Floating vertex?

[Proverbs31]

Quick recap: I had a c-section at 42.5 weeks back in 2005. The OB sited "macrosomia" as the reason, and performed a c-section without me getting the chance to labor. A couple of years later, and a lot wiser, I am planning on a VBAC in a few weeks. I finally got to see my surgery report and the OB noted "floating vertex" on the report, which is the first I ever heard of it, as he never once mentioned it during all of the ultrasounds. My midwife questioned me about it because she had never heard of a 9lb being a floating vertex, especially with me being so small; poor baby was packed in like a sardine. Anyway, so I'm pretty much convinced that the OB lied on the report for whatever reason.

But for arguments sake, if ds really was a floating vertex, is there a way to prevent it from happening this time? Baby is definitely head down and it feels like she is engaged, but I'm not certain.

And why is floating vertex considered a reason for a c-section?

Thank you!

[kate3]

Floating means that the baby's head never engaged in the pelvis. It's common with CPD (although I know that is a loaded term here) and macrosomia. Babies don't engage due to large size, anatomical defects, malposition. If you were almost 43 weeks and still floating I can't say for sure if the head would have never engaged, but in the medical world it would be an indication for a c/s at that gestation.

My midwife questioned me about it because she had never heard of a 9lb being a floating vertex

I've seen and heard of this quite a few times. Engagement can't always be determined by sono, and often babies engage during labor, so this is not something that is even an issue until labor starts (or doesn't start).

[MsBlack]

Just for a little counterpoint--I had a client last year who went to exactly 43wks, 1day. It seemed earlier on--by around 39-40wks, that her baby was descending gradually toward engagement. Then it headed north, and was definitely 'floating' for the rest of her pregnancy. At exactly 43 wks I finally got a little concerned, and we discussed maybe doing an ultrasound to see if the cord was in the way, or there was some other issue preventing baby from descending. I gave the family 'a couple days to decide what to do', since otherwise mom and baby were fine. Their answer? For mom to give birth spontaneously the very next day--after only 4hrs active labor. Once contrax started, baby came right down and out!

Your doc made an assumption is all. There is absolutely NO way to know from 'floating', whether or not labor will initiate and birth will happen. Some women simply have long pregnancies. 9lbs is just not that huge, and anyway, by 40wks baby growth slows quite a bit; by 42wks average growth of a baby is 1/4lb a week, more or less.

True CPD is VERY VERY RARE.

[Proverbs31]

Yeah, see that's why I don't understand why floating vertex would be reason enough for a prophylactic c-section. I would think the pressure of contractions would normally be enough to help baby engage in the pelvis...

[turtlewomyn]

I had a coerced scheduled c-section for fetal macrosomia. DD was 9lb8.5oz (9.lb10oz by their U/S estimate). According to their dates (based on a 12 week U/S) I was 41w3d when they sectioned me, according to my dates (based on LMP and when I actually ovulated and conceived) I was exactly 40w on the day of the c-section.
My DD was also vertex and floating. I have two reasons for this: 1. I had mild polyhydraminos (AFI=25 on the U/S where she was determined to be "too big"). I got my fluid down by cutting out sugar (based on a suggestion of someone on here). At a subsequent U/S (for a BPP) my AFI was down to 21, within the normal range of 12-24. Of course, they didn't tell me this, I found out from my records.
2. I now belive that DD was also malpositioned and in an OP presentation. I got a copy of the book: Teaching and Understanding Optimal Foetal Positioning, and based on her movements I am pretty sure she was OP. I also remember feeling her try to inch her way down and floating back up.

My suggestions to you are to cut out as much refined sugar as possible and to really work on positioning. Take a prenatal yoga class, check out the spinningbabies website, get a copy of OFP or the other book by the same authors ("Sit up and Take Notice!")

I look forward to reading your birth story!!

[balancedmama]

DD was floating until labor. She was 9lb. 4oz at birth after pooping. I think there are studies supposedly indicating that babies who are not engaged at term are less likely to be born vaginally, but who knows whether this is due to true challenges in labor or care providers' lack of faith. I suspect it is the latter. I feel fortunate that I had a MW who trusted me. Oh, additionally, my baby was malpositioned and I also had moderate polyhydramnios (AFI 31 at 24 weeks). I assume the PH continued for the rest of the pregnancy although I refused any more ultrasounds. I was enormous so I think it did. I agree w/ MsBlack who said your dr just made an assumption.