Just when I thought I'd gotten everything squared away finally ... met with my new OB yesterday, who is great. Very patient choice oriented. Very supportive of natural birth, doulas, the whole nine. Avoids episiotomies "like the plague." Supports delayed cord clamping and any position you want to push in. 30-40% of the births he does are without epidurals, which for an OB is rare. He's a perfect fit for me.
And then I find out the baby is transverse lie. At 35w2d. At first I didn't think much of it, figured it was a fluke and he would certainly turn. But I am a worrier by nature, so that sanguine attitude didn't last long. Got home, started doing research, and here's where I am:
* I hope by the time I go in next week he has turned head down. I believe that he has been moving between transverse and vertex for several weeks now, based on where I feel movements. Sometimes he's more oblique (diagonal). I never feel movements that indicate breech -- his head is always in the lower half of the uterus. But my other babies were firmly head down by this point. According to Dr. Google, the fact that I no longer have abs of steel is probably to blame for giving him too much room to lay sideways. I don't have any of the other risk factors (placenta previa, tumors, multiples, prematurity). Okay, you got me there, I never had abs of steel. And now in my third pregnancy I really, really don't.
* Even if he has turned, though, who's to say he couldn't turn back? (the dreaded "unstable lie"). So I feel like I have to go into my next appointment with a suggested course of action.
* The crux of the problem with transverse lie is the high risk of cord prolapse should my water break before labor begins (7-15% chance of cord prolapse is what I have read). OTOH, of women who have a transverse fetus at 37 weeks, under 20% of them will still be transverse during labor (e.g. 80% or so turn vertex on their own). So I want to give him every possible chance to turn and stay head down since that is most likely what he will do. But, the risk of cord prolapse is scary. We live an hour from the hospital I am planning to birth at, where this OB delivers. The closest hospital to my house is 10 minutes away, though ... but even that distance (I think it is 6-7 miles as the crow flies) worries me for something like a cord prolapse. If I was going to have to have a c-section, I would rather it be with my doctor. But, I certainly don't want to schedule one at 38 weeks, which is standard of care for transverse lie. (Note: this is not what he said to me that he would want to do -- he said, make that baby turn and we'll check again next week, so he is not that worried yet. I am just thinking out loud about what if the baby is still transverse next week and the following week).
So I guess right now my thinking is this: if baby stays transverse for the next two weeks, my suggestion to the doctor will be to schedule a version for 39 weeks, and then an immediate induction if it works (and if it doesn't, I don't know ... a scheduled c/s at 40 weeks maybe?). That means my natural birth is out the window, but it's a damn sight better than a c-section, which I would prefer to avoid for many reasons. And of course if at the time of the version appointment he was head down then I would just go home.
In the time between 37 and 39 weeks, though, I am worried about my water breaking. If there was a cord prolapse the baby could easily die if I was at home alone with my two kids, as I usually am during the week (between calling 911, waiting for them to get here, getting to the hospital and getting into an OR, that seems like too many minutes to me, and I wouldn't have anyone to help me hold the baby off the cord while we were waiting for EMS). I would be more comfortable being at the hospital that whole time, although I am not sure that my insurance would pay for it because of the availability of elective c-section. So maybe the version/induction should be scheduled at 38 weeks? I don't know. (For reference my previous LOs were born at 39w6d and 38w6d respectively, so I am not worried about the baby being majorly preterm at either 38 or 39 weeks, and it is why I am worried about my water breaking around this point).
Any thoughts? (please no suggestions for spinning babies, chiropractic, moxibustion, or any of the usual suspects -- I am just trying to think through what I will do if the baby does NOT turn).