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OB recommends repeat c/s for breech B?!?!! X-Post VBAC

post #1 of 42
Thread Starter 
Baby B flipped breech during my last ultrasound 2 weeks ago (33w) probably because I was on my BACK at the hospital for an HOUR. She has not flipped back vertex according to u/s today.

So now my doc is talking about ERC (elective repeat c/s) if she doesn't flip vertex. I knew that ERC was obstetric protocol for breech baby A, but why for baby B? He says that doing a version on baby B could be risky - possible cord entanglement or too much stress on the cesarean scar.

Is this justified? I know that his insurance provider does NOT cover breech delivery. He's been practicing long enough that he used to do breech until his insurance shut him down.

So, the way he couched it was that there's a lot of "controversy" and not good evidence to really support WHAT to do when baby B is breech in a VBACing mom. I'm not finding evidence to suggest that (1) breech B is a problem; (2) external version during "delivery" is contraindicated for VBAC. So, if he's unwilling to do vagi breech delivery, then I think we should (1) hope B follows her sister out head first; (2) turn her if she doesn't.

Advice? I'm kinda freaking out and of course am pretty pissed that someone else's crappy insurance is affecting my birth choices!!!! Oh, and that's on top of the baggage I have about having babies in the hospital.
post #2 of 42
honestly if it where me I would wait until I was well into labor with baby A almost crowning before going in. But I understand that isnt something you might be comfortable with.

Usually if A is head down most places I know have no problem with vaginal delivery.
post #3 of 42
Aww...that's really sad. To have this pulled on you at the last minute.

I don't know what I could do in that situation, sorry.
post #4 of 42
Thread Starter 
Quote:
Originally Posted by MCatLvrMom2A&X View Post
Usually if A is head down most places I know have no problem with vaginal delivery.
Well, that's what I thought. I'm quite confused. I wonder if calling a different provider with a good track record with VBAC and natural twin birth would be a good idea. Of course a 35w twin VBAC transfer ain't ideal for me, the babies, or a new provider. :
post #5 of 42
I don't know if you'd find anyone else to take you this late. My doctor was fine with breach B, but I ended up with a C-section anyways. If I were in your shoes and the babies came 36 weeks or later, I'd just go in like the PP said, almost crowning. I wish my babies had a vaginal delivery. They both came out with very wet lungs, and didn't have the benefit of steroid shots either. They weren't released from the NICU til almost 38 weeks and I think they could have been better off with the benefit of a vaginal delivery
post #6 of 42
yes, sounds like insurance issue. i would personally go in as late as possible and just refuse intervention unless it seemed necessary. a strong partner is always helpful.
post #7 of 42
Purely anecdotal, but I attended a twin HBAC where the second baby was breech and was turned using external version. Baby B flipped easily once A was out. PM me if you want to know more.

I had a HBAC with my first set of twins and my midwives were not concerned about breech and/or effect on the scar.
post #8 of 42
Als, I'm sure you know this, but it's not too late for B to turn. One of my twin girls flipped at 36 weeks after several chiro visits using the Webster technique. Don't give up hope!
post #9 of 42
Thread Starter 
I imagine it'd be pretty hard to switch providers at this point. "Luckily" I'll be 36 weeks next week... beyond the point where he can drop me. But it's sounding more and more like this suggestion to RCS for a breech B is not justified, which is what I thought. I'm really surprised, and therefore disappointed, that this would be his recommendation.

I have been working with a WT chiro the entire pregnancy. It's been so helpful for many things. I was way outa wack today - probably thanks to the emotional stress of this. I slept horribly last night.

Unfortunately HBAC isn't a viable option for me - couldn't possibly afford to bring in a traveling midwife.

Ugh, feeling like a caged animal.
post #10 of 42
Quote:
Originally Posted by labortrials View Post
Is this justified?
It looks to me that you have answered your own question:

Quote:
Originally Posted by labortrials View Post
I know that his insurance provider does NOT cover breech delivery. He's been practicing long enough that he used to do breech until his insurance shut him down.
Notice that the above sentences have nothing to do with:
  • your doctor lacking experience in breech deliveries
  • your particular pregnancy/labour
  • the health of your particular babies
post #11 of 42


There is a LOT of good evidence SUPPORTING vaginal breech delivery. Canada recently reversed it's stand on allowing breech vaginal birth in women without other risks. Now, if those risks include VBAC I'm not sure, but I doubt it.

I'm sorry! It's NOT too late to switch and it wouldn't hurt a darn thing to call around and ask.
post #12 of 42
Thread Starter 
Intertwined, you KNOW these US OBs don't give a rat's patootie what Canadian docs have decided. "Well that's Canada for ya!"

Novella, good points, but again, how much does that really matter? I live in quite a progressive community, but it's amazing how backassward the birth culture is here. Either you sign up for your epidural (according to the hospital, most women request an epi) or cesarean (our local c/s rate was 31% in 2006), or you're one of those "crazy" homebirthers. But thanks to state regulation, breech & twin births canNOT be attended by registered HB MWs.
post #13 of 42
Also anecdotal but I know a woman who had a HBAC and delivered B breech (A was vertex), Around here it seems that OBs tell us that they are fine with vaginal delivery of A vertex B breech but end up finding a "reason" to schedule a C if they can get you on board. Personally here I think it is because they don't have much experience delivering breech and it makes them nervous....it sounds like your provider has experience though so it is probably an insurance issue. My plan is to wait to go in as long as possible but there is no saying that they won't want me deliver B by Ceserian even if I vaginally deliver A.
post #14 of 42
Quote:
Originally Posted by labortrials View Post
[Novella, good points, but again, how much does that really matter? I live in quite a progressive community, but it's amazing how backassward the birth culture is here.
Hey there Labortrials, your feelings of futility are palpable and I'm sorry to hear you face such intense pressure as I did to have your healthcare wishes and bodily integrity respected.

"How much does that really matter?" Evidently, quite a bit to you. Otherwise, we would not have seen this post. If you were satisfied with begrudgingly settling for what your OB is serving up, you wouldn't have written seeking advice.

I guess it comes down to which demon you'd rather live with: accepting medical procedures you don't agree with, or having what could be a bitter fight that may continue right through the stress of labour. For me, it was more important to stand my ground and fight for what my husband and I really thought was the best birth, than beat myself up for years that I didn't persevere in that one opportunity I had to do so. You don't get a "re-do" option.
post #15 of 42
Quote:
Originally Posted by Novella View Post

I guess it comes down to which demon you'd rather live with: accepting medical procedures you don't agree with, or having what could be a bitter fight that may continue right through the stress of labour. For me, it was more important to stand my ground and fight for what my husband and I really thought was the best birth, than beat myself up for years that I didn't persevere in that one opportunity I had to do so. You don't get a "re-do" option.
ooooo - goosebumps!!! rings true to me to. i needed to know i'd done everything i possibly could to get the safest birth possible - then we have to surrender to outcome or be miserable. but if you're fought to get your rights you're more likely to be in a good mental state after birth than if you've felt abused and your carefully considered choices have been invalidated.

post #16 of 42
Thread Starter 
Quote:
Originally Posted by lilysmama1124 View Post
My plan is to wait to go in as long as possible but there is no saying that they won't want me deliver B by Ceserian even if I vaginally deliver A.
Yup, my thought exactly.

Quote:
Originally Posted by Novella View Post
"How much does that really matter?" Evidently, quite a bit to you. Otherwise, we would not have seen this post. If you were satisfied with begrudgingly settling for what your OB is serving up, you wouldn't have written seeking advice.

You don't get a "re-do" option.
The "how much does that really matter" was rhetorical. Well, actually, I'm not sure how much what matters to me matters to "The Tribe."

So true about the redo option. Thanks for reminding me of that!

Anyway, I'm starting to feel more confident about things. My babies are doing wonderfully well, and I trust that B will come out SOMEHOW. My intuition tells me that she'll hold onto her sister's ankles and come out head first. And she has time and room to move.
post #17 of 42
I think the issue is the doctor's liability with a planned vaginal breech. If his malpractice insurance point blank will not cover that under his general policy, it may be difficult if not impossible for him to get a special rider for this one instance. So now he has to consider the liability risk to himself and those that depend on him. If the standard of care for breech B is ECS, and he does not follow that standard of care, he has practically no legs to stand on if there is a bad outcome. I personally try to respect the position my decisions put other people in, but I think you should still go with the plan fits your family the best.
post #18 of 42
So what I don't understand about your doctor -- even a vertex twin B can flip to a breech presentation after Twin A makes his or her exit -- what would his malpractice insurance have him do then? Is this only a problem with how B presents at the start of labor?

It sounds like he's a good doctor -- has breech birth experience and was honest with you about why he can't do a breech birth. Can you talk with him more about what your options are? Will he be honest with you about what will happen in various circumstances? What happens if you refuse to consent to a C-section just because of a breech presentation?

I VBAC-ed my singleton & the hospital where I was originally going to go wanted an epidural in place in case something happened. I didn't want this & in talking it over with the midwife, her advice was to wait until the last minute and go in then. I so did *not* want to do that. Laboring in a car is uncomfortable enough without being in transition in the car, or risking birthing on the side of the road. Can you and your DH rent a hotel room near the hospital and labor there & go in when you're ready, if going in when you're nearly ready to push is an option?

Do you have a doula, and can you get one?

Sending you lots of turn baby, turn vibes!
post #19 of 42
Quote:
Originally Posted by rhiandmoi View Post
I personally try to respect the position my decisions put other people in. . .
Me too! And the person I would choose any day would be my baby over my doctor.
post #20 of 42
Quote:
Originally Posted by Novella View Post
Me too! And the person I would choose any day would be my baby over my doctor.
But I would tell my doctor that I'm sorry he couldn't be my doctor anymore vs. force him to take on a risk he's not comfortable with.
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