Refuse to schedule c-section

[ncavillones]

I'm 35 weeks pregnant with my second child, who was presenting breech at my 34 week check-up. At that appointment, the OB and I talked about my options. My first daughter was also breech, and I had a scheduled section at 39 weeks. We didn't know she was breech until 37 weeks and I didn't really know what my options were until it was too late!
One of the things I learned, after the fact, was that going into labor can turn a breech baby. When my OB and I were discussing options for this baby, should it remain breech, I asked if I could wait to go into labor and she gave me a whole shpiel about why it was better to have a scheduled section, and her reasons were reasonable enough. The hospital, like most hospitals, has a no-breech-delivery policy, so if the baby doesn't turn even after I go into labor, I'm having another section. But my question is this:

Can I refuse to schedule a section and say that I want to go into labor on my own first? Or, if they insist on scheduling the section, can I just not show up for it? How do I handle this? Has anyone done this? I really like the practice (it's midwives and OBs, I primarily see the midwives.)

Thanks!

[MCatLvrMom2A&X]

You can refuse anything. They cannot drop you just because you refuse to schedule a section right this minute. Tell them that you want to wait till closer till your due date then keep putting it off.

[HollyRhea]

This can be difficult, depending on the climate in your hospital. As a doula, I always inform my clients of the benefits of waiting until labor begins on its own. Not just because the contractions can help turn a breech (though not too common), but because of the benefits to the baby. You'll know for sure that baby is as ready as he/she can be, the contractions and hormonal sequence help the baby prepare for extra-uterine life, etc.

That being said, I've had a few clients successfully convince their care providers that this is the way they will go. It's always fun to see the nurses' faces when they hear that it's a known breech and the doctor/midwife gave "permission" for the woman to go on her own. Don't forget - you have the ultimate say in your healthcare. The whole idea of "letting" you wait until labor begins is silly when you put it into this context. If it's what you want and what will give you peace of mind, then require it. You aren't alone - it just takes a lot of guts and conviction to make it happen.

[MamaOf3Cuties]

You can refuse anything. You can also allow them to schedule whatever they want and not show up. They cannot force you into a section. Period. They cannot even force you into a section if you have a breech baby. I would not advise having a breech baby with a dr that is not skilled in delivering a breech baby though. Sadly, it is a skill that is being lost

[ncavillones]

Thanks, mamas. I think I will just have to buck up and be firm. I guess I'm just afraid they'll be mean to me or "tsk tsk" me if something goes wrong! It's just hard to balance my desires for a natural birth and the responsibility I feel in doing what's right for my baby, because everyone, it seems, is on the baby's side! I'm just an incubator, after all. :P

[Mama2Bean]

My DD was breech at 35/36 wks and despite all my and my acupuncturist's efforts, wouldn't turn. My OB was not comfortable doing a breech birth. We did an external version, and it worked like a charm. But if it didn't this was my plan: to insist on going into labor naturally and then having a section if she didn't turn. No one in my area will do a vaginal breech birth (known). Sad, but like the PP said, if someone isn't confident about doing it, then they shouldn't deliver the baby (or catch, that is).

So, this is in the back of my mind since I'm 30 wks pg now. My plan would be the same if LO is breech again. I've heard of babies turning at the last minute lots of times.

GL and be strong. I know it is hard to stand up to HCPs sometimes.

[Plummeting]

Did your doctor provide you with any actual EVIDENCE that waiting to go into labor was more dangerous? Claiming it is doesn't mean anything, unless she can provide you with actual studies showing that trial of labor for breech baby has worse outcomes than scheduling a section at 37 weeks. I haven't researched it, since it's not been an issue I've had to worry about, but I wouldn't just let her tell you it's more dangerous without providing studies to prove it. If she can't do so, then you have all the reason you need right there to refuse to schedule the section.

I did *very* cursory search and came up with this abstract, which contains this quote:

Careful review of maternal and fetal variables indicates that a trial of labor in selected patients resulted in vaginal delivery in only 37% but was achieved without an increase in fetal or maternal mortality or morbidity.

I don't know if your baby is a footling breech, but the only other study I had time to look at was for premature babies and showed that trial of labor was probably NOT as safe for footling breeches, but was fine for complete or frank breeches. Not sure if that applies to full term babies or not. Honestly, you should demand information, which comes in the form of actual studies, from your doctor to prove that she's right. If she has none other than her opinion, then the most likely explanation is that she is scheduling a c-section out of ignorance, or worse (but hopefully less likely) convenience, neither of which has anything to do with the health of you or your baby.

[CherryBomb]

Is there anyone who knows how to deliver a breech baby in the practice, or anywhere local?

How fast was your first labor? My concern with waiting to see if labor turns baby (which, as a PP mentioned, does happen but is not common) would be if you went fast and wound up delivering with an unskilled birth attendant. What do the MWs at the practice say?

I wouldn't schedule a c/s and just not show up. It takes a lot of time to prep for that and I think it's really an unfair thing to do to the nurses. While they're prepping a surgery you have no intention of showing up for, they could be attending to other patients, ykim?

Good luck, I hope that baby turns for you!

[umsami]

Try and find an old timer who is used to delivering breech births. If your insurance company has a database, a lot of times they'll list the year they graduated from med school. My guess is if you can find somebody before the 70s, s/he would have some breech experience. Also, don't just look at OBs, but also Family Practice docs. Also, remember to check both DOs and MDs.

[ncavillones]

My daughter was a footling, so if this one is a footling as well, I will have a scheduled section. But if it's frank or complete, then I will request TOL, or at the very least, put off the scheduled section until week 40 or 41. My daughter was born via section at 39 weeks, and even at that late date, I felt that she had issues that could've been avoided if she had more time-- she was only 6 pounds when she was born, she had low temperature issues, and jaundice.

I've heard that before about old-timers! It's a good tip and I will check with my insurance company.

In the meantime, I'm doing as much as possible to get the baby to turn. Ultrasound today to see what's up in there, then scheduling a version based on that. Wish me luck!

Thanks, mamas!

[lunarlady]

A woman in my Bradley birth class had this issue. She basically stopped taking calls from her OB's office. She had a cell so caller ID allowed her to duck them. They couldn't schedule her section if they couldn't reach her! She allowed labor to start on it's own, then went to the hospital for her section. The doctor and the hospital were a bit annoyed, but she justifiably pointed out that many c-sections are "emergancy" ones, and therefore the hospital is prepared and ready to handle this type of surgury on short notice. And she went early in labor, so they had plenty of time to prep the room, do her epidural, etc. with no danger to her or the baby.

That said, her doctor did not perform the section. Rather, it was performed by the doctor on call. But she felt good knowing that her baby was ready to be born, even though she had to have the section due to breech presentation.

[ncavillones]

I had an ultrasound today and saw the OB. The U/S showed that the baby is frank breech, which the doctor liked because it increases the chances that the baby will turn, unlike a footling.
That said, I did let the doctor know how I felt about wanting TOL, and she agreed not to schedule my section early, and would schedule it for my due date, if it was still necessary. But we are still looking at a homebirth option if the baby doesn't turn... It might come down to finances, since the state of MA doesn't require insurance companies to cover homebirth.

[MaterPrimaePuellae]

My baby is still switching between breech and vertex, and we're at 38 weeks today. He's flipped multiple times now, but he seems to be head down at this point (and he was definitely head up at 37 weeks). I think it's great for her to schedule the section on the due date, if not later-- and keep trying all the inversion techniques. I think that hands/knees and talking to the baby really helped him turn.

[Plummeting]

Well, yay! for a frank breech at least! Hopefully you are able to get the birth you want, whatever that turns out to be.

[sanguine_speed]

I have had a vaginal breech birth AMA, so i sympathize with your fears about being talked down to, lied to, threatened, even in the case of just waiting for labour. In my case, I forced the doctor to catch my breech, and suffered abuse for it.
I understand not wanting to force a doctor to catch a breech, because one could argue there are risks to your baby in this, however forcing your doctor to wait until you go into labour on your own rather than scheduling a c-section? Pretty much zero risk. Just do it. tell them no, and show up when you're ready.

[triony]

Originally Posted by ncavillones

But we are still looking at a homebirth option if the baby doesn't turn... It might come down to finances, since the state of MA doesn't require insurance companies to cover homebirth.

Neither does the state of Virginia, but the MWs have very good success billing around here. Mostly they just avoid mentioning that it was a HB and the insurance companies rarely notice (or care). Try to find a MW that has a billing service or experience billing your company.

[MegBoz]

Originally Posted by CherryBomb

I wouldn't schedule a c/s and just not show up. It takes a lot of time to prep for that and I think it's really an unfair thing to do to the nurses. While they're prepping a surgery you have no intention of showing up for, they could be attending to other patients, ykim?

I agree. So if you don't want to be confrontational, just keep putting it off. The simple, "Whoops! Forgot my date book, let me call later." Or "Let me double check with my DH. Whoops! He has a work conflict, how about 4 days later." etc.

Originally Posted by ncavillones

Thanks, mamas. I think I will just have to buck up and be firm. I guess I'm just afraid they'll be mean to me or "tsk tsk" me if something goes wrong!

That is a realistic concern. Maybe make sure your DP is ready to stand up for you & have a doula or good friend there as well. Technically, a doula can't speak for you when it comes to your healthcare choices, but I would hope a good one would speak up & defend your choices as being responsible, reasonable, valid & 100% safe if they were chastising you for awaiting TOL! I might also prepare for this mentally so any insults didn't get you down too much at such an emotionally vulnerable time.