Breech baby at 36 weeks - Help and advice please!!!

[mum2becks]

Hi, seen my MW today at 36+4 and she is sure baby is breech, I have been booked in for a scan on friday to confirm and then to see a consultant to discuss further, but MW says that I will need a CS if it is breech which will be done at 38 weeks!!! Thats only just over a week away!!!

Has anyone had a breech baby that has turned late? MW did say they may suggest trying to turn it but I have heard mixed reports on this and it worries me that they could hurt the baby!!

Is a CS my only option if it doesnt turn? MW seemed to give the impression that there wouldnt be a choice?

Any help or advice really appreciated as I am now very worried and shocked as a CS was the last thing on my mind!!

DD was breech from 28 weeks until they day she was born - 41+3, as a breech baby at home with IMs. She was my first.

It is still possible for your DC to turn by themselves - especially as I'm figuring you've a DC already so you're stomach muscles are maybe less restraining than they might be .

If the scan does find the baby is breech, you should be offered an ECV, where they try to turn the baby manually from outside your stomach. Different women have very different experiences of ECV, from mildly uncomfortable to painful, and the success rates are very dependent on the skill of the consultant - so ask after the track record. They should only do an ECV if they can do a CS, as there is a very small risk that the baby will become distressed and need to be delivered immediately - but that is a very small risk and they should discuss it with you before hand.

If the baby doesn't turn by whatever means, or you decline an ECV (which is what I did), you have 3 options:

1. CS.
2. Medicalised vaginal breech delivery.
3. Hands-off vaginal breech birth.

This is where it gets tricky as there's an awful lot of misinformation and bad research regarding the safety of breech birth so making a truly informed decision becomes difficult. If you can find them, get hold of "Breech Birth" by Benna Waites and/or "Breech Birth: What are my options" by Jane Evans. They're available from Amazon and AIMS, respectively. I found them both to be very readable and felt they gave me a much more balanced, impartial view of the situation than the NHS registrar I saw. Google Mary Cronk as well - she's an extremely experienced midwife and one of THE breech birth experts in the UK.

If you're interested in investigating a vaginal breech, make sure you are very clear on the distinction between a delivery and a birth - I would have had a CS in preference to a delivery, but a birth in preference to a CS. Sadly, current guidelines (partly based on bad research, the Term Breech Trial by Hannah et al, being the prime culprit) recommend a CS for breech babies and so midwives skilled in breech birth are getting harder and harder to find. Whilst I don't think breech birth is intrinsically dangerous, I do think its dangerous to attempt a breech birth without a skilled midwife.

Some consultants are pro vaginal breech birth and you may be pleasantly suprised - but be prepared that the majority will suggest a CS or, grudgingly, a medicalised delivery. You may want to consider asking for an appointment with the Head of Midwifery / Senior Midwife at the hospital in addition to your consultant's meeting to see what their opinion is - there are still pockets of breech experience in NHS midwives, and the midwifery department are more likely to know about them than the consultants.

You may also want to start talking to IMs - a lot of them are very happy to give an alternative view of things like breech with no commitment on your part, and they often have stronger breech skills (Mary Cronk is an IM, to take one example). They tend to be passionate about what they do and will help if they can.

Fingers crossed it turns - there is still time and it would make life much simpler. But if it doesn't you DO have options.

Hi my current baby has just turned from breech to head down (34 weeks) so a little earlier but its still possible.

Fingers crossed.

Mine's breeched at 36+6, too.

Scan on Monday.

Is this your first?

This is my third and he's still very high and moving round lots - stretchy uterus - so every chance he'll turn.

He's transverse and his head is fairly low, so we'll see, but the hospital policy is to offer ECV and then CS at 39 weeks if that is unsuccessful.

you do have a choice, you can choose to give birth vaginally - the risks of either vaginally or CS are about 50/50 if you ask me, though harder on you physically during the labour for a vaginal birth. they cant make you have a cs if you don't want one unless it is an emergency from what i understand. i had similar experience to you. at 36+weeks midwife thought DS2 was breech and i had to go for a scan - and the week that i waited for that scan was awful. i researched the vaginal delivery when breech and also asked loads of midwives. most were really supportive of vaginal breech, and a few said that all their breech births were fine and most were completely unexpected where they thought the baby was cephalic.

anyway....
turns out that ds2 wasn't breech at all, he had a bony bum! and was born at home at 41weeks. so i guess i'm trying to say dont worry, it may turn out that your bump just has a bony bum like mine. but even if you are breech, then they will get him/her out in the safest way poosible for both you and your baby. I know what its like though having the uncertainty, i cried and cried because it seemed like my planned homebirth was slipping away.

wait til you have the scan, and in th meantime research as much as you can on both vaginal breech delivery and cs, and decide which is best for you.

oh and mil said that dh was breech and he turned in labour. so there's def time yet.

best of luck

oh i forgot to add that i was adamant that i would give birth vaginally, or at least try to, and if things didn't progress then i was willing to submit to a cs. but ulimately wanted to avoid one at all costs!

Thanks for all your replies, I know I should wait for the scan as MW may be wrong and have worried for nothing but I cant help worrying!!!

This is my 2nd child, I already have a DD and she was back to back, but I managed to escape a CS even though she got stuck, so was hoping that this time would be a lot more straight forward!!

I think as you have said tangle I would prefer a natural birth, but a medicalised delivery sounds terrible from what I have been reading so would prefer a CS in that case. It does sound like the norm is a CS at the hospital I am under, as the MW didnt even mention other options but I will discuss them with the consultant on friday.

Fingers crossed this baby turns itself before my scan on friday, or that the MW got it wrong!!

I am 34 weeks and baby is breech at the moment, my midwife has said that if it is still breech when she comes to see me on monday she will refer me for accupuncture (on the NHS I am assuming!) and moxibustion..which I hadn't heard of but is similar to accupunture, but no needles, I think they burn a specific herb near your accunpuncture points. I have done a bit of reading in it, and it is supposed to have a 75% success rate at getting the baby to turn! This might be something you could ask about?

My friend's baby was breech, she went for acupuncture and it turned and she delivered naturally. Consultant was furious - said acupuncture wasn't 'nature's way', he'd wanted her to have a cesarian

Has your midwife suggested trying an ECV first. The Dr scans your tummy to work out baby's position then puts fingers until its bottom and round its head and uses rocking motions to encourage it to do a forward somersault.

I have just had my baby turned by ECV at 38 weeks. It was a bit of a struggle. uncomfortable and took a while but baby is now head down.

MW didnt suggest any other option such as accupuncture, but did say the hospital may suggest trying an ECV, but from what i have read there are very mixed reports on ECV?!?

i was told i had a breech baby at 36 weeks and just found out yesterday at 37 weeks that the baby had moved and was 3/5 engaged! i was gobsmacked b/c i'd gone through the whole issue of c-section or not. [i had decided on a c-section btw]. now it's back to the waiting and wondering game!

good luck

i believe all hospitals are required by NICE to offer ECV to women if that's what you want. but agree, it does seem the results are extrememly varied. on another thread someone mentioned that you ask for ECV success rates for the hospital and per the consultant. that info could help you decide if it's for you.

also know that it's supposed to work better if you've already had a baby b/c as someone else said you are all stretched out. [i've got another one too and am as stretched out as can be!]

DS turned between week 36 - 38.

Mine were both breech at 38 weeks. And they both turned naturally to head-down by the time they were delivered, by doing those exercises where you put your shoulders on the ground and stick your bottom in the air. Nor very dignified, but it really worked. Both times, I would stay in that position for hours ( I would put a magazine on the floor in front of me so I didn't get totally bored) and both times could literally feel the moment when the baby flipped over.
It's definitely worth a try - as compared to the otehr options, a lot less invasive.
Good luck, mum2becks!

mum2becks - it may be that accunpuncture is not something they offer. I guess each health authority differs. Perhaps look into it privately. Just make sure you find someone who is properly qualified.

anyone know how likely baby is to move back to breech? my consultant assured me that baby at 3/5 engaged and 37 weeks was not going to go back to breech; only a 3% chance she said.

Both my boys were termed 'persistently breech' and both delivered by cs - I have no qualms about my experiences

Just wanted to add - there are certain exclusions to ECV being offered. DS1 had his cord round his neck (picked up on arterial ultrasound) so they would not offer ECV. Also, you need a certain amount of amniotic fluid for them to try ECV, so they would also check your amniotic fluid level at the scan.

Really hope you get the birth you want

Breech babies can turn in labour and you are within your rights to ask for a breech trial, they're more likely to let you go for it if it's not your first. But Tangle says it all better than I could.

I spent a lot of time with ice on my ribs as she had her head wedged in them and it was quite painful. It's supposed to encourage them to turn because they want to move away from the cold.

Thanks so much everyone for all the respose,

I know a few of you have said the baby could turn in labour but I am a bit worried about saying I want to wait and see, then s/he doesnt turn and to end up having an emergency CS if it gets stuck because of being breech?

I have been trying positions from the 'spinning babies' site but I havent felt any major movements so dont think it has turned? But it is a very wriggly baby so could probably get itself into all sorts of positions before its actually born!

My baby was head down until 37 weeks then flipped breech. The literature the hospital gave me said 50% of ECVs are successful and of those about 2% flip back again.

Best to find out what sort of breech you have before contemplating a VB. Mine was a footling breech with one foot kicking my cervix. The risk of a VB from that position is that the body slips out before the cervix is dilated and the head gets stuck. The delay coulc mean the cord starts to gel and baby doen't get enough oxygen.

thanks ajm200...when breech, the baby was arse first which i guess is the 'better' breech to have. i'm back at the consultants next week and they will scan me again. i wasn't really looking forward to a c-sectoin but the certainty i thought i was going to have was comforting. this will he/won't he move thing is going to drive me bonkers.

I don't think that when babies turn in labour it's literally last minute, by the time you get to the pushing stage they're in the direction they're going to be born in. There's no reason why a breech baby shouldn't be delivered naturally, so waiting till labour isn't going to mean that you will have to be rushed in for a CS if baby doesn't turn.

ajm2000 - I'm sorry but I believe you have been misinformed on the risks of vaginal birth of breech babies. There are no known cases of a breech baby getting its head stuck during delivery as long as the baby is term and normaly developed, and labour is allowed to start spontaneously and progress naturally with a "hand-off" approach from the midwives. The head has been known to get stuck if the baby is pre-term (the baby is smaller in general with a dispraportionately large head whereas in a term baby the bum and head are very similar in size so if one gets through the other will almost certainly follow). IIRC there may also have been cases when labour has been interfered with (either through augmentation or through too much active management).

The biggest risk in a vaginal breech birth is of cord prolapse, and this risk changes with the baby's position - frank/extended breech is safest (the bum is nearly as good a plug as the head), full/flexed breech is next and footling breech poses the biggest risk. It's worth noting, though, that even for a footling breech presentation this risk is still pretty small - I don't know of any research that's been done to try and quantify it but breech experienced MWs are still more than happy to deliver them, and most MWs I've met are pretty risk averse...

Mum2becks - if you want to know about options other than CS I honestly would try and talk to the midwives in addition to the consultant. If CS is the norm for breech at your hospital then the consultant (if you get to see one, rather than "a member of his team", which is what I got) will most likely only have delivered breech babies by CS. They may have seen the odd medicalised delivery. The chances of them having seen a hands-off vaginal breech birth are extremely slim. The chances of them knowing anything about vaginal breech birth (especially anything accurate about it) are, sadly, equally small.

To be fair, NICE guidelines specifically recommend against vaginal breech birth and so by following these guidelines the consultant will be covering his back. However, IIRC the reason why the NICE guidelines say that is primarily because of concern over breech midwifery skills.

The question I would want to try and get answered (and by the midwives that are getting their hands dirty) is "what happens to the breech babies where the presentation is only identified in labour?" Who delivers them, and how? How confident are the midwives in that situation? Because there will be undiagnosed breeches. If those births tend to go smoothly, I would be discussing the hypothetical situtation where a woman rolls up in labour with a breech baby and refuses to allow an obstetrician access to the room...

Hope some of that is useful. Good luck for tomorrow

Thanks for letting me know Tangle. I'm only repeating what I was told by the consultant.

Sorry if it came over as harsh, ajm200 - it wasn't meant that way but it is a subject I get wound up about. From my personal experience of consultants and midwives, and the experience of other women I've talked to, the whole "baby getting stuck" scenario is one that occurs so often its frightening . How are women supposed to make an informed decision when you can't get access to accurate information?