Breech, polyhydramnios, and big baby

[Copenhagener]

I really need a hand hold. I am 35+2 today and because of the midwife being unable to properly feel baby’s position and my fundal height measuring very big, had an ultrasound today.

It found baby is weighing in the 99th percentile (3.32kg), is Frank breech, and that I have moderate polyhydramnios (32.2 AFI).

I had a Torch panel blood test done straight away, and am waiting on the results, but I don’t have an appointment booked in with a midwife until next Friday. I did some searching online as I didn’t get much information, and I’m feeling very worried now.

The only thing the Ultrasound Tech mentioned was that they’d book me in for an ECV to try to turn her on 25 November - which sounds unlikely to work given her size and having so much amniotic fluid - and then I still have the birth concerns about a huge baby and so much fluid even if it works! I’m feeling very alone and scared and that something bad could happen before I see the specialist, like going into early labour and having a cord prolapse (the ultrasound technician told me this is a possibility and that if my waters break I need to call an ambulance immediately). My aunt lost a baby because of a cord incident at full term, and this is an IVF baby after infertility, so my anxiety is through the roof.

Oh love, that's a lot all at once.
If it was me I would opt for an elective c section with all the risks stacking up there. I would bother letting them try and turn the baby.
(And I am one of those vaginal birth/ breastfeeding types).
My second was measured at absolutely massive (and too much fluid, and in an unstable position). The margin of error when they measure the baby by ultrasound, like a couple of lbs either side. He was born in the 75th centile like his sister.

Ultrasounds are much less accurate at predicting the size of big babies than small ones, and it gets harder as pregnancy goes on too so I didn't stress over the size element. The breech situation may still resolve itself (mine turned between 37 and 38 weeks). Samr as the previous poster, in your situation I'd not go for the ecv (I wasn't going to with mine and my history was more favourable than yours for her to be turned) and have a c section. Keep your hospital bag in the car if you go out and at the first twinge get to the hospital. And bum in the air if your waters so break! Best of luck, you're so close now!

Hello, it must feel really hard being left with this information. Remember Google is never your friend in these situations.
Could you ring your midwife (or like the generic hospital number for the antenatal team) tomorrow and ask to speak to someone? Given your family history and what you've been told it seems reasonable to me to ask to speak to someone sooner for a bit of reassurance.
We had this situation and everything was ok in the end. Xx

I would definitely decline the ecv and request a c section instead - but that's my opinion - think about what's important to you. Planned c sections are very safe and these days safer for a breech baby

Thank you everyone for replying. It’s given me the confidence to outright decline the ECV. We generally don’t have the ‘right’ to a C-Section in the country I’m in (super pro-natural birth and I had a midwife tell me that having a vaginal breech birth can be ‘very rewarding’) but I will fight for what I think is safest for baby and least traumatising for me also given the fluid/size issues combined with my anxiety about baby being hurt or killed during birth.

My partner was born at 33 weeks via section weighing 4kg, and his brother was similarly sized too, so I have good reason to suspect that my baby may in fact be as large as predicted!

I had my “off the charts” baby by elective c section at 37+4. He was 9lb exactly, so large for gestational age but not as enormous as they had thought. I also had polyhydramnios, I was advised to take it easy and be prepared for the possibility of cord prolapse, but they weren’t overly worried. I stopped commuting the 2 hours to work at the point that was diagnosed and worked from home, felt more comfortable with that!

my goodness, fight for a c section! Where do you live?

stick to your guns, hope it goes ok x

I’m in Denmark. Great antenatal care generally, but they’re a little too obsessed with pushing natural births!

I suspect she wouldn’t be saying that if it were her.

all HCP have a duty to give the best advice to their patients. If a breech birth was optimal for baby or mum, they wouldn’t suggest an ECV.

A little update: had an hour long scan today with a foetal medicine specialist. My AFI has increased to 36, pushing me into the severe category for polyhydramnios. Baby is still totally breech.

Gestational diabetes and TORCH panel came
back clear, and nothing unusual was seen on the ultrasound.

The specialist said an ECV won’t work for me as the uterus is too tight for her to grip the baby and my anterior placenta is completely in the way - she was surprised it was even recommended.

The plan is to wait one week to get to 37 weeks gestation, do a final scan for size and position and AFI, and then book in a c-section around 37-38 weeks.

I am a little worried about my waters breaking before then - and I’ve been given a warning, but I guess all I can do now is wait.

Good luck OP. I was booked for an elective section due to baby being breech but went into labour naturally before it. I was fully dilated when we arrived at the hospital and they did an emergency c-section. Baby was delivered safely and was absolutely fine. I’m just sharing my experience to hopefully put your mind at rest around going into labour early. Just listen to your body and at the first sign of any twinges, get yourself checked out.

Good luck!! Glad you've got a plan and a timeline. I'd be staying fairly close to home now in your situation just in case.

I had very severe polyhydramnios, large baby and malposition with DC, I was told if I went into labour before my CS, I was to get a taxi or ambulance straight to hospital and get on all fours with my bottom in the air to keep the baby away from the cord. It was a very scary taxi ride but once we were at hospital (not UK) they leapt into action and the baby came out fine (but wearing her cord twice around her neck, so good job we'd gone straight in).

Good luck OP and try not to worry, just have your bag ready and take it everywhere e.g. if you go visiting anyone, or in the boot of your car if possible, and be ready to go in as soon as you feel any contractions or your waters go. Until your waters go, you're unlikely to feel the contractions very strongly due to the fluid and position of the baby. Better to go for a false alarm than miss the real thing.

Final update: baby has moved into an even more precarious footling breech and is in a back labour position, and the polyhydramnios went up to 37 AFI. She’s now close to 4kg.

After the scan I saw a doctor who took one look at the notes and immediately booked me in for a c-section first thing on Monday! She said she’d have done it tomorrow if they did sections on the weekend.

Very sudden, but I feel relieved to have a plan. Hopefully baby waits patiently until then! Thank you all for your help and sharing your experiences.

That sounds like a good plan under the circs. All the best, OP, and I hope it goes well.

Thanks for the update, best of luck for Monday!

Good luck OP. Will be thinking of you.

@Copenhagener, thant does sound stressful.

I would ask for an elective, earlier rather than later. Both my DC were IVF and breech and I found elective caesarean very calm and reassuring. Such a peaceful birth method for breech babies.

That's great that you're booked in for Monday. All fingers crossed here :-)

Hi all,

baby girl arrived yesterday as planned. I’m very glad I went for the planned section - she was 9.5 pounds (heavier than predicted!), footling breech, and had a huge stomach. No way could I have carrier her to full term.

As far as we can tell, the polyhydramnios was caused by her large size only. There was a whole extra 3 litres of amniotic fluid in there! It splashed all over the floor. She had some trouble breathing initially as she’d swallowed so much fluid, but after 5 minutes on the c-pap machine we were allowed to take her to the recovery room. We were very grateful to the wonderful doctors who sprang into action.

The section was otherwise uneventful for me - and I literally lost 10kg in 30 minutes. Even with the discomfort of the incision and walking, I still feel better than I did pre-birth.

Thanks again all, and I hope this thread may help others in future making similar decisions when faced with polyhydramnios and which birth method to choose.

So glad it all went ok and congratulations!
I also had 3 litres extra and dropped 10kg immediately!

Congrats OP! 🎉

Thank you all! So so helpful to me! I’m 33+2 at the moment and baby is fully transverse. I’ve had polyhydramnios since 24 weeks and GD. Last scan baby was 92nd centile and I’m currently booked in for the induction at 37 weeks. I’m so scared we won’t make it that far and with him just sitting across me is even more chance for prolapse. Saw the midwife two days ago and she wasn’t concerned that he was transverse and said there’s still time for him to flip and would recommend the induction - genuinely thinking there’s too much fluid and his head is too big to fully engage.. thinking I should just change the induction to a section and then if he happens to flip just change my mind on the day?

Hi there!

Congratulations on your pregnancy!

I can’t speak for transverse exactly, but 33 is still quite early days. We ended up not booking my section until 37+2 weeks, but those last weeks were honestly miserable and I was largely bedbound. Most babies will not turn after 36 weeks - and in my case she didn’t have room to by that point because she was such a chonker like yours. I’d definitely have a Plan B in place with a section requested in case of continued transverse in case your baby doesn’t turn.

For me: an induction wasn’t acceptable - I’ve actually not heard of inductions being recommended if baby is transverse with poly because the prolapse risk is so high. Midwives aren’t experts with polyhydramnios so make sure you ask to speak to a consultant who specialises in prenatal to finalise your birth plan - my consultant was completely at odds with the midwives and her decision trumped theirs - thankfully because during the birth I was told that a natural birth/induction would’ve definitely ended in an emergency section. It would’ve also required doctors to be at the birth, midwives who were experts in breech; no spontaneous labour allowed, and to give birth on my back; be hooked up to monitors, etc, and the doctor strongly advised against it. They literally booked the section within 30 seconds of reading my pregnancy ultrasound notes.

If the poly has been caused specifically by your GD that rules out a lot of nasty things that can cause it, which is a relief. You’ll feel SO much better when your baby is out and the fluid is gone. I’ll warn you that it’s unlikely you’ll get skin to skin immediately following your birth if the poly is severe - emptying their lungs takes a while.

Let me know if you have any more questions and good luck!

I recommend reading the literature to help medical decision making on this so you can argue your case if necessary (I picked a random nhs site as they all say roughly the same thing) https://www.barnsleyhospital.nhs.uk/sites/default/files/2023-07/polyhydramnios.pdf

@Copenhagener thank you so so much OP! Yes they’ve said they won’t go ahead with the induction if he’s still in an unstable position and won’t let me go past 37 weeks because of the poly and GD.. I don’t think a section is the birth I ‘want’ but I do think in my gut it’s the safest and I think I’ll feel more resolved once that’s decided. I have a scan with my consultant who’s been overseeing my case since the poly was diagnosed so hoping he will just book it in!

Definitely looking forward to feeling more comfortable!
how was your recovery? This (and the respiratory issues for the baby) are my main concerns..