Breech Concerns

[alexis2233]

I am 34 weeks and the baby always measures just a few days larger. She is also breech facing my spine. I wanted to know what are the chances of her flipping downward? I know it can happen just before labour. But my doctor said that since this is my first pregnancy it's getting to be less likely for her to flip as she may "drop" soon. Then once she drops she probably wouldn't flip.

I am considering a c-section and I keep seeing that it would be done before the due date, giving less time. I also have looked at the external version, and I don't have a good feeling about it, nor breech vaginal birth. I wanted to hear some opinions on any of these matters.

Thanks :)

[AlexisT]

First babies do drop earlier, and once they're engaged in the pelvis, that's usually it.

OTOH... first babies also sometimes stay breech longer. The usual "rule" is if it's still breech at 37, it's not likely to move because it's run out of room. But a good number of babies flip at 35-36. At 37, you start making decisions. An elective CS is scheduled at 39 or a little after (some docs will schedule on your EDD; it really depends on how the calendar works out). Frankly, if the baby's breech and engaged at 39 weeks, your chances of having it move are slim to none, so you're not losing any time in that sense.

Anecdata: First baby stayed high and breech till 36 weeks, when she flipped and engaged. 2nd baby, in my nice stretched out uterus, went vertex months ago and is busy hanging out at the bottom.

A version is a good option if your doc is experienced. With an experienced OB and proper precautions, ECV is safe and has a good success rate (keep in mind that some babies won't turn for a good reason). My first hospital (on the NHS) prided itself on having a 100% ECV offer rate and something like 75% of ECVs worked. If the baby doesn't appear to like the ECV, they'll stop. It is uncomfortable, and it needs to be done in the hospital, but if you're a good candidate it's seriously worth considering. People will recommend trying things like chiro and moxibustion, but ECV has the most solid evidence backing its use. Also, I've heard people say things like "you need to use moxibustion early to make it work".... well, that will mush in the natural likelihood of the baby to turn on its own with anything the technique itself did. (Yes, I'm aware of that study that claimed an 82% success rate with the Webster Technique: there are some huge flaws with that study.)

Breech vaginal delivery? Well, you need a doc/MW who has attended a lot of breech births and knows what to do. The chances of your OB being one of them? Slim to none. There are fewer and fewer practitioners who know how to attend breech birth, and this was true even before the Term Breech Trial. That was the death blow, but things were already shaky. I have my doubts as to whether we'll ever really see a swing back because it's so hard for doctors to get the experience that makes vaginal breech safe. If you happen to have a local OB/MW with a good reputation for breech (and I mean good in all senses: I do occasionally hear about providers who slip over the line into "cavalier"), and you're willing to switch at this point, then you might consider it. But this may really not be practical advice for many women, and it's far from unreasonable to schedule a CS if it comes to that. It's what I would have done had my DD not flipped (she wound up needing a CS anyway for entirely different reasons). I could've showed up and refused a section, but honestly, I figured that a CS was safer than a vaginal birth with midwives and OBs who had never voluntarily attended one.

[carseatqueen]

My third was breech till after 37 weeks, then turned 12 hours after the Webster technique (at the chiro), turned back breech a few days later, then turned vertex again 12 hours after the chiro at 38 weeks. Ornery child. He stayed vertex and was born without event just after 38 weeks. So, it's antidotal, but very successful for me. I had tried everything else except an ECV before the chiro and he wouldn't even budge.

Since I was with a midwife (who can't legally deliver known breech in my state) and without maternity coverage I was trying realy hard to avoid going the hospital/OB route. If I had a CS insurace would have had to pay, but if I had an ECV or vaginal breech at the hospital I would have been on the hook for 100%. Add that to the fact that I was totally confident in having a vaginal breech since he was frank breech and I was the "perfect" canidate for a vaginal breech with prior fast, successful vaginal deliveries- and I wasn't about to get a CS just for breech- but I believe that's a personal decision that I would never push on someone else in the same situation. Thankfully he turned and we didn't have to work out the logistics of all of that.

I would at least encourage you to try everything you can to get your baby to turn. Even if the Chiro doesn't work you will feel better- I know I did and it was amazing. I'd also try an ECV and don't schedule your section till 40 weeks if that's what you decide is best. Just another story, but I know a mom that was told her baby was huge and would never turn so they did a section at 38 weeks. He was barely 5#s and ended up staying in the hospital a few extra days just because he wasn't quite ready.