VBAC hopeful with breech baby UPDATE had my ECV!

[DMG8]

She is literally sitting cross legged on my cervix and has her head up right above my belly button, I can often feel her head poke out. Talk about screwing with my VBAC plans. I had my 3D ultrasound at 29w 6d and she was head down, it was hard to get good pics of her. However, the next morning I knew she turned - it was 6am and I was wide awake because of the way she moved. At 30w 2d I had an appointment and u/s and yep, she was head up behind my belly button. She's been that way ever since and I'm starting to freak out (I'm 35w 2d now). 

So far my OB hasn't mentioned c-section or anything yet. Last week the doc I saw told me not to worry because there's plenty of time for her to move again, plus she felt my stomach and said she still has plenty of room in there too. She said it's too early to discuss a version. She told me to do pelvic tilts to help her move - head down butt up position. However, my DD just thinks this is an invitation to sit on my head. Not fun. I saw a different doc today and he barely seemed concerned that she's breech and told me to try crawling around because it helps get the baby moving. He said we could talk version at my 37 week appointment. I am pretty shocked that they are willing to do a version at all since I'm a VBAC patient - I know lots of OBs frown upon versions on women with previous c-sections (even though studies show it's safe with VBACs) so I'm not going to argue. I just hope it doesn't come to that. 

Has anyone had gotten a breech baby to turn?  If so, how far along were you when the baby turned? 

If you had a breech baby did you try a version at all?  How did it turn out?  

Or has anyone had a successful VBAC with a breech baby?  

I'd love any advice you all have to offer! Thanks! 

[kltroy]

Oh I completely feel for you! My first was a c-section for breech presentation.  When I got to 31 weeks with baby #2 (planned VBAC) and it was breech, I couldn't believe it.  First, yes, it's entirely possible that baby will flip.  Versions have a much higher success rates when it's not baby #1 b/c there's a bit more "wiggle room" in your uterus.  And yes, it's safe, so go ahead and try it.  Second, aside from breech tilts there are a few things you can do (also in combination with them).  In particular, I would get a referral for a chiropractor who does Webster maneuver -- this can help to make your pelvis more symmetrical so that baby can settle head-down more easily (at least, that's the theory - certainly can't hurt).  Also, get a referral for an accupuncturist who does moxabustion.  This sounds so goofy (and it is!) but I did this at 31 weeks with baby #2.  It works because, for whatever reason, stimulating the spots on the outsides of your pinky toes makes the baby move a lot.  A good accupuncturist will do accupuncture within these spots, might run a little electrical stimulation through the needles (feels tingly), and will leave them in for 45 mins or so.  Then will show you how to do the moxa sticks yourself (you burn them so that they are hot right at the same location) and will send you home with them to do 2x/day. 

So, the combination of all three of these things can really help.  Get your pelvis in order. Get the baby to move, and then do some breech tilts to help baby move to head down (baby's movements will be generally random, but the more movement you get, the more likely those random movements will knock baby into a vertex position). 

The other thing you can try is a guided meditation/visualization CD that Hypnobabies produces called Turn your Breech Baby NOW. 

At the end of the day, if you have a care provider who will do a vag. breech birth, there is actually no reason that you can't do this and have it be a VBAC.  The risks associated with vag. breech birth are not at all related to those associated with VBAC.  I was able to identify such a person where I live and told him that I would give him a call if my baby was still breech around 38 or 39 weeks.  However, if you can't find that person or if you don't feel comfortable with a breech delivery, there are lots of excellent suggestions of how to make the most of a scheduled c-section.  Not what you want I know, but sometimes we have to deal with what comes our way in life.

Best of luck!

PS: Another woman within my ICAN chapter had her first c/s for breech, and her second was breech until 36 weeks.  Then baby flipped.  She went on to have a successful VBAC -- and two more after that!

PPS:  My girl flipped during week 31 the morning after I started the moxabustion, and I had a successful VBAC 10 weeks later :)

[LisaSedai]

Last year the ICAN group in Atlanta had 3 breech VBACs but we have a really good OB- he also does versions pretty early and has an excellent success rate with turning breech babies. If I remember right, he does require breech VBAC to be delivered in the OR just in case it turns out to need a C/S. How comfortable is your OB at delivering breech babies?

[TiffanyToo]

I would do Websters and accupuncture before a external version. They both have higher success rates than external version and are less invasive. Here is a link with a number of ideas and thoughts on the topic if breech.

http://www.gentlebirth.org/archives/breech.html 

After a successful VBAC I had another c-section for DS being breech at 40 weeks. No one I called would even talk to me about version or vaginal birth breech.

[cairomama]

I had a c/s for breech. My second baby was breech from 20 weeks on. I tried everything everyone else has mentioned, but what finally worked was a version at 36.5 weeks. It was very easy. I used Hypnobabies to completely relax so the doc could move the baby. It worked and three weeks later I went into labor on my own and had a very easy VBAC.

[DMG8]

I'm 36w 2d now and she's still breech.  :(   The doctor today said he's had great success with ECVs and since I had so much cramping and BH over the weekend he went ahead and scheduled me for an ECV next week.  He will be out of town but said some other docs in the group do ECVs.  I go in Monday for an ultrasound to check her size, position and all of that, if she's still breech, then I will get an NST and if all looks well I'll go over to the hospital.  I'm really hoping though that she turns this week.  

Up until this point I've been doing Inversions, crawling, breech tilts (not often enough though), and other things.  This town is so small I haven't been able to find a chiro who does Webster (well, there is one but after some of the things I've heard from friends I'm not going there!).  I just spent 20 minutes doing a breech tilt and I'll do it again in a bit.  I'm going to be a good girl and do them everyday this week, no more "hoping" she'll turn, I'm not leaving this up to her anymore! :lol:

I don't know if any of the docs in my OB group are ok with breech VBAC deliveries - they are all perinatologists except for two CNMs - I haven't asked yet since I'm hoping it doesn't come to that (yes, the head in the sand approach).  However, the doc I saw today (one of the older ones) said he's had babies turn right before moms go into labor and so far none of the docs have mentioned a c-section to me.  

Please send me good luck vibes that this baby turns soon so I can stop stressing!  Thanks for all your advice and stories, hearing from other women does help A LOT! 

[roadfamily6now]

Good Luck momma! Sounds like you have a fairly supportive team there. Most OB's at this point would be scheduling a  c-section. Even if baby is still breech, I would wait for labor to start.

Hang in there! Most babies turn. :)

[Monkey Keeper]

Originally Posted by DMG8 

Has anyone had gotten a breech baby to turn?  If so, how far along were you when the baby turned? 

Me!  My VBAC baby was discovered half-footling breech at 34w, and he flipped to vertex, back to breech and back vertex (and elsewhere) but finally settled head-down at just past 39w. And as you can see in my sig, he wasn't a little guy!

If you had a breech baby did you try a version at all?  How did it turn out?  

I had a version scheduled but he was head-down the day before, so we canceled.  He moved breech again after but I wasn't willing to go through a version with him flipping around like that.

Or has anyone had a successful VBAC with a breech baby?

DS was head down when labor started, so I didn't deliver a vaginal breech.  I was not confident enough in myself to pursue that, but if a subsequent baby turns up breech, I might just go for it since we have a couple local providers who willingly deliver.

I'd love any advice you all have to offer! Thanks! 

My plan was to attempt the version (obviously that did not happen) and then wait for labor to start to make a decision.  Both my ob and my doula were very supportive of this since a lot of babies do turn head down in early labor. One thing that helped a lot for me was therapeutic massage.  Baby always was in a much, much better position after that.
 

[DMG8]

Originally Posted by PinkBunch 

My plan was to attempt the version (obviously that did not happen) and then wait for labor to start to make a decision.  Both my ob and my doula were very supportive of this since a lot of babies do turn head down in early labor. One thing that helped a lot for me was therapeutic massage.  Baby always was in a much, much better position after that.
 

I'm happy to hear you say that because I scheduled a pregnancy massage for this Saturday!  I hope it helps relax me some and will help the baby turn.  

[gwendolyn98]

I had an EVC done at 37 weeks and it was successful and I just had an amazing VBAC on April 1st!   I'm sending thoughts your way for a successful EVC !

[DMG8]

UPDATE:  I just got a call from a nurse at my OB group and apparently I was the subject of a group meeting this morning.  Some of the OBs aren't on board with doing my version next week.  The nurse said they really want to meet with me to discuss this and asked when I could come in.  I asked what time was good and she said whatever time was good for me . . . this doesn't sound promising to me, it sounds like bad news and I'm worried.  Luckily I was able to talk my DH into going tomorrow - it's over an hour drive to their main office and he has patients in the afternoon so it's not exactly convenient.  But I need him there with me to show them he supports me and since he's a doc too I'm hoping his support will carry some weight.  

I've read research that says versions are safe on VBAC moms, heck breech births with providers that know how to deliver breech babies are safe too (just too many OBs don't seem to have this skill anymore).  I know they can't force me into a c-section.  But I'm worried.  Any words of wisdom ladies?  I'm freaking out.  

[dlm194]

You said it.  They can't force you into a c-section.  It might help to bring some of the research with you though.

If your uterus can't handle a version, chances are it can't handle labor.  I'd rather find out during the version than during labor.  They are prepared for an emergency during version.

Sela HY, Fiegenberg T, Ben-Meir A, Elchalal U, Ezra Y. Safety and efficacy
of external cephalic version for women with a previous cesarean delivery.
Eur J Obstet Gynecol Reprod Biol. 2009 Feb;142(2):111-4. Epub 2008 Nov 18.

Department of Obstetrics & Gynecology, Hadassah Hebrew University Medical
Center, Ein-Kerem, P.O. Box 12000, Jerusalem 91120, Israel.
[e-mail]

OBJECTIVE: To evaluate the success and morbidity rates for attempted
external cephalic version (ECV) in patients with one previous cesarean
delivery (CD) and a breech-presenting fetus at term. STUDY DESIGN: This is a
retrospective study of outcomes of ECV at our institution for all women with
one previous CD and a breech-presenting fetus at term between January 1997
and June 2005. A literature review was also performed as a Medline search
(1966-2006). RESULTS: ECV was attempted for 42 women with a
breech-presenting fetus and previous CD. The success rate of ECV was 74.0%,
and 84% of women with successful ECV delivered vaginally. All fetal and
maternal outcomes were favorable. Only four Medline reports met our
inclusion criteria, representing a total of 124 patients and a mean ECV
success rate of 76.6%. Thus we assessed 166 cases of attempted ECV and find
an average ECV success rate of 76.5% and favorable fetal and maternal
outcomes. CONCLUSIONS: Women with a breech-presenting fetus at term and
previous CD, who desire a trial of labor, should be counseled regarding the
accumulating evidence about the efficacy and apparently safety of this
procedure and may be offered an ECV attempt.

PMID: 19019528

----------------------------------------------------------

Abenhaim HA, Varin J, Boucher M. External cephalic version among women with
a previous cesarean delivery: report on 36 cases and review of the
literature.

J Perinat Med. 2009;37(2):156-60.
C.H.U. Sainte-Justine Hospital, University of Montreal, Montreal, Canada.

AIMS: Whether or not women with a previous cesarean section should be
considered for an external cephalic version remains unclear. In our study,
we sought to examine the relationship between a history of previous cesarean
section and outcomes of external cephalic version for pregnancies at 36
completed weeks of gestation or more. METHODS: Data on obstetrical history
and on external cephalic version outcomes was obtained from the C.H.U.
Sainte-Justine External Cephalic Version Database. Baseline clinical
characteristics were compared among women with and without a history of
previous cesarean section. We used logistic regression analysis to evaluate
the effect of previous cesarean section on success of external cephalic
version while adjusting for parity, maternal body mass index, gestational
age, estimated fetal weight, and amniotic fluid index. RESULTS: Over a
15-year period, 1425 external cephalic versions were attempted of which 36
(2.5%) were performed on women with a previous cesarean section. Although
women with a history of previous cesarean section were more likely to be
older and para >2 (38.93% vs. 15.0%), there were no difference in
gestational age, estimated fetal weight, and amniotic fluid index. Women
with a prior cesarean section had a success rate similar to women without
[50.0% vs. 51.6%, adjusted OR: 1.31 (0.48-3.59)]. CONCLUSION: Women with a
previous cesarean section who undergo an external cephalic version have
similar success rates than do women without. Concern about procedural
success in women with a previous cesarean section is unwarranted and should
not deter attempting an external cephalic version.

PMID: 19021458

----------------------------------------------------------

de Meeus JB, Ellia F, Magnin G. External cephalic version after previous
cesarean section: a series of 38 cases.
Eur J Obstet Gynecol Reprod Biol. 1998 Oct;81(1):65-8.

Department of Obstetrics, Gynaecology and Reproductive Biology, University
Hospital of Poitiers, France.

OBJECTIVE: To determine if external cephalic version (ECV) is a reasonable
alternative to repeat cesarean section in case of breech presentation. STUDY
DESIGN: Retrospective study of 38 women with one previous cesarean section
and a breech presentation after 36 weeks of gestational age who have had at
least one experience of ECV. Statistics used the Fisher's test with
significance when P<0.05. RESULTS: Version attempts were successful in 25 of
the 38 women (65.8%). Seventy-six percent of the successful version women
went on to have vaginal birth after cesarean section. A total of 19
successful vaginal deliveries occurred (50%). Success rate of ECV was
lowered when breech was the indication of the previous cesarean section. The
vaginal delivery rate was increased after successful ECV in patients
previously vaginally delivered, but this difference did not reached
significance (P=0.057). No maternal or neonatal complications occurred.
CONCLUSION: ECV is acceptable and effective in women with a prior low
transverse uterine scar, when safety criteria are observed.

PMID: 9846717

----------------------------------------------------------

Schachter M, Kogan S, Blickstein I. External cephalic version after previous
cesarean section--a clinical dilemma. Int J Gynaecol Obstet. 1994
Apr;45(1):17-20.

Department of Obstetrics and Gynecology, Kaplan Hospital, Rehovot, Israel.

OBJECTIVES: To describe our limited experience with external cephalic
version from breech to vertex presentation at term, with the use of
ritodrine tocolysis, in women who had undergone a previous cesarean
delivery. METHODS: Eleven parturients after previous cesarean delivery
underwent external version after 36 gestational weeks, utilizing tocolysis
with ritodrine, after excluding cases of low-lying placenta, severe
oligohydramnion or ruptured membranes. Patients were then followed until
delivery and scar examination was carried out after vaginal delivery, or at
re-cesarean section, according to mode of delivery. RESULTS: All 11
attempted versions were successful. Six patients subsequently delivered
vaginally and five by re-cesarean section. None of the uterine scars showed
any signs of dehiscence. Three of the five infants delivered by re-cesarean
section weighed over 4000 g, whereas all of the vaginally-delivered infants
weighed under 3500 g. CONCLUSIONS: External cephalic version to vertex
presentation after previous cesarean section was successful in all 11
carefully selected patients. No untoward effects were noted, and no signs of
scar dehiscence were found. The safety and efficacy of this procedure after
previous cesarean delivery should be examined further.

PMID: 7913053

----------------------------------------------------------

Flamm BL, Fried MW, Lonky NM, Giles WS. External cephalic version after
previous cesarean section. Am J Obstet Gynecol. 1991 Aug;165(2):370-2.

Department of Obstetrics and Gynecology, Kaiser Permanente Medical Centers,
Los Angeles, Riverside, CA 92505.

Approximately 100,000 cesarean sections are performed each year in the
United States because of breech presentation. Numerous studies have shown
that external cephalic version can eliminate the need for many of these
operations. However, because of the fear of uterine rupture, these studies
have generally excluded patients who have undergone previous cesarean
section. To evaluate the validity of this exclusion policy, we studied
patients with one or more previous cesarean sections and breach
presentations near term. Version attempts were successful in 82% of 56
patients who had undergone a previous cesarean section. Sixty-five percent
of the successful version patients went on to have vaginal birth after
cesarean section. There were no serious maternal or fetal complications
associated with the version attempts. We conclude that external cephalic
version is a reasonable option in patients with prior low transverse
cesarean section.

PMID: 1872341

[Ms. B. Sprout]

mama. I will be thinking about you tomorrow!

[labortrials]

Stay strong!  I'd be pushing hard for the version if I were you.  I know that OBs in my area don't seem to have malpractice insurance that covers vagi breech.  Crock o crap, eh?  You could also try acupuncture (sorry can't remember if you said you had tried that yet).

Will be thinking of you.  Let us know how it goes!!

[jenniro]

Originally Posted by Ms. B. Sprout 

mama. I will be thinking about you tomorrow!

Me too!

[TiffanyToo]

Really acupuncture/moxibustion has a hire degree of success than version.  Sorry they have decided to throw their weight around and to scare you.

[DMG8]

I went to the appointment this morning and even though we discussed the version it turned into an "Informed Consent" meeting about my VBAC.  I already had this discussion with another doc when I initially went with their practice so I was a bit annoyed but I get it - I'm a lawyer so I get the legal aspects and I'm sure they get pressure from their malpractice insurance to make sure they're making sure their patients are informed.  However, I can see why so many women buckle and agree to the repeat c-section!  That was BRUTAL.  Just what a pregnant mother needs to hear - how she's putting her life, her babies life and her future reproduction at risk by trying for a VBAC.  However, none of it was news to me since I've done my research and I made my decision months ago.  I was pleased that at the end when I said "Yes, I'd still like to have a VBAC" the doc said she understood my reasons and respected that, she also said it's obviously my decision and I have my autonomy.  I never felt judged or like she was trying to coerce me.  She said she personally wouldn't choose a version as a prior c-section mom but she agreed to do it on Wednesday since she'll be the doc at the hospital that day.  She was more supportive than I ever anticipated and she even said I should try acupuncture which kind of shocked me because so many docs are against non-traditional medicine.  I'm not sure I can get my DH on board with that though - he's not really comfortable with it but we'll see.  

Overall I'm pleased with the outcome of the meeting because she agreed to do the version and she at no point talked down to me about my decision.  One thing that's been bothering me though is that she said mom's who had a c-section for "failure to progress" no matter if it was due to poor positioning of the baby or whatever the reason, have a much lower success rate with VBAC - she said my chances are 40-50% but I've never heard such a low number before!  Has anyone had a VBAC after a FTP c-section?  My DD was sunny side up and didn't get past 0 station.  I am committed to my VBAC and refuse to let the scary "risks" deter me because I honestly believe it's the best choice for me and my baby.  

[Ms. B. Sprout]

Wow! I am IMPRESSED with you, mama! Good for you for holding your ground. I know it's much easier said than done, so good for you for doing it.

I have had 2 different OBs spout their bullshit percentages at me, and the percentages are worthless. I had a doc tell me I could never dilate to 10, and he had to admit he was wrong after I did just that with my second birth. I imagine lots of ladies can tell similar stories.

[labortrials]

Well this is in the NIH VBAC consensus statement:

"Nonrecurring indications for cesarean delivery are also associated with a higher rate of VBAC. For example, compared to arrest of labor, prior cesarean delivery for malpresentation is associated with a higher rate of VBAC."

So, I'd say that they've misrepresented your chances.  Plus you'll never know if you don't try.

I wonder if they were trying to CTA because YOU are a lawyer?

I'm glad you're pleased with the outcome.  Still, it is unethical of them to pressure you will poorly supported statements like you putting your baby at risk . . . and especially yourself?  Come on - the research in NO way supports that VBAC is riskier for mom.

If you need more ammo, seriously the NIH report is chock full of it!

You go grrl!!

[TiffanyToo]

Do you have doula to help support your VBAC?

Here is a link that talks about using moxibustion for turning a breech baby and the success http://www.gentlebirth.org/archives/breech.html#Moxa