Breech, ECV and VBAC

[jenninjapan]

I went with the scheduled section for my first baby at 38 weeks for breech.  I feel it was a big mistake.  Now I am planning on an HBAC, but preparing for another possible breech (at 20 weeks this babe is pretty much 99% of the time breech/transverse - I have yet to feel a kick anywhere near the top of my uterus - I know it is early, but he is in the exact position DS1 assumed for the last 7 weeks of that pregnancy).

I know the longer I wait (past 38 weeks) the chance of the baby spontaneously turning on his own is pretty good, but I am still going to give the HBAC my all even if he doesnt turn.

Anyone else have a VBAC/HBAC/UBAC with a breech?

Also does anyone have any info on ECV or had one done with prior section experience?  I have read that an ECV is riskier and can increase chances of rupture if you have had prior uterine surgery. (I read this in Gaskins Spiritual Midwifery)

[TiffanyToo]

Originally Posted by jenninjapan 

I went with the scheduled section for my first baby at 38 weeks for breech.  I feel it was a big mistake.  Now I am planning on an HBAC, but preparing for another possible breech (at 20 weeks this babe is pretty much 99% of the time breech/transverse - I have yet to feel a kick anywhere near the top of my uterus - I know it is early, but he is in the exact position DS1 assumed for the last 7 weeks of that pregnancy).

I would be focusing on a healthy pregnancy.20 weeks is IMO to early to focus a lot of attention on breech. I would find and see a chiropractor to keep you in alignment and should baby be breech around 35 weeks start having the chiropractor use Webster technique to turn baby. If baby is happily still breech position by week 37 I would see an acupuncturist for moxibustion. I would also think about pustilla, talking to baby about turning etc. I would do all of this before external version. IMO these are all less invasive and often have higher results than EV.

[nononose]

The research I read about ECV all said that a prior section did not contradict an ECV. If your uterus can't withstand an ECV, then it wouldn't have withstood labour. I dont' have any of the sources anymore though. That said, I will not be doing another ECV with this babe if it also happens to be breech (my first was sectioned for breech as well - and I'm 22 weeks, so we're close!).  I am, however, very comfortable with the idea of birthing a breech baby, so turning it in utero is not a priority.  We did 3 ECVs with my daughter and none worked - she wanted to stay that way, and I will honour that for any future children.  They were extremely painful and in hindsight, I do not think they were in her best interest (of course, I might be signing a different tune if she actually flipped!).

I wouldn't worry about breech at 20 weeks.  Not until 34ish.  You can see a chiro at any time to encourage optimal pelvic alignment, and avoid slouching/leaning back too much.  Acupuncture and moxi bustion are great suggestions.  Some advise against pulsatilla (although it is commonly suggested for breech).  Swimming is great, talking to the baby, inversions.  There are a lot of resources for flipping a baby, but nothing is really going to do anything this early, I don't think.

I know of at least one person who had a VBAC at a birth centre with a breech.  If mine ends up being breech, it will be a HBAC or UC.  I will not enter a hospital carrying a breech unless I'm rolled in unconscious.  Good luck and try not to worry.  I hope the little one flips to head down!

[jenninjapan]

Tiffany Too - thanks for your reply but my question was about ECV and VBAC, not how to turn a breech - been there done that (and spending every day doing exercises, stretches and watching my posture this time round) though nothing worked last time.   IMO 6 weeks is early enough to start worrying about breech, especially if you have a history of it.  It did NOT even enter my mind once that my baby might be a breech and spent the first 32 weeks of my previous pregnancy in lala land.  I waited too late to try and educate myself and ended up believing dr.s and midwife that a section was the ONLY safe option.

Nononose - I feel the same way.  I would very much like this one to turn head down, but ultimately he will decide how things go this time round - I just have the next 18 weeks or so to make my peace with it. (Easier said than done!)  My version at 33 weeks last time round was also painful and I don't want to go through that again - I have too many misgivings about messing with mother nature (ie did he never end up turning because the version tangled him up, etc.).  I have a different midwife this time round with a lot of experience with breech so like you I am going nowhere near a hospital after 36 weeks.  Let's hope our babes this time round flip and STAY head down.

[Monkey Keeper]

I was scheduled for an ECV for my breech VBAC babe at 36w and change.  However, he turned (thanks to chiropractic and massage and a fat ton of amniotic fluid!) vertex beforehand, and we got to cancel.  Both my OB and the peri who would have done the ECV indicated that a prior c/s was not a barrier.  

I would have had an option to deliver breech--there are 2 OBs at the hospital where I deliver who do breech vaginal births--but DS was partial footing, one foot down and one across my uterus.  I was at least going to wait for labor in hopes he would either move to Frank or vertex, but if he stayed the way he was (or probably if he stayed breech at all) I was comfortable with the c/s.  I think that if you have a very experienced care provider, plan to go without any pain meds AND have the confidence in your body, then vaginal breech is the way to go.  I personally had a lot of doubt and fear, so I knew that would be working against me.

Sending many head-down vibes to you both!

[cagnew]

I was wondering the same thing. I'm almost 38 weeks, a VBACer, and just found out the baby has flipped back to breech. ECV terrifies me because it sounds very painful. I will be starting the webster stuff this week.

My OB won't do breech births. I'm trying to find other options. This really stinks.

I hope your baby  turns for you. Even though the odds are great that it will, I can understand wanting to start thinking about it now.

[nononose]

Jenn, I am so happy to hear you have a midwife that is supportive and experienced with breech!  What more could we ask for ;)  In my opinion, the biggest part of the battle, and the most important ingredient, is finding a care provider with the confidence and skill to sit on their hands and watch the breech come out, only intervening when absolutely necessary (and catching for a soft landing!).  BTW, breech is definitely NOT a contradiction for a VBAC.  Absolutely no added risk apart from what each carries on their own.

Mine is stil jumping around in there, so I won't/can't comment on any position, but I will say that I do only feel movement at the bottom of my uterus.  That is because I'm pretty much numb from the scar up to about where the fundus currently is.  I'm expecting that to change in a few weeks.  If I put my hand on my belly, I can feel with my hand.

[nononose]

cagnew, many, many women find ECV to be relatively painless.  It all depends on how gentle the hands are and how easily the babe is turned, among other things.  If that were my ONLY option, and a choice of ECV or c/s, the choice would be clear - ECV.  That's why I did 3 of them last time.  (with no regrets, I just have different personal factors to consider this time around).  Good luck.  I hope your baby flips soon!

[Monkey Keeper]

cagnew--Do you have access to acupuncture?  My birth team--including my OB!--indicated that moxibustion and acupuncture have the highest success rate for turning breech babes.  Also, if he had room to flip from vertex to breech this late, it's highly likely he has the room to flip back.  My DS was 9lbs, 5oz and 22.5", and I am only 5'6" and 145lbs not pregnant--he got himself flipped to breech and then back vertex after the 39w point.  Visualize, work with your chiro, do some inversions.  Most of all be confident that he knows which way is out!  I wish you the best.

[cairomama]

I had a scheduled c/s for breech with my first. He was breech that I knew about from 6 months on and never moved much. I was talked out of an ECV, but did all the natural things to get him to turn. My VBAC baby was breech from 20 weeks on. She never turned or moved much despite doing even more natural things to try to get her to turn. I did the ECV at 36.5 weeks. I was in the hospital for 4 hours for monitoring before and after, but the actual procedure took a few minutes. It was very easy. It worked and three weeks later I went into labor on my own and had a very easy unmedicated VBAC. I did use Hypnobabies during the ECV and birth. I think it helped me relax completely so I provided no resistance when they were trying to turn her which helped it worked faster and without pain. I was sweaty and hot from being on my back but otherwise it was very easy. An experienced doc talked a resident through doing the procedure on me. The experienced doc was very comfortable with ECV and made it seem like no big deal. I was given a consent form that went over risks, but they were very peaceful and positive about that. I think that ECV is one of those things that there is wide variation on success rates. You made need to go to another doc to have it done properly. Of course, if you have the vaginal breech option and are comfortable you can go for that instead or in case it doesn't work.

[TiffanyToo]

FYI make sure your drinking enough water so that baby has enough fluid. Sometimes that is all that is needed to turn a baby the fluid to move with ease