Internal exam to check babe's position?

[DeChRi]

I told my OB I was thinking I would forego any internal exams prior to babies birth. I had 2 or so last time. I am not terribly opposed to them in general, but DD1 was 0% effaced and 0cm 20 hrs before she came, and DD2 was 3cm for 3 wks before she came. So it just doesn't do much for me.

She asked to do one internal at 36 wks to confirm baby position. I have not heard that an internal exam is helpful to do this. Is that accurate? I know she can make a good guess w/o an internal, just curious what she gains by doing one. She is fine if I opt out, so it is not a huge deal, but I am now curious.

[CallMeMommy]

Confirm what position? That baby's head-down? That can easily be done externally. If she's talking about head presentation, like a brow presentation or posterior, that can change way before labor (even during labor). If it's even possible to check, I'm not sure.

[sanguine_speed]

My understanding is that sometimes it is possible to feel a hard head or a softer bum through the uterus internally. Personally, I have not wanted nor had any internal exams this pregnancy. When breech was suspected on palpation, I was comfortable with an ultrasound which I found less invasive and uncomfortable than a digital exam. So I guess this depends on your comfort level with a pelvic exam or an ultrasound.
Or, you may be comfortable not having confirmation either way.

[DeChRi]

Thanks for the replies. She specifically wants to check for head down. My last baby was breech until 37 wks when I had the chiro put my hips/pelvis back in whack. I've had horrible SPD and hip alignment issues this time so I think she may be concerned for same thing? Dunno. I don't have a huge prob w/ internals, if there is a reason, which usually there isn't. I just didn't know if this was a valid one.

[sioleabha]

I always wonder about the value in confirming that a baby is head down at 36 weeks. How often do babies really stay in the same position from 36 weeks onward? I've heard SO MANY stories of breech babies turning late in pregnancy, and I myself had a head-down baby turn breech at 42 weeks.

[katelove]

We don't do them routinely in Australia. IMO if a breech is suspected but can't be confirmed by abdominal assessment then a definitive answer should be sought. In this case that would be USS. I would ask the Ob if, after doing the internal she would still want to do an ultrasound for confirmation. If the answer was yes then no need for the internal.

And, I agree with the PPs, there is no reason to get a definitive answer on position until you actually need to do something about it - consider ECV, make decisions about birth etc.

[blueeyes]

Even if she did the exam, the baby can change position at ANY time. My youngest DD decided while I was in hard labor to turn tail! They manually turned her position, not very comfortable, but I was able to deliver her head first.

[mischievium]

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[sanguine_speed]

Originally Posted by sioleabha

I always wonder about the value in confirming that a baby is head down at 36 weeks. How often do babies really stay in the same position from 36 weeks onward?

More than 90 times out of 100.

IME, there is value in knowing at 36 weeks (as I am today).

Here at least, a home birth cannot be attended by a registered midwife if the baby is breech. Also, it is hard to achieve a vaginal breech birth at a hospital, and knowing that you are likely to face this difficulty is important for prep--calling around to find someone, reading up on literature, etc.
So yah, for me, knowing was really important emotionally and psychologically.
Sure the baby could turn 'at any time', but in reality, it's unlikely to turn again in the last few weeks, and it's good to begin to have a picture of what your birth place will be, while also keeping a back-up plan in case the baby does decide to turn last minute.