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View Full Version : OT - if baby is breech, opinions on version...UPDATE on p. 2


Lisa Kay
06-21-2006, 12:04 AM
Well, I'm not quite 36 weeks along with baby #4. I've ended up having ultrasounds at weeks 20, 28, and 32. Baby was breech, then not, and then breech again. I certainly know from past experience that the baby still has time to flip around and be head down. So here's my question...

At my 34 week appointment, my OB was thinking that the baby is still breech (no internal exam or ultrasound at that appt., just her thoughts based on the external exam and knowing where the baby's head was at 32 weeks). She mentioned that the first internal exam would be at my 36 week appt. (next Monday morning). If the baby is still breech, she will probably recommend doing a version the next week.

We almost did a version with baby #2 at 38 weeks, but when they did the ultrasound before getting started we found she had already flipped around on her own. Yeah! (And phew!) Having almost had a version done before, I know that I'm not at all excited about the prospect of really going through with one.

Anyone have any thoughts on the subject either way? I have, of course, been on the internet looking for information, and talking to my nurse friends. I'm interested in hearing opinions from any of you doulas/docs/nurses etc. out there, and anyone that's been in a similar situation.

Thanks for taking the time to offer your thoughts. It would certainly be nice to find out on Monday that she is head down. But I have a feeling she is still doing some acrobatics in there, based on the movements I feel.

KristiMetz
06-21-2006, 12:19 AM
Well, a lot of the natural birth people feel very strongly that doing a c-section just because you have a breech baby is one of the reasons that the c-section rate is so high.

I don't have any firsthand experience or knowledge, but if you want the opinion of those dedicated more to natural birthing, this site has some pretty good info.

http://www.mothering.com/discussions/forumdisplay.php?f=213

I think if you saw a midwife, she would probably give you a different opinion, just based on what I have read, they try to avoid surgery unless it's really necessary and are more skilled at delivering breech babies.

Good luck! It's tough, especially if a doc gives you advice and you're not sure you agree with it. I had a lot of complications with my pregnancy so I can relate.

DoulaLyndsey
06-21-2006, 08:34 AM
Doctors typically will not perform a breech delivery because of the risk of head entrapment and also because as the baby comes out, the cord gets compressed between the head and the cervix. Midwifes usually aren't allowed to deliver breech babies at the risk of losing their license, so most likely if baby is breech, a cesearean will be performed.

However, there are exercises that you can perform to encourage the baby to flip. A great website is http://www.spinningbabies.com/. I've also heard of some women having luck with chiropractors and acupuncture. If you're really adamant about avoiding a c-section, I would look into those as options also.

:thumbsup:

DoulaLyndsey
06-21-2006, 08:37 AM
I also wanted to mention that if the baby is flipping a lot towards the end of the pregnancy, they are a higher risk for cord entanglement. Not trying to scare you, but a baby that has an unstable lie I would like to see monitored more than normal to make sure s/he is tolerating the labor well.

bjc1050
06-21-2006, 09:50 AM
My daughter was born breech 39 years ago and was not delivered cesearean. She did fine...thanks to God and my doctor.

TwoLeftNeedles
06-21-2006, 09:59 AM
I delivered my first child naturally -- no drugs at all. It was the greatest experience of my life.

I delivered my second by quasi-emergency c-section (IUGR, needed to come out, wasn't tolerating induced labor). I was heartbroken that I didn't have a repeat of the fabulous experience I was looking forward to. However, it was absolutely necessary for the safety of my child, and I would make the same decision again.

I would certainly avoid a c-section if you can with reason. It's better for you and for baby to go through labor. If you can't, you can't, though, and that will be okay. You'll have done the best you could.

So I guess I'm saying not to marry yourself to one method of delivery or another. Take each day as it comes, and when the day comes to make the decision, use the circumstances at THAT time to do what is best for you and your child.

Julie
06-21-2006, 10:16 AM
If I were in the same situation, I'd be doing the exercises that Lyndsey posted about -- I know several people who successfully turned their babies that way. :D An external version was attempted on my sister immediately before labor and it didn't work...she went right for an emergncy C. She was much like the pp, first labor was short and intervention-free, second was stressful and full of every intervention known to man. Two healthy babies though :thumbsup:

Good luck, I hope she turns!! :D

skNYC
06-21-2006, 10:34 AM
It depends on how good your doctor is with versioning. My first one didn't turn until she was at 38 weeks and my doc didn't seem concern at my 36 checkup that she was breech. Then with my 2nd one I had a different doc, he was concern when he didn't turn at 32 weeks. But at 35 weeks, he turned. The doc was all ready for an inversion and so were we. Anyway, the usually the kids will turn themselves. Since you had experienc with late turners, I think things will work out. Even with invesion, the doc has sono to guide them, and they are all standby for a c-section if things don't go well. Good luck.

jamiejeans
06-21-2006, 10:40 AM
Hi Lisa Kay

Versions are not 100% successful. Some of the MD's I work with quote a success rate of approx 70% at best. And there is no way to keep a baby vertex once turned. I assisted in a version recently that was successful. About ten minutes later the baby turned to a transverse position.

Versions come with risks as well. Although I have not seen any personally, I have had once close call. This is how we perform them on my L&D unit:
1. Woman is placed on fetal monitor for approx 20-30 minutes.
2. An IV is placed for emergency purposes.
3. Ultrasound is done to confirm baby's position
4. Terbutaline is given by injection to prevent uterine irritability and contractions. A common side effect of this medication is feeling a slightly racing heart or palpitations, and sometimes the baby's heart rate will increase.
5. MD attempts version. The procedure looks very uncomfortable and I have had some women who can not complete the procedure. Just picture someone pushing on your abdomen with all their might.
6. Several attempts may be done, but usually after 3 attempts and baby has not turned, they call it a day.
7. Women then stays for another 30-60 minutes for continued monitoring.

The close call I did have was during a version attempt, the baby pressed up against it's cord and the heart rate went to the 50's and didn't recover for over a minute. Fortunately it did recover, but had the heart rate not recovered, the woman would have been rushed for an emergency c-section. But remember, I have been doing this type of nursing for 6 years and this was the only close call.

Even though breech vaginal delivery occured as a norm even 30 years ago, liability has pretty much necessitated c-sections. Vaginal breech births are tricky as someone mentioned early in regards to head entrapment. They do still occur but only because the baby is coming out no matter what! I recently had a birth that was breech that occured in the OR... we were rushing to do a c-section because the woman was fully dilated and breech. The baby came out on the OR table and did just fine! But you'll be hard pressed to find an MD who would do this willingly.

I personally would go for the version as it is generally safe and I would want a vaginal birth. It would be hard for me to accept having a c-section as that is not how I picture my birth experience, but I would want a safe birth regardless of route. And no matter what way the baby comes out, so long as all is well.... it's still a birth and a healthy baby!

Julie
06-21-2006, 12:34 PM
Just picture someone pushing on your abdomen with all their might.

My sister said it looked like something out of a sci-fi movie, all these people pushing and pulling her enormous belly. :roflhard:

knittingdoula
06-22-2006, 04:42 AM
Hi - I'm going to chime in here a bit with a couple of comments.

First, people seem to be offering their opinions, which is fine, as personal experience is certainly wonderful to share. No doubt.

However, what I think any woman who is pregnant and facing a decision needs is information based on RESEARCH, and not even necessarily what some people see doctors doing nowadays. Obstetricians are famous for ignoring the research in their field, no matter how voluminous, and simply going by tradition. Hence, you have still have women being denied food and drink during labor (and given reasons for this that have no basis in the literature), confined to bed, made to push in stirrups, continually monitored despite being low risk, etc. etc. It gets frustrating to see this time and time again. I just did a birth in LA and heard more obstetric myths in 4 hours than I had heard in 7 years of being a doula. It was so sad. Even sadder was that the staff actually believed what they were saying, despite overwhelming scientific evidence against them.

I wish, more than anything, that women were given more evidence based options. If you look at places like The Farm, run by Ina May Gaskin, she does breech births with decent frequency and does just fine. The problem with delivering vaginal breech births is more in the training of the doctors - a lot of old docs were trained, a lot of newer docs have not been, so there's a gap in experience there.

I'm going to quote to you from Henci Goer's book The Thinking Woman's Guide to a Better Birth. Henci is VERY well respected in the field of medical writing, and she is a lamaze educator and doula to boot. Her book sums up the research data on a host of pregnancy and birth-related issues.

"Numerous studies have shown that the changeover from mostly vaginal breech birth to nearly universal cesarean delivery didn't close the gap between breech and head-first outcomes." (p.32)

"Despite these facts, most US obstetricians today believe that the only safe breech delivery is an abdominal delivery, although as one author who recently reviewed the literature wrote, "The generally applied approach of cesarean to breech is not based on clinical facts." Authorities in other countries do not share this belief, and neither do a number of eminent American physicians .... These experts may debate who makes a good candidate for vaginal breech birth and how vaginal breech birth should be conducted, but they don't think every woman carrying a breech baby requires a cesarean." (p.33)

Goer cites that often, c-sec is done as the result of defensive medicine, hardly a "reason behind medical care decisions". (p. 34) Training, as I also said, is also a reason, though the skills can be learned.

Having said that, here are some options for those who are stuck in a system which advocates universal c-sec for the breech baby:

1. You can do home version, where you assume different positions to get the baby into an optimal position. I agree with the pp who mentioned spinningbabies.com. Excellent site. For more info on positions, check out Henci's book. Also anything by Penny Simkin, such as The Birth Partner or Pregnancy, Childbirth and the Newborn.

2. External cephalic version (ECV) is also an option, one that has been utilized by doctors and midwives alike, both in industrialized and non-industrialized nations, with varying degrees of technology. However, "Babies that don't want to turn should never be forced."

3. Consider hypnosis, which has a higher rate of turning than ECV studies. The study in question looked at 100 hypnotized women, and ultimately turned 80% of the babies. Hypnosis can calm fear and induce relaxation, which may be just what the baby needs.

4. Chinese medicine can help as well, using something called moxibustion, which uses heat from burning herbs instead of needles. A randomized study using moxibustion posted higher success rates than most ECV trials.

Studies have agreed that ECV is safe, as long as it is done gently. Compared to cesarean, it is definitely an option to explore before scheduling major abdominal surgery. Birth injuries from vaginal breech births, such as a broken collar bone or Erb's palsy can also occur during cesarean section, as can cuts to the baby from a scalpel. Injury to mother or baby can happen from both vaginal or cesarean birth, so the issue is not so clear cut. Goer notes that "Depending on the individual case, vaginal birth is as much a reasonable, responsible choice as is planned cesarean section."

The risk of head entrapment is rare, and I would be interested to see what the research data says regarding cord compression, Lyndsey. Is it common or rare? Goer makes only a brief reference to head entrapment, and none to cord compression as significant risks. This is important information to convey when discussing the various risks of any intervention with a woman. Sure, the thought of head entrapment is absolutely terrifying, but knowing that something is rare can be comforting when making an informed decision.

Ok, so there ya go!!! Hope this helps. Get ahold of Henci's book - it's fantastic. Also good is her other book, meant for practitioners, entitled Obstetric Myths, Research Realities, in which she analyzes all the date up to the date of publication of her book. She's writing a new edition of her book, and I can't wait to read it!

Above all, make your decision with an open heart, a clear head and a full stomach! No matter what, the birth of a baby is a beautiful and wondrous experience, and you deserve to be given all the information and support you need to make a comfortable and informed decision. Best of luck to you, and if you need me to blather on even more, PM me. :heart:

Alison

VickiIL
06-22-2006, 07:56 AM
I would try the exercises that were mentioned before. Also Chiropractors often have success in turning baby. I would try both of these options before a version or a c-section.

DoulaLyndsey
06-22-2006, 08:23 AM
The risk of head entrapment is rare, and I would be interested to see what the research data says regarding cord compression, Lyndsey. Is it common or rare?

It is very rare, I was just trying to point out reasons why doctors say they perform so many cesearans, I guess I should've been a little more clear :blush: . Truth is, the large majority of babies will turn to the head down position, but for the ones that don't, even though a breech birth may not be as risky as doctors make it out to be, you'll be hard pressed to find a doctor or midwife that will knowingly deliver a breech baby. Too much is at stake for them as far as malpractice and liability.

misstialouise
06-22-2006, 05:24 PM
I was born footling breech almost 31 years ago.

Down here most breech are C-Sect's without a question. There are still some doctors who will deliver breech naturally though... not many.

wildforyarn
06-22-2006, 08:38 PM
I had an external version with my first baby and it worked. I was 37 weeks and while I tried other home remedies to try and get him to flip, he stayed breech until the version. The risks that I remembered were that there is like a 70/30 percent chance that it works, it could cause you to go into labor, it is uncomfortable.

I had decided to give it a try and if I went into labor, so be it. They gave me a medicine to relax my muscles and they had three people doing it. They tried it once, and he did not want to move. They tried it again and he flipped super easily and stayed that way until birth. The whole experience was not bad for me at all. It was not painful, just uncomfortable. My DH thought it was neat because you could see totally the babies shape/outline of his body. And, he was amazed that you could actually do something like that. My doctor said they would only try it twice because they do not want to force the baby if he/she does not want to move.

I ended up with an emergency c-section, but that was not due to the version at all. I gave birth to my DS 5 weeks later after being in and out of labor for three days. Long story. Anyway, he is here, and healthy and five years old now.

I just wanted you to know of my experience. It was a pleasant one and it worked. I would just talk to you doctor, ask lots of questions about how they perform it and their routine. They should be keeping you after it for a while to check if you start to contract. I did start to contract, but they settled down and went away after about an hour.

Good luck with whatever you decide.

Lisa Kay
06-24-2006, 09:19 AM
Thanks for the info, everyone!

I'll keep you posted. Let's hope she's already turned on her own. :pray:

Lisa Kay
06-26-2006, 05:23 PM
Yeah! Time for a happy dance! :happydance:
Just had my 36 week appt., and the baby is now head down. Yippee! :cheering:

That was sure a relief to find out, and put a smile on my face for the rest of the day. Of course, I know from past experience that there's always the possibility of her turning breech again on me, but we'll just take it week by week and be happy that she's head down at the moment.

Thanks to all of you that gave web site and book suggestions. I've been checking out the web sites, and was able to find a few of the books to read. I certainly appreciate all of the input.

KristiMetz
06-26-2006, 10:12 PM
:cheering: :cheering: :cheering: :cheering: :cheering: :cheering: :cheering:

HollyP
06-26-2006, 10:15 PM
:happydance: What a relief! Hope she stays that way!

IrishBaby
06-27-2006, 08:12 AM
Glad she turned back! Start doing squats as often as possible (deep squats with legs wide apart, bottom a few inches above the ground), to encourage the baby to engage in the pelvis and stop flipping around. :)

butterflymama
06-27-2006, 10:36 AM
Both of my boys were late turners. Seems like as soon as I dealt with my uncertainties of labor they turned. LOL And boy, when big babies turn late, you know when they turn! :lol:

Yay for you and babe! :cheering:

Cristy
06-27-2006, 07:20 PM
YAY!!

I've been thinking of you...glad to hear things are good (so far!).

dustinac
06-27-2006, 09:15 PM
:cheering: thats wonderful!!!