Urgent: Set for VBAC at birth center, 37w, breech baby

[DeChRi]

I am writing on behalf of a friend. She is 37w1d right now. In our city there are no Drs/OBs/midwives that will do VBACs. She opted to go 45 min to a freestanding birth center to deliver, as they do VBACs. The reason for her first c-sec was breech presentation. At 36w baby was breech. She did chiro, acupncture, moxi, spinningbabies, you name it. She is now 37+1 and baby is still breech. She called to ask if my local OB (I am 38w) does c-sec, as she needs a new Dr fast to do the c-sec, as she resigned herself to another. The birth center will not do attempt an external version. She could go to a local OB, hope to get in fast, try a version, but at that point the local OB won't let her have a VBAC, so can she bail and go back to the birth center?

My thought, at this point, is to scour for Drs in the other direction (we are an hour or so from the Kansas City metro) and find an OB that does versions and VBACs and hope she beats the clock. She has no idea on how to find an OB that does VBACs in the area.

My questions are:
1) Is there any additional risk to a version attempt after she has had 1 c-sec?
2) At this late in the game, is starting the search for a new OB that does VBACs a moot point?

She has kind of resigned herself to another c-sec, but if there is another option, she would love it.

Any input on how to beat the clock here, and how to find a VBAC friendly Dr in the KC area?

THanks!

[cairomama]

I had a c/s for breech who wouldn't turn for anything and then a second breech who was exactly the same way. I went two hours away to have a version done. It worked and I went into labor on my own three weeks later and had a very easy VBAC.

http://cairomama.blogspot.com/2009/0...c-version.html

http://cairomama.blogspot.com/2010/0...ater-long.html

Also, their may be someone willing to do a vaginal breech delivery. Contact the local ICAN chapter, doulas, childbirth educators, homebirth midwives for suggestions for providers who will do ECVs or vaginal breech delivery.

http://www.ican-online.org/

Her other option is to wait to go into labor. If baby doesn't turn in labor, then have a c-section. Labor is good for the baby and the baby might turn in labor.

Try a university hospital for the ECV, that is what I did. They need examples to teach the residents so they may be more willing to do it.

Encourage her to get on the phone and call, call, call. Do not give up. Also, doctors might not advertise that they do vaginal breech delivery, but if you are confident and informed you can sometimes get doctors to support you.

She can always find someone to do a c/s. If she shows up in labor, they won't refuse to do a c/s, so I would just tell her to concentrate on finding a provider for ECV or vaginal breech. Don't be afraid to drive a few hours to get it. I did and it was totally worth it.

[DeChRi]

Cairo - Thank you! I directed her to the ICAN website and passed along your advice. We actually have a stellar teaching university hospital in the KC area (KU Medical Center) which may be a good option.

I appreciate your wisdom!

[Ruthe]

I don't really have anything helpful to add but just had to point out that any ob who does not do VBAC is not going to attempt a version for breech in a woman he wouldn't deliver vaginally anyway... what would be the point of the procedure? Sorry I'm not more help but just wanted to make sure you'd thought that one through so you don't waste time that you don't have! I hope she can resolve her situation, best wishes.

[AustinMom]

I may be being totally sneaky (but that's just me when I want my way with Birth) but I'd see an OB who does version and if they said they wouldn't due to me not delivering with them, I'd just put them under the assumption that I would, and then not. I don't see why she can't see an OB, say she will go through him, get the ECV, and then go birth at the birthing center. Yeah, it's a little sly, but I don't see any reason why it's not worth it. I think it's crappy that an OB would refuse a ECV if the mom has no intentions to deliver with them. So I don't have any guilt about doing this. They are there for medical procedures and advice and to refuse ECV due to not sticking with them, IMO, be denying care, and I think that's somewhere written to be illegal. Not sure.

Oh, and I TOTALLY second going into labor if all else fails and deciding from there. Yes, babies do turn in labor. A breech baby is no reason to schedule a CS. There is no danger in breech labor. The 'fear'/'danger' is with the delivery of the baby's head. So even if she went into labor, labored EXTREMELY quickly and got to pushing, you'd still have time to 'safely' get to hospital. Any amount of labor is helpful to the baby and to mom. Hormonally, physically, emotionally, bio-chemically, etc.

Personally, I'm a VBAC, and if my baby was breech, I'd still do a vaginal birth, but I feel that's a mom's choice. The Thinking Woman's Guide to a Better Birth has a great topic on breech, with studies and facts. That is another option.

[JessicaS]

Originally Posted by DeChRi

I am writing on behalf of a friend. She is 37w1d right now. In our city there are no Drs/OBs/midwives that will do VBACs. She opted to go 45 min to a freestanding birth center to deliver, as they do VBACs. The reason for her first c-sec was breech presentation. At 36w baby was breech. She did chiro, acupncture, moxi, spinningbabies, you name it. She is now 37+1 and baby is still breech. She called to ask if my local OB (I am 38w) does c-sec, as she needs a new Dr fast to do the c-sec, as she resigned herself to another. The birth center will not do attempt an external version. She could go to a local OB, hope to get in fast, try a version, but at that point the local OB won't let her have a VBAC, so can she bail and go back to the birth center?

My thought, at this point, is to scour for Drs in the other direction (we are an hour or so from the Kansas City metro) and find an OB that does versions and VBACs and hope she beats the clock. She has no idea on how to find an OB that does VBACs in the area.

My questions are:
1) Is there any additional risk to a version attempt after she has had 1 c-sec?
2) At this late in the game, is starting the search for a new OB that does VBACs a moot point?

She has kind of resigned herself to another c-sec, but if there is another option, she would love it.

Any input on how to beat the clock here, and how to find a VBAC friendly Dr in the KC area?

THanks!

I am in Kansas City.

Here is a CNM

http://www.ksmidwife.com/

Dr. Howard Schwartz does VBACs I have heard a lot of great things about him

I wouldn't take no for an answer here. There are a lot of options in this area.

Are you in Kansas or Missouri? Would it matter for her ins which state?

[khaoskat]

Originally Posted by DeChRi

I am writing on behalf of a friend. She is 37w1d right now. In our city there are no Drs/OBs/midwives that will do VBACs. She opted to go 45 min to a freestanding birth center to deliver, as they do VBACs. The reason for her first c-sec was breech presentation. At 36w baby was breech. She did chiro, acupncture, moxi, spinningbabies, you name it. She is now 37+1 and baby is still breech. She called to ask if my local OB (I am 38w) does c-sec, as she needs a new Dr fast to do the c-sec, as she resigned herself to another. The birth center will not do attempt an external version. She could go to a local OB, hope to get in fast, try a version, but at that point the local OB won't let her have a VBAC, so can she bail and go back to the birth center?

My thought, at this point, is to scour for Drs in the other direction (we are an hour or so from the Kansas City metro) and find an OB that does versions and VBACs and hope she beats the clock. She has no idea on how to find an OB that does VBACs in the area.

My questions are:
1) Is there any additional risk to a version attempt after she has had 1 c-sec?
2) At this late in the game, is starting the search for a new OB that does VBACs a moot point?

She has kind of resigned herself to another c-sec, but if there is another option, she would love it.

Any input on how to beat the clock here, and how to find a VBAC friendly Dr in the KC area?

THanks!

ICAN lists multiple hospitals in the KC area that allow VBACs. Contact ICAN and they can give her some ideas.