Breech baby - turning it at 39 weeks - is this too late?

[hotpotmama]

Saw mw last week, was 34 weeks. Baby is breech. She told me if its still breech, I will be sent to hospital at 39 weeks for a scan to confirm and they will try to turn it there.

Am starting to worry and think it should be scanned earlier and they should try and turn it earlier too, more like 37 weeks.

I don't want to go into labour before they try and turn it and end up having an emergency c/s which is more likely if they are leaving it until 39 weeks. Also, am panicking as is my 3rd baby and first two arrived fairly quickly, about 4 hours (DS1) then 3 hours (DS2)

What do you think? Not supposed to be seeing mw until 36 weeks but think I should try and see her this week, although trying to get an appt so late is virtually mission impossible.

Yes they tried to turn mine at 36 wks I would say 39 and the baby will be too big?? Mine wasn't successful and i had a c-section planned at 38*3 this was so I didn't go into labour with a breech. She was my first and I now wish I had left her longer to see if she turned on her own, but they said she probably wouldn't have!! now due my second in two wks and hoping for a vbac!!!

I don't have any experience of this but I would imagine that 39 weeks is bloody late to try ECV.
bearing in mind you're considered to be term at 37 weeks you may have had baby before then anyway.
would totally push to be seen sooner, if you want the ECV.
youknow though, that is is perfectly ok to have a natural breech birth.
do google mary cronk

Hi Hotpot,

Just saw your message as I'm about to post with a similar problem although I'm not as far on as you (oblique breech at 29 wks).

I am already booked for a scan at 32 wks as placenta previa diagnosed at the 20 wk scan (I'm not overly worried as had this with DD1, and the placenta kindly moved itself!)

Have the midwives given you any exercises to do in the meantime to try to help with the positioning?

Best wishes

Claire

Thanks for replies. Fingerwoman, wish I was brave enough to have a natural breech birth but not sure I am. Isn't it riskier than a c/s?

Feel upset about lots of things re. the c/s at the mo inc. feel cheated of a natural birth, having to stay in hospital longer, not being able to drive, pick up my other two DS's.

Am gutted at the thought of having a c/s as my first two were natural births and a c/s just wasn't in my plans re. this birth .

Jivegirl, no she said there was nothing I could do, however have found there are things which may help. I had low lying placenta with my 2nd, btw, but luckily it had moved up slightly by the time I gave birth and was only partially covering so I was allowed a natural birth. Hope yours does too.

Vicky11, good luck with the VBAC, by the way!.

here is a link to the premise of mary cronk's "hands off the breech" work mary cronk

I am led to believe that the current recommendation to c-section all breech babies came about after a study showed that there were better outcomes with c-section than if a DOCTOR did a natural birth.
In fact, the vast majority of births, breech or otherwise, would be done by experienced midwives. so the study was pretty much less than useless.
Unfortunately the recommendation stuck, and now of course midwives don't get to do many breech births.

If you did want a vaginal birth then I suspect your hospital would try and ensure that an experienced midwife was there for you (not all hospitals are rabidly anti vaginal breech).
Personally I would be happy to have a breech delivery vaginally, there are several mumsnetters who have done so too, perhaps another thread would out them?
Could you afford an independent midwife? Mary Cronk herself still works as one! there are still very experienced midwives out there who are more than happy to take on the breech deliveries

you don't HAVE to have your baby turned if you don't want to, either.

i'd push to see the consultant WAY earlier than 39 weeks, particularly if you had two previous babies at before due date.

Thanks for the link. I doubt the hospital would be able to guarantee an experienced midwife, at my first birth was sharing a midwife with another woman in labour, lucky for me that I was ahead of her or I don't think I would have seen much of her!

I am such a worrier that not sure a breech natural birth is right for me, then again neither is a c/s. (Just wanted another straightforward one like the last two ). Episiotomy sounds awful (despite having torn twice with both DS's).

Am praying this baby turns!

well quite, c-section holds many risks too.

read up on it as much as you can, you can't make a decision unless you are full informed.

hope all goes well

ECV is usually done at 36-37 weeks, so yes, 39 is leaving it rather late IMHO. I would push for a scan and appointment with the consultant asap. I would highly recommend the book Breech Birth by Benna Waites. It goes through all the evidence surrounding breeches and your different options. The evidence isn't nearly as clear-cut as many obstetricians state, but the problem is that because most breech babies are now born by CS the skills for delivering breech babies are being lost by doctors and midwives

What exactly are the main risks with a c-section? Am dreading it but suppose I need to be informed so I know.

How do you turn a breech baby? What's an ECV?

Haven't read all thread, but I have experience on this as first baby was breech. It was picked up at 35 weeks. I looked into acupuncture etc, but it was too late for anyone to try. The only thing available was ECV so I had that done. It was both painful and unsuccessful as it should have ideally been performed, I think, between 34 and 36 weeks, so I was left a little late.

I also didn't feel as if I had the risks explained properly to me. It's quite an aggressive procedure, which left me bruised, and I'm sure would not have been a pleasant experience for my unborn DD either. However, you need to take into consideration the fact that ECV is supposedly less risky overall than a c-section, but talk to you mw about this.

My c-section was performed at 39 weeks. To try and turn a breech baby at 39 weeks is far too late. You should be having the operation by then in order to avoid you going into labour and ending up, as you point out, having an emergency c-section (worse all round as it's higher-risk and completely inconvenient for you. If you're going to have a c-section, make it an elective one if at all poss!!)

It sounds as if you're being badly misinformed so go and ask for second opinions in your hospital, if you don't want to go back to the mw. An ECV is not compulsory either.

I am now 33 weeks pg and now my current unborn baby has been breech for the last six weeks. I'm doing the optimal fetal positioning exercises to try and turn it and will book in for moxibustion if it hasn't turned in the next few days. Moxibustion is also something you could try (look up on net) as it's been highly recommended to me, but ideally performed by 35 weeks ish.

Sorry this is long. My advice is that you need to be taking action right away if you want to avoid c-section as your options are ticking by as the baby grows.

My DD was born by cs because she was breech. I think 39 weeks is way too late, tbh, I've never heard of it this late, it's normally around 37 weeks. Where's that lulu woman, she's be ab;e to advise!!

I refused a ecv because I was worried my bub was going to be big, previous history of big babies. The cs was fine, now problems at all.

Good luck.

I got told that if mine is breech at my 34 week appointment (which is actually at 35 weeks), they'll do a scan and try turning the baby at 36 weeks. I think it's meant to be done at 36 weeks.

I spoke to a midwife at the hospital today as couldn't get an appointment at my local clinic.

She was lovely and told me that I should see my midwife next week and then if its still breech, be booked into hospital the following week for a scan and possible turning of baby. She said 39 weeks was too late so thats a big relief. Maybe I misheard the midwife last week but am sure she did say 39 weeks.

Told me to try one of those big exercise balls when I asked if there was anything I could do to turn it. Wish me luck!

Thanks for all the replies.

definitely too late for ECV at 39wks

DD was breech & I had ECV at 37wks - successful, only for her to turn breech again 2 days later

She turned head down under her own steam at 38+6 - I felt the kicks changing position (m/w didn't believe me when I went for my pre-op clinic the following day for the el c/s for breech - was told it was far too late to turn, until she palpated me & then scanned me & it turned out I was right ) so el c/s was cancelled & DD was born at 39+4 (ended up an em c/s, but that's another story).

She wasn't exactly small at 8lb 8.5oz either, so don't give up hope there is still a good chance baby will turn.

Thanks BB. Will keep hoping. My last two were big, 9lb 6oz and 8lb 11oz so was thinking this one would be too big by now to turn, but maybe it will!

Go to your GP and get him/her to kick ass, if you want an ECV. Like you I was breech with my 3rd pg, had ECV at 37 weeks and went on to have a normal (v. speedy) delivery at term.

ECV is more likely to be successful in 2nd and subsequent pgs, so really worth trying if you like the idea. 37 weeks was the norm for ECV in my hospital. You could also try acupuncture and chiropractic as backups.

Don't leave it till 39 weeks, MW is talking nonsense.

FinallyPregnant - ECV stands for External Cephalic Version. It's where a Dr tries to turn the baby manually while it's still in your uterus. The mother will often (but not always) be given drugs to relax the uterine muscles before hand. The experience varies on a case by case basis - some women describe it as just a bit uncomfortable while for others it's very painful. Success rate is about 50% on average, but varies with the skill of the practitioner, the position of the baby and an assortment of other factors.

I think NICE guidelines recommend offering an ECV at 37 weeks if the baby is confirmed breech. From a developmental point of view you want to leave it as close to term as you can, as a small number of babies will get so distressed by the procedure they need to be delivered by CS immediately. But the later you leave it the larger the baby is likely to be and the more likely the mother is to go into spontaneous labour (which the NHS generally seem to see as a Bad Thing).

BTW, DD was born just about a year ago as a footling breech at home with IMs at 41+3 weeks.

The whole "CS is safer for breech" can of worms... Ah yes! The current NHS policy to recommend CS for breech babies is primarily based on a study commonly known as the Term Breech Trial, published in The Lancet in 2000 by Hannah et al and entitled "Planned caesarean section versus planned vaginal birth for breech presentation at term: a randomised multicentre trial" (the full text is available for free if you register on the Lancet's site). This study seemed to find that a planned CS gave statistically better outcomes for mother and baby than a planned vaginal birth. On the back of this, most Western countries started delivering the vast majority of their breech babies by CS almost overnight.

Unfortunately, the paper has an alarming number of fairly fundamental flaws, to the extent it's one of the worst pieces of research I've ever had the misfortune to read. These flaws encompass

• the design (comparing planned rather than actual mode of delivery),
• the inclusion criteria (in order to be included centres needed to deliver a certain %age of their breech babies vaginally - to get included some tripled their vaginal birth rate over night. If they were confident to birth all these breech babies, why such a big increase?)
• the execution (despite the guidelines indicating attending practioners for VB should be skilled in breech, there are indications this was not always the case)
• and the analysis (babies that died from causes obviously unrelated to mode of birth included in statistics).

The points I've highlighted are just a few of the issues that have been raised since the report was published. When taken en masse there are so many flaws that are so basic a number of papers and/or letters have been written recommending that the conclusions of the Term Breech Trial should be discounted immediately. Unfortunately this hasn't happened and most Dr's still see a breech presentation as abnormal. If you can find an experienced midwife they're far more likely to look on breech as an unusual variation on normal, but experienced midwives are getting harder and harder to find - there's a real risk that the skills required to birth breech babies safely will die out . And everyone agrees that a CS is a safer option than trying for a vaginal birth without the necessary skills on hand.

My experience of breech and the NHS was that as soon as breech was confirmed I was sent off to see the consultant, who gave me an option of an ECV or a CS. When pushed they said that if I really wanted I could try for a vaginal delivery, but it would be Dr led, in theatre, in stirrups, with a big pair of forceps and a large audience - there is a HUGE difference between a midwife led vaginal breech birth (a la Mary Cronk) and a Dr led vaginal breech delivery. I think if I'd talked to the midwives themselves I might have got a different version, but by then we were already leaning strongly towards IMs and homebirth so we didn't persue that line of enquiry. We also declined an ECV, due to the size of the baby and her position.

To my knowledge there is NO research (good or bad) that compares a vaginal breech birth with either a vaginal breech delivery or a CS.

When we were discussing things with our midwives they were adamant that if a vaginal breech birth is to go ahead you should have a normally developed, term baby and the labour should start completely spontaneously and progress naturally. If either of these fail to happen it's a good indication that there's a problem and a CS is the safest way to get the baby into the world.

The other Big Risk that Drs like to throw into the ring when you talk about birthing breech babies vaginally is the whole "head getting stuck" issue. If you talk to experienced midwives, this just doesn't tend to happen with normal, term babies. The two scenarios where it is talked about are where the baby is pre-term (more likely to be breech, and at earlier stages of development there's a discrepancy between the size of hips and the size of the head which tends to disapear at term), or where too much of a hands-on approach is taken (causing the woman's perinuem to contract before the head is delivered).

If you don't want a CS and the baby doesn't turn, start talking to people now. Ask to talk to the Head of Midwifery at the hospital and ask about their experience - I have heard of wards re-working staff rotas to try and make sure an experienced midwife would be available so it is possible. If you get no joy at the hospital where you're booked you could look at other local hospitals. Talk to AIMS and ask for advice. If you're beligerent enough it is possible to work miracles (for example I heard of one lady that managed to get her PCT to pay for an IM for her breech birth - it may not be common but how much of that is because people assume it's a non-starter?)

Sorry that's such a long reply - anyone that's made it to the end deserves a medal! And just to finish, I don't believe that all women with breech babies should try and birth them vaginaly. I do think that it's an option that isn't often presented by the NHS and so a lot of women don't feel they have a choice, and that just isn't fair.

Whatever happens, good luck and I hope you have a good birth experience

I was told at 38 weeks (following a growth scan) that I was breech, MW had missed it all along. I tried everything but the ECV was too painful (dd was only 5lbs 2oz)and the moxibustion too late. Although my dd tried so hard to turn for those few days we did it for. As it turned out my dd was wedged in an awful position and even with the C section it took longer than normal to get her out, so it all came together in the safest way in the end.
Best of luck, try the moxibustion asap, I truly believe this would have worked if I had started earlier.

what I forgot to add HPM was that DD was my first - with two biggish babies beforehand curent DB has plently of room to turn, so fingers crossed

(I say biggish as DS - my second - was 10lb10.5oz thank goodness he was head down )

If you are keen on a vaginal delivery then definitely consider ECV, it's supposed to be easier with subsequent babies than with first as your womb muscles are more stretched, and I didn't find it that bad even with a first baby, just a bit uncomfortable rather than painful.

Thanks again for all your replies, very interesting to read, Tangle.

I think I am just scared to death of giving birth breech style but also very scared of a caesarean so not a good candidate for either on that basis.

Keep trying to feel whether the round bump near my ribs is a bum or a head but if the midwifes can't get it spot on every time, not sure I have got a chance!

Thanks again

my friend had ecv at 39 weeks and baby was born fine a couple of days later

could this website help?