Unstable lie- baby was head down week 38 and 39 is Breech!!!

[MumToBe2002]

hey all,

i am very upset and disappointed.. baby was changing position for the last couple of weeks until week 38 seemed to settle into head down and I was very pleased as I am hoping for a VBAC. yesterday when i turned 39 weeks made a big change to a frank breech position. Now i am told to just go for elective section as going into labor with a breech baby is an emergency. no one is giving me answers as to why is this baby changing positions a lot, he is 3.50 Kg so not a small baby, my fluid is 8.2 slightly raised but they don’t think thats linked. the only thing with this pregnancy I have PGP and i am hardly able to walk or when i change position in bed i hear clicks basically my joints clicking. doctors do not think thats the case.
my question :

1. Can this baby still go into head down, is it worth holding onto elective until almost 40 weeks ?
2. is there anything i could possibly do ? I am very upset cos was hoping to have 4/5 kids this is my 2nd first was c section after full dilation ( went naturally to labour) unfortunately baby heartbeat was dropping they’ve refused to use forceps and chose c section . after a second section i will always need to have a surgery and might not have the number of kids I am hoping for.

i keep blaming myself for this and think if I done more exercise and sorted my PGP i would have had a successful VBAC..

thanks all x

That's a v v bizarre response we commonly scan previous breeches to see if they have flipped before sectioning. I'd ssk to change units/consultants

Loads of breech people labour before there elective dates it's not an issue u don't dilate from nothing to 10cm that quickly. A section takes around 1h15 to do so even if someone was mid op they'd be space by the time the midwifes done the paperwork

I think @TheHazelCritic means that it's a bit off that the OP has been told 'what if there's no availability for a section' if she does go into labour, given that anyone could end up needing an emergency C section.

It's interesting and reassuring that your hospital would allow the chance at a VBAC, but maybe there's something else in the OP's history that would make that inadvisable, that hasn't been communicated properly to her. Hopefully @MumToBe2002 can get more clarity from her hospital tomorrow!

As an aside, you say no-one dilates from nothing to 10 cm too quickly for a CS, my labour was officially recorded in my notes as being 13 minutes...!

Unstable lie is more complicated than breach. With unstable lie, the baby moves often. If it moves into a position which leaves the pelvis ‘open’ then when you go into labour and waters break, the cord can prolapse which is an obstetric emergency and you’d need a c-section within minutes. My trust hospitalises at 37 weeks for unstable lie.

@MumToBe2002 I hope you get some answers today. Could you go in with a list of questions? I’d recommend asking whether your baby is being classed as breach or unstable lie as that can have an impact on your options. From what I gather, unstable lie is more likely in women who have had it previously so it would be worth knowing so you can factor it in for future pregnancies, if you have it now.

FWIW, my trust we’re happy to try an ECV at 39 or even 40 weeks (admittedly no prior c-section), followed by an induction.

@TickTockPolly I am classed as ‘unstable lie’ and no one offered to admit me, just being pushed for c section.. i will contact them soon and ask all my questions. my previous pregnancy my baby was head down from week 27 and since never moved and went into labour at 40+3. no one is telling me of might be possible reasons?
i will try and request for ECV as that’s my last option.

The difficulty with your plan is what might happen when this happens out-of-office-hours. Many hospitals only have one team available onsite to do obstetrics overnight and if that team are in theatre with a complex case (for example a big PPH/uterine rupture etc) and you came in in labour and breech they really may not be able to guarantee getting you to theatre for a section before you deliver. Due to the fact so many women who are breech decide to have sections rather than vaginal deliveries fewer MWs and obstetricians are experienced in vaginal breech births these days too (they will all know how to do it, but may not have done it that often/have much experience managing any problems).

While PP is right that a straightforward section doesn’t take that long so even if you were labouring the chances are they would be able to get you to theatre before you delivered, a complex theatre case can take much much longer and it definitely isn’t unheard of for women who want a section to deliver vaginally whilst waiting for the previous case to finish. Hospitals cannot have infinite numbers of staff on-site/on-call just in case - there is usually a fairly fixed number based on the usual workload/pattern of the hospital and in a DGH type of hospital that will be fewer staff than in a big tertiary centre where they could possibly pull staff from other teams and wing-it. There will usually be another layer of medical cover (at a max of 30mins away from the hospital), but not necessarily an extra layer of scrub staff/odp cover. In a scenario where multiple emergencies are going on most of us probably would ‘phone a friend’ on the off-chance but in the middle of the night there’s really no guarantee.

If you laboured during a day shift often there will be a) more theatre staff about b) more MWs with a range of skills about, so it may be less of a problem. The real problem arises out of hours, and it’d be Sod’s Law that that’s when it would happen! If they aren’t able to guarantee that your plan of assessing on arrival and going straight to theatre if you’re breech will work then you’ll need to make a decision about where your level of ‘acceptable risk’ lies. They will be able too to advise you personally about the risks as apply to you rather than the whole population (eg. is your old uterine scar normal; why did your last delivery end in a section at fully (any unusual anatomy), etc) and those might help you decide what you want/understand their advice.

If they’re discussing the risk of head-entrapment it sounds like they’re worried that the baby is mobile enough they’re not going to present as frank breech on the day and maybe one of the higher risk presentations. One of the (multiple) risks with a footling is that you can get most of the body through a cervix that’s not fully dilated, but you can’t get the head through and that is a potential obstetric catastrophe.

The only people who can really advise you are the team looking after you who know your obstetrician history in proper detail and know their skill-set/logistic setup/other case load etc in detail too… a bunch of opinions on MN is really not that helpful for you. Your team clearly can’t make you have something you don’t want, but they can make sure you understand the relative benefits/risks of the various options so you can make the decision that feels right for you.

@MumToBe2002 don’t focus on why it’s happened right now. It’s nothing you’ve done wrong. It’s just one of those things. Unstable lie is more common in second/subsequent pregnancies than first.

@CrispAppleStrudels just wanted to ask was your amniotic fluid within normal range and how big was your baby ? sorry just trying to find out if i have a hope for baby to turn last minute x

Amniotic fluid was all normal. Baby was 2.8kg so on the smaller side, but I had high blood pressure from 36w and then preeclampsia from 39w so its likely her growth had been affected by that.

@CrispAppleStrudels thansk for your reply! mine is a bigger baby around 3.4 Kg probably shouldn’t be too hopeful!
thanks all, i’ll see how all this goes X

Hi all,
I am 39+4 and I was told baby is head down :)
consultant said you have a very severe case of “unstable lie” if you want to have a chance for VBAC go for induction even though we would advise spontaneous labour for VBAC But your case is different.
are there any positive VBAC infection stories please ? i am very worried, happy and hopeful xx