Need some advice/perspective/support- I'll take anything! LONG!

[LarsMal]

I haven't been on the boards for very long, but from what I've read, there is some great advice/perspective to be gained from you all! I'll try to make this as concise as possible, but it's going to be pretty long:

Today I went for my 36 week visit- first internal. I was so excited when my OB said DD's head was down and she could feel the fontanel (sp?). I said- Oh great, she turned! Then my OB's face dropped. She looked at me and said- Don't do that to me, now I need to double check. (DD has been sitting breech since my 20 week sono.) My OB grabs the sono machine and NOPE, DD is still breech. According to my OB, DD has a nice fontanel in her behind :-) At least she tried to make light of her little mistake!

So, I was prepared to discuss the possibility of a C-section today since DD has been breech for so long. What I wasn't expecting was that my fluids are adequate, but not great, and my placenta is partly in front and wrapping around. What this means, according to my OB, is that an ECV (where they try to turn the baby while doing a sono) is a bit more risky.

Basically she told me I have three options (well, 4 if I just want to wait it out, but she doesn't think that's very safe right now.)

1) Have the ECV soon to turn DD, but not deliver
Risk: It's painful with no epidural
Also, if something goes wrong, I would have to have an emergency c-section, and have general anesthesia AND DD's lungs might not be quite ready

2) Wait a couple weeks and have the ECV then and have an epidural for it, and if it doesn't work go straight to a C-section
Risk: DD might be too big by then, and with my lower fluid level and placenta where it is, it might not work anyway- or I could still end up with an emergency C-section.

3) Just plan the c-section and not even try to turn her.

Ugh...I just don't know what to do. My OB wants me to have another sono soon to determine DD's size and my fluid levels, and go from there. DH and my mom think I'm making too much of this and should just schedule the C, but a big part of me wants to give it a shot (especially since we plan on having one more). I certainly don't want to put DD in harm, but if there is a chance it could work and I could avoid surgery, I would definitely prefer that.

HELP!!! I just don't know what to do...

[KBecks]

I have little experience, but will share anyway since you'll take anything. :)

My experience is having two planned c-sections after having prior utering surgery for mega-fibroid removal. So a vaginal birth was never an option, although if I had the opportunity, I would have wanted to try it, and possibly unmedicated too.

As you've said, at 36 weeks the lungs may or may not be mature. That's kind of a concern, as I wouldn't want to risk an immediate trip to the NICU for lung issues if you can avoid it. I think it would be nicer to hold your baby after the birth, you know? I don't *think* the lungs would be a big problem at 36 weeks, but why go there if you don't have to?

I guess option #2 sounds interesting -- does waiting mean -- waiting until you are in labor? I think that an "emergency" c-section really means having a c/s after you've gone through the exhaustion etc of labor. So would they wait until you are in labor and have the epidural to do the turning, or would they do it before you are in labor? Does that make sense? I guess I would also avoid having the "emergency" c-section if you can avoid it -- because being under general anesthesia for the birth seems not so great either -- same thing about holding the baby after the birth.

And I want to reassure you that if you choose option 3, a planned c-section, at least in my experience, it was not terrible at all. Let me know if you have any questions about details about my planned c/s experiences.

Good luck with whatever plan it ends up being!

[brittone2]

nak-
For low intervention ideas, check out www.spinningbabies.com for suggestions on ways you might work on trying to get her to turn. Also, a chiropractor certified in the Webster technique may be able to help. The sooner the better...36/37 weeks is a good time to try. Moxibustion has also been shown to help (there have actually been some decent studies done on it) turn babies. It is worth a shot IMO.

Good luck :)

[LarsMal]

Waiting just means waiting until I'm 38 weeks, not trying to turn her sooner, giving her lungs a little more time to develop. I was induced at 38 weeks with DS because my fluids were low. I was afraid that might happen again.

If I waited until 38 weeks I would have the epidural, they would try to turn her and if it didn't work I'd go into have the C-section, or if something went wrong I'd already have the epidural in, so I wouldn't need general anasthesia (make sense). The "emergency" c-section would happen if they tried to turn her sooner- like next week, and something went wrong and they had to rush me in for the surgery.

I guess my biggest fear is the recovery (trying to recover, take care of DD, and 16 month old DS). What was your recover like?

[hillview]

Hummm ... I had an "emergency c-section" after 20 hours of labor, I was pretty tired and stressed. If I had thought that was what I'd have ended up doing I'd have just had a scheduled c-section! I would do whatever is safest for you and DD. Option 2 or 3 seem best. A c-section wasn't how I planned to deliver (I had a doula and was all about trying un medicated) but it turned out fine and I got to stay in the hospital a little longer!

Good luck!
/hillary

[megs4413]

ditto to brittone's suggestions. this is what i was going to suggest...

my advice would be try any and all other possibilities first (i have heard some people have luck with accupuncture) to get the baby to turn and also wait until 38 wks to have the external version done with epidural. i wouldn't do a version now cause the lungs could still be iffy at this point and you don't medically need the baby out yet...(for the flow fluids).

i'm sorry you're going through this...it must be incredibly stressful! i'm sending turn-baby-turn vibes! let us know what you end up doing!

[table4three]

Well, my son was born at approx 36 weeks by emergency c-section and his lungs weren't ready. He spent almost 2 weeks in the NICU. So, I think the chance of needing a c/s at 36 weeks because of an ECV gone wrong can be risky.

Good luck deciding what will be best for you.

[wencit]

My personal opinion is that a healthy baby trumps all, whether you deliver vaginally or by C-section. For that reason alone, I would go with the planned C-section, but I would also give the spinning babies stuff a shot beforehand and hope that your DD turns naturally. It's an incredibly difficult decision, no matter what you choose.

>I guess my biggest fear is the recovery (trying to recover,
>take care of DD, and 16 month old DS). What was your recover
>like?

I had a C-section after 24 hours of labor with my son and failure to progress. Granted, I didn't have another child to take care of after he was born, but I can honestly say that learning to breastfeed was much harder for me than recovering from the C-section! By the 2-week mark postpartum, I felt back to about 90% of my pre-baby self. Of course, everyone is different, but that was my experience. It really helps if you have some kind of support system lined up. Do you have any family or friends nearby that could possibly help out?

Good luck!

[SnuggleBuggles]

1) Have the ECV soon to turn DD, but not deliver
Risk: It's painful with no epidural
Also, if something goes wrong, I would have to have an emergency c-section, and have general anesthesia AND DD's lungs might not be quite ready

*It doesn't always hurt. SOmetimes baby is very compliant and the baby just turns with little force. They can also offer a muscle relaxer to make it a bit more comfortable. Compare the pain of the 5-10 minute procedure vs weeks of surgery recovery.

*Ask her how hard she will try to rotate dd. It may be that she will only try hard if everything looks ideal so as not to increase the c-section risk.


2) Wait a couple weeks and have the ECV then and have an epidural for it, and if it doesn't work go straight to a C-section
Risk: DD might be too big by then, and with my lower fluid level and placenta where it is, it might not work anyway- or I could still end up with an emergency C-section.

*Choosing an ECV is always going to have risks and benefits. So does surgery. So does waiting. It's all complicated and it is all a matter of picking the risks you feel comfortable with.

3) Just plan the c-section and not even try to turn her.

That is indeed an option.

Ugh...I just don't know what to do. My OB wants me to have another sono soon to determine DD's size and my fluid levels, and go from there. DH and my mom think I'm making too much of this and should just schedule the C, but a big part of me wants to give it a shot (especially since we plan on having one more). I certainly don't want to put DD in harm, but if there is a chance it could work and I could avoid surgery, I would definitely prefer that.


*I wouldn't factor baby's size into the equation. You have given birth before so you have a "proven pelvis." Until you are in labor with a well positioned baby you or your DR. (or anyone else) has no idea how big of a baby you can safely birth,

You are right to consider the birth options for #2- VBACs are getting harder and harder to come by so you will be limiting your possibilities for next time.

Drink plenty of water to keep your fluid up- they are related.


Option 4...

What kind of breech position is she in? Provided it isn't footling why not just try and wait it out? See what happens and go into labor naturally. A c-section at that point would not be an emergency situation.

Pros would be that you give her ample time to turn on her own and you will be sure she is ready since she will have initiated labor. Some babies have been known to turn even hours before the mom is due to have a c-section (heck, I heard one mom say that the baby turned even closer to the surgery than that).


Option #5- try all the different things you can on your own. Go visit a chiropractor for the Webster technique. It can be as effective as an ECV without the risks so it is probably the very first thing I would try.

ETA- I too read a study more recently that said that moxi...(can't spell, it's in the links) has a really good track record.
This is one of the best all inclusive links I have found. It discusses ECV and things you can do to turn the baby. Check it out:
http://www.mother-care.ca/breech.htm

Just information and encouragement:
http://www.spinningbabies.com/
http://www.breechbabies.com/
http://www.radmid.demon.co.uk/presentation.htm


Beth

ETA also- check out maternitywise.org. It really lays out the risks/ benefits of c-sections and vaginal births. It is very neutral and helpful.

[KBecks]

I had great recoveries to all 3 surgeries, but everyone is different. My healing was great. A 4-day hospital stay is quite long and I felt too cooped up, but you're taken care of after surgery. After you come home, you'll need help. DH stayed home for a half-week, then I was by myself with the kids and we did it, I was really nervous but it worked out. I would recommend more help if you can get it.

I thing giving the lungs more time is important. Again good luck!

[ellies mom]

My DD was a footling breech. We did an ECV close to 38 weeks. She did not turn. They offered to schedule the c-section around just after 39 weeks and try the ECV again, performing the c-section if she didn't turn. I think they were going to induce if she did.

After the first ECV, I decided to go straight for the scheduled c-section. But, if you have the option to do what my doctors offered, that would give you two chances to turn her.

[daniele_ut]

>If I waited until 38 weeks I would have the epidural, they
>would try to turn her and if it didn't work I'd go into have
>the C-section, or if something went wrong I'd already have the
>epidural in, so I wouldn't need general anasthesia (make
>sense). The "emergency" c-section would happen if they tried
>to turn her sooner- like next week, and something went wrong
>and they had to rush me in for the surgery.

I found myself in a very similar situation when I was pregnant with DS. At 36 weeks 3 days he was frank breech, as he had been from 25 weeks on, but I had my first internal and found out that I was already 4.5cm dilated. I had been planning a VBAC, so we discussed the probability of whether labor would be imminent. My doc thought I wouldn't go much longer, so his opinion was that we should schedule ECV for the next day in the OR with an epidural. If it failed, then I would schedule a c-section for 39 weeks, though he thought I wouldn't make it that long. If it was successful I would wait for labor to start. If anything went wrong during the ECV, which has a pretty low risk of complications, then he'd deliver DS. We made the appointment, but in the end the choice was taken away from me. I went into labor at 3am before my 8am appointment and when I got the the hospital my fluid was less than 5, making ECV too risky. I was in active labor and had progressed to a 6, but they tried to stop my labor anyway, which didn't work. My doc felt that with the low fluid level that DS needed to be delivered regardless, so I had a c-section at 6:30 that morning. DS's lungs weren't developed fully and he ended up spending 3 weeks in the NICU, receiving surfactant treatment.

Frankly, I wouldn't do ECV at 36 weeks unless you knew labor was imminent, given our experience with Respiratory Distress at 36 weeks. If there was some other reason the doc was inclined to induce at that early stage, then I might consider it. The other risk with performing ECV that early is the chance that baby will turn back before labor starts.

If I were in your position, I would wait until 38 weeks to see if the baby decides to turn on her own. If she doesn't, then schedule the ECV. If that doesn't work, then schedule the c-section.

My recovery from my second c-section was relatively easy, but I did have 3 weeks at home with my baby in the hospital, so it was definitely affected by that. I didn't get any more sleep, honestly, because I was at the hospital and pumping around the clock, but I did have a lot of help with DS. I also didn't have a toddler to care for.

Good luck with everything!!!

[oliviasmomma]

As far as recovery, I didn't think it was bad at all. DD was footling breech, and I have a bicornuate uterus, so trying to turn her was not an option (no room). I was going to have a scheduled c-section, but my water broke a week earlier. I think it was much easier than it would have been if I'd labored for hours beforehand. I think doing both must put a lot of stress on your body (but if it had been an option for me I would have!) I would wait, then try to turn at 38 weeks--the baby might turn by then anyway. There are some non-invasive turning options out there that you could try in the meantime.

All in all, I think the c-section recovery is not too hard--although my MIL said the gas pains were worse than any labor pains she ever had. #5 out of 6 was a c-section and she said when the pain started, she called the nurse because she was sure she was going into labor again, lol! Oh, I'd avoid an "emergency" cs if at all possible, from what I know, they do the vertical incision which has a longer recovery time. My incision is horozontal and barely visible.

[ShanaMama]

Have you considered the option of steriod shots? These are given at some point during the pregnancy to 'bolster' the baby's lungs if you are anticipating a possible preemie. Do keep in mind that baby will be a newborn during the winter, & your 16 mo will be trailing germs in & out if s/he is in any type of daycare situation.

I haven't seen anyone mention the shots & I know ppl here are more experienced than I am... so maybe you're already past the window. Not too sure, but good luck with your decision.

[lizajane]

if it were me, i would schedule the c-section. in my un-researched opinion, it seems the saftest option. and the risk of am emergency c-section seems high. i would hate to go through a lot of stress and then require the emergency c-section.

BUT that is just my "what would you do." i have not BTDT to share.

[Tondi G]

Before you do an ECV have a look around in your area and see if you can find an acupuncturist who can do Moxibustion for you! I know someone who had it done when her baby was breech and nothing else had worked to get the baby to turn. It worked for her!

I was facing an induction and went to see my acupuncturist. After the second visit (2 days before my OB wanted to induce me) I got home and was spotting.... my little guy came the next morning! My chiropractors wife also saw her and the baby came a day later! I really believe in acupuncture!

If you try the spinningbabies stuff and moxibustion and baby still doesn't turn then I'd go ahead and schedule the c-section, but for after 38 weeks.... wouldn't want to risk lung issues!

Good luck and keep us posted!

~Tondi

[denna]

I agree w/ brittone and megs. I was going to suggest accupuncture too. MIL is an accupunturist that specializes in pre-natal accupunture, she helps in these situations all the time.

No BTDT C-section experience but I did have DS at 38 weeks. He was very healthy, weighing in at 7lbs on the dot and 21in long. No medical problems at all.

IMO I would go w/ option #2 and try what you can in the mean time to turn the baby. Trying this now at 36 weeks is not worth the risk.

Good luck w/ this decision and keep us updated.

[LarsMal]

Thanks to everyone for their advice and great website recs. I am going to give some of the at-home suggestions a shot and see if anything works.

We have opted out of #1- not worth the risk

As of now I have a sono scheduled for next week. If my fluid levels are good and she still hasn't turned I am going to try the ECV on Jan. 3rd. They'll do it in the OR and if it works, great, they'll induce me for labor, and if it doesn't I'll have the c-section right then and there.

If my levels don't look good next Wed., and DD is still breech, I will have to be scheduled for a c-section next Thurs. or Friday (or even that day if they are really low).

So either way, she'll be here in two weeks at the latest. AHHHHH!!!!

Think "turn, turn, turn"!

[JoyNChrist]

I'm glad you've found a decision that you're comfortable with.

Sending lots of "turning vibes" your way!

And either way, you get to meet your new little girl really soon - how exciting!

[youngmommy]

Please try going to a chiro right away. I'm sure spinningbabies also has some good suggestions.

[denna]

Great! That is so good to hear. Sending ((TURN)) your way!

Good luck,

Denna

[psophia17]

I didn't see this thread before today, but DS2 was breech until 36ish weeks, when I did inversions to turn him (per the spinning babies website).

Here's a diagram I posted at the preggo board, to show what I did:
http://209.85.48.10/8918/62/upload/p2964966.jpg

I did it for half an hour or so every other day for a week, and I stopped when I knew for sure DS2 had turned - I could feel a big difference when his head was up top than when his bum was up top.

[KBecks]

Side note, my incision is vertical and the recovery wasn't bad, (but I'm one tough cookie). The scar is pretty noticeable though.

[blueeyedb]

Like pp, I did inversions with my breech DS and he turned on his own. They are a bit annoying, but not painful or harmful to the baby, so it might be worth a shot. Good luck and I'm sending many, many turn vibes your way!

[LarsMal]

That is a great diagram! I particularly like your advice for big boobs!!! I have been reading about that- what was it called "slant board" or something- but I couldn't really understand it fully in words alone. I will definitely have to try it now that I can see a picture of it. Hopefully it will work!

[Fairy]

Without reading the other posts, my advice to you is to just have the c/s. I don't think it's a big deal, but that's just me. I was in the same position, DS was breach, but I had other complications that required a c/s; it's not possible for me to deliver vaginally (trust me, it truly isn't possible). Now, we didn't know that the c/s would be truly required until that 38 week or so point, we just knew it was likely. There are alot of benefits to a c/s, like not having that big ole swollen peepee and alot less bleeding. However, there are pros and cons to everything, and a c/s is real surgery, so there's a longer recovery time. BUT you get to stay in the hospital longer!

Turning the baby can be a nasty business when it comes to pain, and the stress you're undergoing right now? If you just schedule the c/s, at least you know what you're gonna do.

Whatever you decide to do, good luck!