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Emmecat View Drop Down
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    Posted: 14 October 2010 at 7:47am

Ok so let me preempt this question by saying yes I realise this breech bubs of mine may still turn on her own, but I'm a planner and like to have a plan B in place, hence the question!

So, this baby girl is still bum down with her head up by my right rib. I am getting scanned on the 26th to see what kind of breech she is...we suspect footling or similar as I am getting kicked low down, but obviously a scan will tell us this, as well as her size. So in the next 10 days or so till then I plan to use the swiss ball, swim etc etc.

BUT, my two options after that (and taking into account trying acupunture and moxibustion etc from 35 weeks) are these:

1) Book an elective c-section for a certain date, most likely around 38, poss 39 weeks. My mw reccomends this option as my labour history (of 1 baby lol) shows I labour fast and hard and she is worried if we leave labour to start naturally then we might encounter serious problems.

2) allow labour to start naturally, knowing the above and take a 'see what happens' approach, also knowing that yes sometimes babies turn at the last minute. MW wants me to know under those circumstances I would need to be able to get to hospital at the first contraction, which I'd need to do anyway if bubs was right way up! But that we'd need to be really quick and also acknowledge that once in the delivery suite there would be every chance of an emergencey section. And I think they'd only let me have this option if the baby is in the full split breech position anyway?  Does that sound right? Think the mw said no way if the bubs is footling.

So, my question is- which option do you think you'd go with? I would obviously much prefer to birth 'naturally', mainly cos of the recovery period (I know how long it took me to get back on my feet after my emergency ab op earlier in the pregnancy!).  Also I am worried that if I have a c-section then BF will be much harder to establish, or even happen (although Clodagh is still BF so I guess that might help?)

I feel like I have to choose between 2 pretty sh*tty sounding  Plan B's TBH.  But would like to hear from more experienced Mums who might've had both types of births or just people who have different views on what they might do in this situation.

TIA



Edited by Emmecat

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freckle View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote freckle Quote  Post ReplyReply Direct Link To This Post Posted: 14 October 2010 at 8:03am
Hugs Emmecat! I will really cross my fingers she turns and you don't have to make this choice... I have never had a c/s so can't really comment on recovery etc... But if I was in your situation, and had a history of fast labour I would be inclined to go with option 1 I think... I think I would be so nervous that I'd take too long to get there and things progressing too quickly ... the first option sounds much safer to me and in the end the main thing is you are baby are safe...
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Kalimirella Quote  Post ReplyReply Direct Link To This Post Posted: 14 October 2010 at 8:16am
Depends on size too, I hope bridget from April thread comes talks in here. She had a not known breech baby in the ambulance on the way to hospital, need I add also a very quick labour!!
Her baby was only 5lbs though (perfect in every way just on the small side + full term) so that may have helped.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote newme Quote  Post ReplyReply Direct Link To This Post Posted: 14 October 2010 at 8:38am
A couple of tough options.

DS was breech and I had an elective c-section. BF was not a problem at all, we had skin to skin within 20 minutes or so and BF straight away...and I fed him until he was 22 months. So I wouldn't worry about that aspect of it.

From the two options you have put up, I would go for option 1. Simply because I would prefer the certainty of knowing what was going to happen.

My recovery from an elective c-section was pretty easy. I was up and about later the same day and off pain relief. It was a pain not being able to drive etc. I think recovery from an elective is easier than an emergency c-section. However, I am definately going for a home vbac this time!

Is ECV an option? If the baby is in footling breech, and as it is your 2nd pregnancy it may very well be successful?
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Post Options Post Options   Thanks (0) Thanks(0)   Quote weegee Quote  Post ReplyReply Direct Link To This Post Posted: 14 October 2010 at 9:39am
I'd pick option 2 all the way. Addie turned by herself (with the help of homeopathic pulsatilla and bowen therapy) at almost 40 weeks, btw

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Post Options Post Options   Thanks (0) Thanks(0)   Quote kebakat Quote  Post ReplyReply Direct Link To This Post Posted: 14 October 2010 at 10:09am
Option 1 for the safety of you and bubs. If I laboured very quickly and it was urgent I got to hospital immediately under normal circumstances I wouldn't wanna complicate things with adding a breech birth to that.

I also wondered about ecv?
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Post Options Post Options   Thanks (0) Thanks(0)   Quote fire_engine Quote  Post ReplyReply Direct Link To This Post Posted: 14 October 2010 at 10:11am
Are you going to try an ECV? How far are you from the hospital?

If it's breech and in good position (with chin down and not footling breech), then I'd probably try for a vag birth (assuming your first was a vag birth) but it's easy for me to say
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Post Options Post Options   Thanks (0) Thanks(0)   Quote fadeless Quote  Post ReplyReply Direct Link To This Post Posted: 14 October 2010 at 10:39am
I'd go with #2, i have had an emergency c/s and went on to have 4 Vbacs with my last baby he was 2lbs heavier than my c/s bubs. The c/s wasnt bad but i'd hate to have a c/s with older children, i found it very hard doing things after i had DD and she was the only 1 i had to deal with. Its a choice you have to be comfortable and positive about, good luck and sending you head down vibes!!

Edited by fadeless
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I'd go with number 2, I guess, though I can understand you not feeling entirely happy with either option.

Even though we had no idea just how quickly DD2 would end up coming, I still stipulated that if she was known breech we would still be staying home - my mw's proviso was that she have her second mw there from the word go (rather than showing up later) as she had experience with catching breech babies and my primary mw hadn't.

Remember, do what YOU are happiest with, and you can say no to any thing (process or procedure) at any time if you are too uncomfortable with it.

Edited by HippyMama
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Post Options Post Options   Thanks (0) Thanks(0)   Quote EmDee Quote  Post ReplyReply Direct Link To This Post Posted: 14 October 2010 at 11:48am
I'd go with option 2. I had to consider it with Caleb, though he turned by himself thankfully around 34 or 35 weeks. For me, my mw was very confident that I could do a breech birth after 2 straight forward VBs and her confidence helped me gain confidence.

All the best with your decision, and I hope she turns for you so you don't have to worry about it anyway
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Emmecat Quote  Post ReplyReply Direct Link To This Post Posted: 14 October 2010 at 12:33pm

I so appreciate your repsonse so far.  The answers to a few of your questions are:

  • We live at least 30 minutes drive from Wellington hospital...and thats not accounting for peak hour traffic.
  • DF will most likely be at work if I go into labour during the day and as a courier covering the greater Wgtn region, may well take a good while to get home. SO I will either be on my own or my Mum may be with me if she can come down and stay with us, however she's a little prone to panicking iykwim?
  • Clodagh was an ambulance trip to hospital due to the sudden & hard onset of labour, although she was born in hospital (I also had bleeding when my waters broke).
  • ECV is an option; I am concerned  about the pain involved (call me shallow ) and also the danger of complications ie something going wrong during the procedure which may lead to an EARLY emergancy c-section, or worse, the cord getting caught or something (Clodagh's was wrapped around her neck a few times at birth so am a bit worried about that).

edited to add- my mw is wonderful, I have full confidence in her and she seems the right amount of 'crunchy' and medical-type person for me lol. She is not confident about birthing breech babes vaginally at all though,  not just her, but anyone doing it in general I mean. Before we found out bubs was breech, we had a hypnobirthing water birth planned and she was well into it. And her first suggestions at turning babe incl acupuncture and moxibustion so she's def not just a 'cut it out' kind of peraon...which make me kind of believe her when she says birthing breech is more dangerous unless certain circumstances are met (my health, 2nd preg, babes position etc). She's not panicking or making me worried, all this is ME getting worried on my own lol).



Edited by Emmecat

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Post Options Post Options   Thanks (0) Thanks(0)   Quote freckle Quote  Post ReplyReply Direct Link To This Post Posted: 14 October 2010 at 1:16pm
You sound like you trust your MW and therefore, I would be inclined to listen to her and take her advice - she is the medical professional and has much more experience with birth than any of us ... I would just try and focus on doing what you can to facilitate baby turning and try not to stress too much at this stage...
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Post Options Post Options   Thanks (0) Thanks(0)   Quote fire_engine Quote  Post ReplyReply Direct Link To This Post Posted: 14 October 2010 at 1:17pm
TBH, the thing that would make me hesitate most is the MW. If she was experienced in breech, then that's one thing but if she's not confident then I would wonder if that would make you more likely to end up CSed anyway IYKWIM?

With the ECV, it might be worth talking with the OB about the risks/benefits of the ECV vs. risks/benefits of attempt at vag breech birth vs. risks/benefits of elective CS. Can your MW book you in to see the OB who is relatively OK with vag breech births?

Remember there's always the option that weegee had but didn't need - book in for an elective. when under epidural, then have a go at ECV .....
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Post Options Post Options   Thanks (0) Thanks(0)   Quote MyLilSquishy Quote  Post ReplyReply Direct Link To This Post Posted: 14 October 2010 at 1:25pm
DS was a footling breech and had a total of about 10 days head down. his head was under my left rib andhis left foot was engaged with his right foot sitcking out.



I had 3 ECVs (2x one day another a week later) and they HURT but I was wanting to try everything I could. also tried homeopathic pills and yoga and lying upside down with my butt on the couch amoung other things to try and turn him. the pain of the ECVs dissapates very quickly though... half an hour later and pain was gone.



I would suggest #1. (plan an ECS) because I would much rather have it planned and calm with DP there and 'nothing to worry about' rather than needing it in an emergency because you wanted to wait and see. also if you labour too fast to actually make it to the hospital and into surgery, and your boy is breech, you risk him coming out with one foot, other up and potentially 'get stuck' or break his hips (not saying it WILL happen but its a real risk)


also like being able to say to people (spesh family) "this is when its happening. we want this long. you can come at this time" and knowing that DP could book the time off work ahead so the he was 100% there and not late arriving because of traffic or is he couldnt be reached etc.



my MW is a trained nurse and is confident anough with breech babies... but advised against it (especially in my case with him as a footling breech). we had a water birth planned and was wanting to be home within a few hours. she had a huge range of suggestions because she prefers to try everything before 'cut it out' becomes an option.




alost just re-read your questions ...

When you plan an ECV, they make sure that there is a minimum of 1 OR free incase something goes wrong, they have you hooked up to the external feotal monitor and as I am A- blood type, i got an injection of Anti D afterwards JIC.


also while the ECV hurt, it was more like when someone gives you a back massage and they are rough iygwim? but none of mine worked because of the position of my placenta changed the shape of my uterus - went from being an inverted triangle to a rectangle so he had no where to go lol. but he didnt even move half an inch. stubborn little man!


feel free to PM me... but my suggestion is unequivocally to plan an elective CS. (more relaxed and you can make sure the people you want to be there are there)
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Post Options Post Options   Thanks (0) Thanks(0)   Quote fire_engine Quote  Post ReplyReply Direct Link To This Post Posted: 14 October 2010 at 1:39pm
Originally posted by freckle freckle wrote:

You sound like you trust your MW and therefore, I would be inclined to listen to her and take her advice - she is the medical professional and has much more experience with birth than any of us ... I would just try and focus on doing what you can to facilitate baby turning and try not to stress too much at this stage...


Fair point Freckle, and remember those of us who are pro #2 haven't birthed breech babies (I'm pretty sure)
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Post Options Post Options   Thanks (0) Thanks(0)   Quote HippyMama Quote  Post ReplyReply Direct Link To This Post Posted: 14 October 2010 at 1:59pm
I thought I'd dig out my copy of Breech Birth, Woman-Wise and throw a few excerpts out there as I follow this discussion, and hopefully some of it will be helpful.

Originally posted by Maggie Banks Maggie Banks wrote:



p. 21

There have been no prospective trials large enough to demonstrate any excess perinatal mortality risk for breech babies when a trial of vaginal delivery is attempted. The excess risk of 1:300 is therefore a calculation being noted as statistically nonsignificant.



There is also a very useful, albeit large section on exercises and other remedies that may be helpful in turning a breech baby, including the use of pulsatilla, hypnosis, acupuncture and chiropractic manipulation.

This is a snippet of what she has to say on the ECV maneuver:

Originally posted by Maggie Banks Maggie Banks wrote:


p. 43

Prior to attempting to turn the baby:

* The woman should be thoroughly happy with the procedure being attempted. Relaxation is essential to the success of the ECV.

* The midwife needs to have excluded that the placenta is low lying.

* The woman's abdomen should be palpated to ensure that the baby is still breech, to assess engagement liquor volume and uterine tightenings.

* If there is any doubt as to the baby's presentation still being breech a second opinion or ultrasound scan should be sought.

p. 46

If all attempts to encourage the breech baby into a cephalic presentation have been unsuccessful, there needs to be a point where one accepts that the baby's intention is to remain in a breech presentation. Each woman will reach her own end point for deciding when that point is."


I also found this section quite poignant given your comment on your mum's tendency to become a bit panicky (even though it is written in the context of the woman-midwife relationship):

Originally posted by Maggie Banks Maggie Banks wrote:


p. 54

Impact of fear on labour

Fear filled language can be used which has a powerful impact on birth by increasing anxiety for both the woman an the birth attendant.

... and ...

Kassel surveyed twenty one midwives who support women to give birth normally to their breech babies. Overwhelmingly these midwives saw breech birth not as high risk" but as requiring special and extra considerations. Most felt that it is the fear of breech birth in our socieities that posed any additional risk. This fear factor requires the mother to be more vigilant in her mental preparation.


There is also an excellent section (easy to read / well written) on the technical aspects of when a woman is actually in labour with a breech baby, with bits that are helpful for both the woman and the midwife - if there is anything in that particular area that you would like to know more about I can always re-read that chapter properly for you and pass the info on (ie: too many for me to choose from!).

Although, in talking to other women who have birthed breech babies, it is echoed in this book one very important thing to remember:

Originally posted by Maggie Banks Maggie Banks wrote:


p. 82

As with any birth there should be no touching of the baby as the woman gives birth unless absolutely necessary. The old midwifery adage hands off the breech unless there is a complication should be constantly playing in the midwife's mind until the nape of the neck is seen.



And last but not least, on caring for a breech-birthed bubba immediately after 'exit'

Originally posted by Maggie Banks Maggie Banks wrote:


p. 85

Should supportive measures be needed this can be done with the baby in the mother's arms requiring no separation from her unless the baby requires extensive resuscitation. The mother plays a vital role in "calling her baby in" telling him how please she is to see himand how beautiful he is. It will be an instinctive action for her not to take her eyes off the baby. In the meanwhile the baby has the continued support with the cord still intact, beating and providing oxygenation. If it has stopped beating it may restart later. The baby will be kept warm next to his mother and if necessary hot water bottles can be used.



I do apologise as I know this will be a lot of information to absorb, and I'm not trying to judge you or tell you what to do at all, but I just wanted to put the information out there as it was something I too had concerns over with DD2 and ended up extensively researching and discussing with my midwife.
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Remember, you are not managing an inconvenience; You are raising a human being. ~ Kittie Franz

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I would probably go with option one, an elective is so much easier to recover from than an emergency Section(from experience).
I myself wouldnt not feel comfortable trying to birth a breech baby, especially if I had the history of fast hrd labours.

BF will be totally fine! My milk came in on day 3 both times and you will still be able to feed both girls, just gotta make sure C doesnt lean on your CS scar.

But definitely dont stress at this stage, Caden was breech at 35 weeks and he turned I felt it!!!!! Just do all you can to get her to turn, scrub the floor, crawl around, swim!!!
*hugs*

Edited by Sheza

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Post Options Post Options   Thanks (0) Thanks(0)   Quote Emmecat Quote  Post ReplyReply Direct Link To This Post Posted: 14 October 2010 at 2:40pm

Wow I really appreciate all your input ladies, it's good to hear different accounts and both sides of the story.

Hippymama- that book sounds awesome and I completely agree with the fear thing & labour, the only thing is that my mw is NOT comfortable birthing breech babies, nor the idea in general...and she really is not the hard ass medical type either, she's not as lefty crunchy as I could've found I guess but she's def very open to those sort of ideas iykwim (as I am hehe  ). she said there's only one obstertrician in Wgtn (not the Hutt) who will attempt a breech vaginal birth...and I'd have to meet all the criteria. I know I meet at least one, in that it's my 2nd bubba. But it'd also have to be a split breech. Soooo I guess I'm kind of stuck on my Plan B until we have the scan.  Which is hard cos I really am a planner lol.  I don't care about how the baby coems out really, it;s not like I'm the type to feel incomplete if I don't get a vaginal birth (maybe cos I've had one?)...it's totally about the recovery aspect and the BF. I would be GUTTED if something went wrong and I couldn't BF.  But then putting it in persective, I would be more gutted obviously if something went wrong with bubs cos of my indecision.


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Emmecat View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Emmecat Quote  Post ReplyReply Direct Link To This Post Posted: 14 October 2010 at 2:42pm
Oh and just thought I'd add, it's cool that so many breech bubs have turned at the last minute....but that's the crux of my problem....they're not gonna 'let' me go that long unless I put my foot down and say Lets See What Happens.....otherwise they'll book me in for a section about 38 weeks cos of my labour history.

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Post Options Post Options   Thanks (0) Thanks(0)   Quote fire_engine Quote  Post ReplyReply Direct Link To This Post Posted: 14 October 2010 at 2:45pm
Damned crystal ball, where did I leave it.

Sorry EC - rock | hard place? When's the latest you can make up your mind? Can you say to your MW at 37 weeks, yes, I've decided I will have a CS or do they want you to commit. Given the # that seem to turn late, I'd be tempted to leave committing for as long as possible.
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