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C-section - please help me understand this doctor's thinking.

post #1 of 24
Thread Starter 
I'll be 33 weeks on Monday. Ultrasound yesterday shows Little Boy (baby A) breech, and Little Girl (baby B) transverse. They've been hanging out in these positions for about a month now, and seem pretty comfy like that. My doctor is the least intervention-happy guy in town, but he is gently prodding me toward c-section nonetheless. And not just c-section - c-section at 37 weeks. He says that if the babies stay in these positions, it's "not a good idea for [me] to go into labor." He says there's a higher risk of cord prolapse.

Can someone explain this to me? Is there really a problem if I go into labor with the babies in these positions? Even if they don't move, I would rather go into labor and then have the c-section than just pre-empt labor altogether. Isn't cord prolapse something that happens on the way out of the birth canal? Won't I have enough time between the onset of labor and the pushing to get prepped for a c-section if that's what we have to do? I'm not going to refuse the c-section if it is medically necessary at the time of birth, but I don't understand why we shouldn't give the babies (and me!) every chance at a non-medicated vaginal birth.

(X-POSTED IN BIRTH AND BEYOND FORUM)
post #2 of 24
Have hope, your babies can still turn, even in labor. It would be best to go into labor than to just go get a c-section. Labor produces certain hormones. These hormones are important for the babies, it gets them prepared for life outside the womb, like helping them with breathing. Yes a prolapsed cord is when the cord comes out first, just because of how the babies are positioned doesn't mean you are at risk for prolapsed cord. I believe babies go into certain positions in utero because that is the best place for them to be. Babies are smart, they know what to do, they are interested in surviving. Be positive, trust your babies. Some doctors tend to plan for things to go wrong and figure out what they can do to fix it before it even happens. Your doc is putting the cart before the horse. Trust birth-interfearance is risky.
post #3 of 24
Actually, a breech and transverse baby do put you at a higher risk of cord prolapse. This can happen if your water breaks with one of the babies and the cord is swept into the vagina before the presenting part.

However, the chance is actually pretty small, and it's only IF your water breaks to begin your labor (in which case you would want to move to the hospital post haste). I see no reason, if you are willing to take this small risk, that you cannot attempt a trial of labor and see if the presenting baby will move vertex. This is something you really need to talk to your OB about. They do tend to be C-section happy because it covers their butts.
post #4 of 24
i second what dgonz880 said. my babies were flipping right up until the very end, born at 40wks. they settled at breech/breech unfortunately, dr said he wouldn't deliver vaginally, so i just labored as long as possible at home and got to hospital at 8cm. my water broke as my first sign of labor and my doula and i just monitored the situation until it was time to go in.
even though my dr wouldn't do a breech vaginal delivery, he was willing to let me go to 42 weeks so long as things looked healthy. i wish these drs would just have a little faith
stay positive and trust in the process. i talked to the girls everyday
post #5 of 24
I agree that waiting for labor would be the best course for everyone involved. If he's willing to deliver the babies vaginally if baby A is vertex, you could wait it out and see if the baby will turn. My baby A was engaged in a frank breech position and still turned one day before they were born at 39 weeks and 1 day. If I had been seeing a Dr. rather than a midwife, I probably would have been pressured to have a c-section at 37, 38 or 39 weeks and baby A would not have had a chance to turn. It's amazing what babies are capable of and as previously mentioned, they will do what is in their best interest, even if it's not what WE want.
post #6 of 24
Quote:
Originally Posted by uccellina View Post
I'll be 33 weeks on Monday. Ultrasound yesterday shows Little Boy (baby A) breech, and Little Girl (baby B) transverse. They've been hanging out in these positions for about a month now, and seem pretty comfy like that. My doctor is the least intervention-happy guy in town, but he is gently prodding me toward c-section nonetheless. And not just c-section - c-section at 37 weeks. He says that if the babies stay in these positions, it's "not a good idea for [me] to go into labor." He says there's a higher risk of cord prolapse.

Can someone explain this to me? Is there really a problem if I go into labor with the babies in these positions? Even if they don't move, I would rather go into labor and then have the c-section than just pre-empt labor altogether. Isn't cord prolapse something that happens on the way out of the birth canal? Won't I have enough time between the onset of labor and the pushing to get prepped for a c-section if that's what we have to do? I'm not going to refuse the c-section if it is medically necessary at the time of birth, but I don't understand why we shouldn't give the babies (and me!) every chance at a non-medicated vaginal birth.

(X-POSTED IN BIRTH AND BEYOND FORUM)
I can't help you with what your doctor is thinking. I think you might consider spending more time talking with him about this.

FWIW, my twins were breech. Baby A was frank and Baby B was footling.
post #7 of 24
Both of mine were transverse throughout the whole pregnancy. My ob was happy to let me go to 38 weeks and then see what happens, but Raphi was seen to be in distress in the 36 week ultrasound, so out they came! But if everything looks fine, I don't know why he wants to hurry you along? I know that where we are if it is an emergency c-section DHs are not allowed in, but if it is planned they are. So on Thursday the ob at the high-risk clinic said that he would schedule us for the following Sunday so that DH could be there. Is that a consideration?
post #8 of 24
Thread Starter 
Thank you all for your responses! After further discussion with my midwife and reading up a bit more, I think we're going to push for 38 weeks rather than 37, and I'm going to focus on spinning these babies with inversions. If they don't turn, I'll schedule the c-section with the understanding that it will be un-scheduled if they turn last-minute.

Shuli - they'll let my husband in no matter what, fortunately.
post #9 of 24
My baby A was footling breech and baby B was sideways (don't know what you call that - her head was essentially tucked into her brother's stomach with her butt down).

My doc would only deliver if A was vertex (and then turn B or deliver B breech).

Even though they knew I was at risk of cord prolapse (all the cord was dangling low in the ultrasounds, below A's feet, so if my water broke, that would have been bad), the hospital would not allow a c-section before 39 weeks without an amnio demonstrating lung maturity.

So I had a scheduled c-section at 39 weeks, one day.

In short, the issue wasnt' necessarily that I would go into labor, it was the possibility of my water breaking with the twins on top of all the cord.

There's also an amnio test they can do to test for lung maturity. It's not conclusive, but if it comes back negative (meaning the lungs aren't fully mature), it may give you more of an argument to wait another week if you wish.
post #10 of 24
Have you tried the Webster technique to encourage babies to turn? My Baby A was breech and Baby B was vertex until about 36 weeks. A few trips to the chiro and both babies were vertex and stayed that way until birth.
post #11 of 24
Thread Starter 
Royaloakmi - I will definitely request the test for lung maturity. Thanks for mentioning it! Just out of curiosity, are you in the U.S.? I guess I'm surprised that there's a hospital anywhere at this point that wouldn't allow a c-section before 39 weeks with twins.

Purpleheather - My doctor, my midwife, and my chiropractor - who specializes in Webster - have all advised against trying it with twins, due to the risk of breaking the waters.
post #12 of 24
I tried hands/knees, pulsatilla, etc and could not get baby A to turn vertex (B was already vertex) When I finally gave up, the next day A turned vertex and B decided to push A out of the way and present first. That was at 36+ weeks. Plenty of time to turn on their own.
post #13 of 24
Yes, I'm in the U.S.

Just so you know, the amnio test only shows that the lungs ARE mature. In other words, you can get a false negative (but supposedly not a false positive.)

Yes I am in the U.S. (in the Detroit area). They would only allow an emergency c-section before 39 weeks (multiples or singletons, didn't matter).

I don't know how Webster technique would lead to waters breaking . . . I did it in an effort to turn mine. It was very gentle (although completely ineffective.)

I had more baby movement with moxibustion (tons actually), though that didn't work to turn them in the end either.
post #14 of 24
i did webster, too and had lots of movement and yes, it was very gentle(it didn't turn them vertex but i do believe it aided in getting me to 40 weeks.) the moxi and the pulsatilla did the most for movement though! plus lots of inversion/meditation/positive thinking
i don't have all the facts, but i would be really concerned if my dr told me c-sect at 37 weeks from the facts you gave. that is a month away! is the cord in a really dangerous place?
post #15 of 24
what about the website spinningbabies.com ? is that good for twins? I spent a lot of time down on my hands and knees talking to the twins telling them to stay head down.

Good luck!
post #16 of 24
Thread Starter 
I am doing the inversions from spinningbabies.com, and I'm definitely getting a lot of movement from Baby A since starting them. Let's hope it will convince him to shift his little butt.

I don't think the cord is in a dangerous place, so far as we know, because the placentas are sitting up top. Like I said, I'm going to hold out until 38 weeks.
post #17 of 24
my girls were in the exact same position as yours and never turned. I was really hoping for a vaginal delivery, but i never even went into labor. I actually made an appointment to have them and it was a c-section. It was the easiest thing i've ever done. I think that as long as they are healthy it doesn't really matter how they are delivered. Yes they say c-sections are much harder to recover from, but in my experience, i was walking like I hadn't had twins by day 6. Good Luck and who knows, they could turn!
post #18 of 24
Quote:
Originally Posted by uccellina View Post
Purpleheather - My doctor, my midwife, and my chiropractor - who specializes in Webster - have all advised against trying it with twins, due to the risk of breaking the waters.
That's something I've never heard before. How would Webster break the waters? There is no contact whatsoever with your uterus. I'd be interested to know where that information came from.
post #19 of 24
Interesting question. My peri recently mentioned that there is some research that indicates twins do better when born around 37w. But this was just an offhand remark, I can't recall what it was in response to, and we didn't discuss it further. I think she said that the research was not conclusive yet?

I'll add that Kaiser (where my peri is) likes to do things as naturally as possible. At class tonight was a woman who is 38w with twins and she said there've been no discussions of scheduling a c-sec.

I'm sure you'll get things straightened out.
post #20 of 24
Quote:
Originally Posted by purpleheather79 View Post
Have you tried the Webster technique to encourage babies to turn? My Baby A was breech and Baby B was vertex until about 36 weeks. A few trips to the chiro and both babies were vertex and stayed that way until birth.
Quote:
Originally Posted by uccellina View Post
Purpleheather - My doctor, my midwife, and my chiropractor - who specializes in Webster - have all advised against trying it with twins, due to the risk of breaking the waters.
Quote:
Originally Posted by purpleheather79 View Post
That's something I've never heard before. How would Webster break the waters? There is no contact whatsoever with your uterus. I'd be interested to know where that information came from.

I was wondering this, too. Webster Technique is not like an external version (which, as far as I know, has to be done in an OR--or at least very near--because of the risks involved with the procedure.) Honestly, I don't know if an external cephalic version even is an option where twins are concerned. But I was curious about whether Webster would work with twins.

In my first (singleton) pregnancy, my baby was breech late and the midwives sent me over to the OB side of the practice and basically said I could try a version or else have a c-section. I scheduled the OB consult but made sure I had some time in between to meet up with a Webster-certified chiropractor and start alternative efforts to get the baby to turn. I did the positioning and visualization/talking, and I went for several appointments with the chiro within a few days. I believe in my case it was that my pelvis had gotten out of whack and there was a lot of lower uterine tension. She had originally dropped, but then pulled back and turned around.

I saw the chiropractor for the first time on Friday, and my OB consult was to be on Tuesday morning. Over the weekend, I spent a lot of time in positions to encourage movement and I did feel a lot of scrabbling and shifting. On Monday I believed she'd turned, and we confirmed it via ultrasound on Tuesday. I met with the chiro both Monday & then early Tuesday morning.

I was surprised to see the claim that, with Webster, there'd be some kind of increased risk of breaking the waters. It was a matter of relieving the external causes of the uterine strain--muscular or skeletal in nature. It really was non-invasive, just involving things like wedges under one foot and gentle adjustments that made me stand straighter and feel generally more comfortable. I think the emphasis is more sacral/sacrum--it wasn't belly-oriented or baby-oriented at all, that's for sure. (No effort to "move" or shift the baby.)

I think there's some comprehensive website that lists all the Webster-certified chiropractors....my husband used that directory to find one close to us.

It sounds like you are having some good responses in your efforts to encourage optimal positioning, and I wish you the best on the homestretch!
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