginally to a breach baby.

From my research, I found that the medical profession has got so used to automatically offering ELCS in these circumstances that the practices of breach delivery and even ECV have become less common, and as a result the medical profession (collectively) don't have the wealth of expertise that used to exist for these practices.

For me, ECV was a no brainier; the risk was small and managed, and I would've done anything to avoid having to have major abdominal surgery and the recovery that goes with it.

My first ECV was successful, my second one wasn't. I knew immediately that it wasn't going to work, I think the consultant who did it the first time was very experienced, and the second one was not.

Obviously, you need to do what you feel is best with all the information you have.

I had an ELCS with my twins because DT2 was breech at 36 weeks. I ummmed and aaaaaahed about it all the way through, and the day they were going to induce me I freaked out and decided on an elcs.

It was AMAZING. I was absolutely terrified of having one though. So calm, controlled, and cheerful, we were having a bit of a giggle for half of it, I felt in the best possible hands. DT2 was born not breathing, and I am so glad that I had the section because she was out in minutes, and an army of medics poured in and got her breathing properly. I’ve never been so grateful in my entire life to the NHS.

Recovery wasn’t as bad as I’d feared. I was up and mobile the day after (hobbling in a lot of pain), discharged after 2 days (had to stay in because of the twins being observed as they were early) and back to driving after 2 weeks. The end of my pregnancy was so awful, that recovery from the section was easy in comparison!

If I have any more kids, I will definitely have another section, it was fantastic.

hallamoo I expect you might get a different view from midwives, in my experience they tend to be very pro vaginal birth. Tbh, I was personally much more interested in the stats than people's anecdotal experience (though I would be interested in somebody's experience of carrying out a procedure once I had already decided to go for it).

I was very risk-averse when I had my DD, as I pregnant with my first at 41 after fertility treatment, and of course this will have coloured my view. I just wanted to avoid as much risk as I could for her. I was particularly exercised about the more catastrophic risks, such as brain damage/death etc, so was willing to trade eg the slightly increased risks of transient breathing difficulties from a CS, and the potential for damage to me, for its safer profile for brain damage. Once I read the (admittedly small) risk of brain damage/death to the baby from ECV I was completely sure I would not be going there.

It may have helped that I had had major abdominal surgery previously, and knew that while painful, it would not be the end of the world (and it's not as though vaginal birth is pain-free either at the time or during its aftermath). In the event the recovery from the CS was much easier than that from the earlier operation, despite having a PPH during it.

I quite often jump on threads about ECV on here, because it sometimes seems to be offered by hospitals without a comprehensive discussion of the risks and benefits when compared to CS. Some hospitals/trusts seem to be on a mission to lower CS figures regardless of what the mother wants, and birth seems to be an area where, in some hospitals (not all), information is still being withheld from the patient, and a paternalistic 'doctor knows best' attitude prevails. All patients should be able to give informed consent to treatment, and accurate information is key to that.

You can ask about the success rates and the EMCS rates after ECV for your particular hospital and practicioner. I personally would have tried ECV after reading the risk statistics, but it's a personal decision you have to come to yourself.

I was in this position and chose ELCS. A large UK study showed only 35% of women who had ECV delivered normally. Some because ECV failed and some because there was another issue requiring emergency section. So on those odds I decided not to bother. Turned out baby was extremely wedged in and my fluids were slightly low so would almost certainly have failed anyway.

'A large UK study showed only 35% of women who had ECV delivered normally.'

Given, that another stat given on this thread that CS accounts for 40% of births - the 35% ECV stat is hardly a surprise! Does the remaining 65% include those who were unsuccessful and went on to have an ELCS?

By this theory, 60% of all births are not CS, and some of those will require intervention whether an ECV has been carried out or not!

I wonder what the % is for births having any kind of intervention is (excluding CS)? ...and what the % is for births having no intervention?

You can manipulate the stats to say whatever you like.

Whilst stats are important, I would couple that with the advise/expertise of the medical team, and my own experience of births. That said, I probably would not attempt a breach vaginal delivery as a first time mum.

I think it's important to be in possession of all the facts, and to be aware of what the human body has been capable of, over millennia, rather than listening to a few horror stories (which you can find for any type of birth).