Breech HBAC? Is it safe??? - Mothering Forums

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Old 01-23-2009, 06:23 PM - Thread Starter
 
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I am planning a homebirth/VBAC and I'm a little over 36 weeks. This is baby #2 for me, my first was a c/s due to an induction (as you all know how that goes) that was done so my (former) OB could hurry up and deliver me as she was 9 months pregnant herself and about to go into labor. I did dilate all the way, but had all the interventions, including having my water manually broken which I believe caused my son to become stuck in a posterior position. An epidural numbed me and I had a lot or trouble pushing, so was sectioned.

Anyway this pregnancy I switched to a midwife and got a doula who both do homebirths and VBACs. Only problem is, my baby has been transverse and breech since the 20w ultrasound! Baby is a flipper and is constantly moving around so it's not like he/she is "stuck" in a transverse or breech position. One visit to my midwife some weeks ago baby was breech, the next week I had a 3D u/s done and baby was head down (yea!), and then the following week had another midwife appt and baby was transverse. Ugh. When I sleep at night I feel baby slip into either a vertex or breech position instead of diagonal or transverse. I've been going to a chiropractor who does Webster's for about 5 or 6 weeks now and I do a lot of the exercises on spinningbabies.com. I am starting to lose hope this baby will flip to head down and stay head down, so I am trying to get comfortable with the idea of a possible breech HBAC. My midwife has done a lot of breeches and HBACs, and my doula does not see any reason why a breech HBAC can't be done.

I, on the other hand, am nervous about the idea, but terrified about another c/s! What would you do??? Has anyone on here ever had a breech HBAC? I need some positive encouragement!

Thanks!

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Old 01-23-2009, 06:38 PM
 
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I don't have any experience in this, but how wonderful to have so much support from your midwife and doula! YEAH!!!!!

Sending you lots of head down vibes..maybe since your little one is such a flipper, by the time s/he's really time to come out, will stay down and come on out! Fingers crossed, prayers and vibes that this is the case!

Sorry I'm no help, but vibes indeed!

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Old 01-23-2009, 06:47 PM
 
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I'm currently deciding that very thing right now. My first babe was a section for breech, and this baby is persistently transverse for 2 months now. At first I thought I would not be comfortable with a breech at home for my first vaginal birth, but the more I looked at my options (which are almost none) I'm getting more comfortable with the idea (assuming baby rotates from transverse before or at the start of labor).

The important thing with breeches is to have an experienced provider, and I believe, to be ready to transfer or call 911 immediately if there are any problems. Having someone who doesn't know what they're doing attend your vaginal breech is more dangerous to you and babe than having a cesarean for breech, in my opinion. The care provider in this situation is so important; it sounds like your midwife has breech experience. Ask her more details: what presentations were the breeches? where they first or subsequent babies? how many needed rescusitation? how many needed transfer? did any have birth injuries? if so, how long until the injuries were resolved (were injuries minor temporary ones or permanent ones)?

For me, it looks like I may be able to have a breech VBAC in a faraway hospital, but my husband believes that trying a breech at home is our best option, and I tend to agree with him -- we're less than 10 minutes from Mayo Clinic, so we've got backup facilities extremely close to us with emergency cesarean and rescuscitation capabilities.

There are a few more things to consider and have in place with a breech homebirth, but it's definitely doable, and lots of ladies have done it. Just make sure you're fully informed of all the risks and benefits so you can make the best decision for you and baby.
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Old 01-24-2009, 08:38 AM - Thread Starter
 
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Thank you guys for responding!!!

MNHall- thanks so much for all the flipping vibes!

Thanks Jackie for all that info! I haven't gotten the chance to ask my MW about her breech experience, I just know she has it. I know she also does a LOT of HBACs, but I don't know about breech HBACs.

I know you said your lo is transverse- mine seems to like transverse the best too! Over a month ago my MW manually moved my little one to head down, but by the next day baby was all over the place again... is it true that it is easier with transverse than breech, as far as moving baby or baby having higher chances of moving to vertex?

I don't know if I feel comfortable with a breech HBAC, as scared I am of going through another c/s. I would never forgive myself if something happened to my baby, you know? Ugh. How far along are you, Jackie?

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Old 01-24-2009, 07:16 PM
 
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I'm 32 weeks right now, and from what I understand, transverse can actually be trickier to turn than breech. That's because most transverse babies need to tuck their chin, roll UP to breech, then roll DOWN through another transverse lie and finally to vertex. A baby may be able to simply rotate the 1/4 turn down to vertex if baby is laying with its back toward the sky and its face toward the ground, but that's not usually the case, from what I understand from talking with both my homebirth midwife and my hospital CNMs ... Very few babies will "back flip" to vertex, so it really depends on how the transverse baby is lying. There's not a lot of research that I've been able to find on transverse lie. I know there's no way a trasnverse baby can be born vaginally unless he/she flips to breech or vertex, so that's probably why.

I just can't believe I'm going through this again with baby #2. I've finally come to the conclusion that yes, there may be something with my body that makes me incapable of carrying a term vertex baby, but that does not automatically mean that I can not BIRTH a breech baby. Make sense? So I carry breech; that doesn't mean I can't birth breech. Maybe it's just the way my body needs to do it ...
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Old 01-24-2009, 07:35 PM
 
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Just so long as you know that a tranverse presentation can not be delivered vaginally, and so long as your attendants know how to recognize a transverse presentation.

http://books.google.com/books?id=ELU...um=8&ct=result
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Old 01-24-2009, 07:38 PM
 
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Yup, with transverse, you'd need another section. If I knew my midwife was experienced with breech birth, I'd be fine with it.

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Old 01-24-2009, 07:48 PM
 
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Originally Posted by JackieM View Post
I'm 32 weeks right now, and from what I understand, transverse can actually be trickier to turn than breech. That's because most transverse babies need to tuck their chin, roll UP to breech, then roll DOWN through another transverse lie and finally to vertex. A baby may be able to simply rotate the 1/4 turn down to vertex if baby is laying with its back toward the sky and its face toward the ground, but that's not usually the case, from what I understand from talking with both my homebirth midwife and my hospital CNMs ... Very few babies will "back flip" to vertex, so it really depends on how the transverse baby is lying.
I could't find it on spinningbabies last time I was there but maybe this is why they advise for fetal positioning to lie head-down on an inclined ironing board, or do the inversion on the stairs? Both positions would give the baby a chance to be in a position to only have to do the 1/4 turn with gravity in thier favour. So, JFTB, are you doing the inversion technique too? or just the "easy" exercises? maybe it's time to step it up if you're not. Good luck!!

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Old 01-24-2009, 07:49 PM
 
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Gads, rhia, thanks for that link.

I swear, I am ALWAYS in the "extremely small minority" -- first with frank breech babe #1 (3-4%) and now transverse babe #2 (.3%) This kid seems to turn easily, especially at night when I'm on my side, so I'm hoping a version will be successful if he doesn't turn before 38 weeks.
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Old 01-24-2009, 07:51 PM
 
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Kristen, yep, I've been doing the extreme inversion. Also doing chiro. Will be talking to acupuncturist about acu and moxi this week, but that often can't be started until later in the pregnancy, so we'll see. Also doing lots of bobbing up and down in my health club's warm, deep pool. They think I'm crazy there.
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Old 01-24-2009, 07:53 PM
 
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I would start calling chiros and accupuncturists. Also keep in mind that babies can turn even in labor. My brother was breech the whole 9 months until 2 hours before my mom's water broke. He was born 2 hours later.
Praying baby turns for you.
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Old 01-26-2009, 03:04 PM - Thread Starter
 
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Thanks for all the replies!!!! I was out of town this weekend and had no internet access so sorry for the delayed response!

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This kid seems to turn easily, especially at night when I'm on my side.
ME TOO! This is totally my little one too- at night when I lay on my side the baby goes back to being vertex or breech (or sometimes oblique). Hoping that means our babies will turn before labor or at least will be able to be easily manipulated to head down for a vb!

I've been seeing a chiro since the beginning of Dec but don't know if it's helping... I emailed my acupuncturist (had acu done after my 3rd m/c) to see if he does moxibustion and haven't heard from him yet... anyone on here know anyone in the DC suburbs (MD/VA) or DC that does it?????

Jackie, was there ever any "cause" for your first baby's position? Sometimes I get worried when I read stuff on the net about something being wrong with the baby, and therefore it's in the wrong position... the vast majority of breech or transverse babies are "normal", right?

kdtmom2b- hahaha- yes, I've been doing the "easy" exercises- hands & feet, knees to chest, etc.

Jackie- I *think* my baby is face down, not face up. Only b/c when my MW moved him/her to head-down from transverse weeks ago at my prenatal, she just moved baby a few pushes and was head down and ready to go. And, the butt was poking high up in my tummy. But, of course, baby decided to turn right back. Part of me worries there is a reason, like I read stories of babies having short cords, etc.... I've had several u/s's during this PG, do you think that is something that would have been picked up? Mainly I feel like my stomach is just completely stretched out from my son who was HUGE at birth (he's 2 1/2 now). Before I had him I had a nice tight tummy, afterwards I have had a ton of extra skin and wrinkles (no more bikinis!). So I am assuming my stomach muscles were also very stretched out. DS was head down at 20w and never budged or flipped.

A little while ago today I felt baby move transverse and I saw the bulge of the head on one side and butt on the other and it was SOOOOO uncomfortable it took my breath away! So I did hands and knees and baby slid back to vertex or breech (can never tell which it is). My MW is coming on Thursday for a home visit- hopefully she'll make me feel better!!!

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Old 01-26-2009, 06:03 PM
 
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Nope, mine was an undiagnosed breech -- nothing wrong with cord, placenta or uterus to indicate a reason for breech. He was just stubborn.

Cords can be seen on doppler ultrasound, which tracks the blood flow and allows the technician to count the vessels in the cord.

My babe seems consistently transverse/oblique, so I'm jealous yours goes to at least breech.

I have an appointment with the acupuncturist tomorrow morning ...
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Old 01-26-2009, 06:09 PM
 
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Sometimes they go head-down/anterior during labor too. That's what happened with my friend's daughter. She was presenting breech and flipped during labor.

Expecting a boy? Be sure to check out MDC's Case Against Circumcision!
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Old 01-27-2009, 01:43 AM - Thread Starter
 
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My babe seems consistently transverse/oblique, so I'm jealous yours goes to at least breech.
...
It only goes to breech when I lay on my side, otherwise mine always seems to be transverse/diagonal (oblique???) too! I pray we both get our VBACs!!!! Good luck at your appt tomorrow!

Thanks, My Scorpio! Stories like that give me hope!

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Old 01-28-2009, 04:37 PM - Thread Starter
 
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Jackie how did your appt go???

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Old 01-28-2009, 05:22 PM
 
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Are you getting the Webster technique done when you get chiropractic adjustments? This is where a large amount of the the benefit comes in with breech.

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Old 01-29-2009, 02:05 AM
 
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Well, baby seemed to move a lot more than normal during the 24 hours after the acupuncture appointment. She didn't do any points used for turning breech, just some points for relaxation and my hip pain. I think the relaxation is what helped baby feel free to move more, as I've been doing more conscious deep/yoga breathing the last 24 hours. I'm a bad doula, I haven't been practicing at all for this upcoming birth; my toddler is very demanding, a close friend was just diagnosed with cancer and I just don't have a lot of free time. So I'm going to do more focused relaxation work from now on, and see what happens.

Good news: I've found 2 maya abdominal massage practitioners within 1.5 hours of my house, so that's also on my plan of attack for now ...
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Old 01-29-2009, 03:07 AM
 
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The problem with a sacral lie is not the butt first but usually the reason for the sacral lie.

Often the reasons can be a uterus with a muscular band around it, hydrocephalus, CPD, or cord or placental issues most of which are ruled out with an ultrasound scan; other than that, an experienced attendant who is comfortable with a sacral presentation is all you really need. Good luck

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Old 01-29-2009, 06:59 PM - Thread Starter
 
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The problem with a sacral lie is not the butt first but usually the reason for the sacral lie.

Often the reasons can be a uterus with a muscular band around it, hydrocephalus, CPD, or cord or placental issues most of which are ruled out with an ultrasound scan; other than that, an experienced attendant who is comfortable with a sacral presentation is all you really need. Good luck
What is a sacral lie?

I have had 3 u/s's (NT scan, 20w level II u/s, and a 3D u/s around 33 weeks)... none of those showed anything abnormal... should I still be worried?

Jackie, glad baby is moving more! Sorry about your friend.

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Old 01-29-2009, 09:15 PM
 
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dd2 was a c/s at 41w6d because she was persistently footling breach. We really believe that her position was because the placenta was very low lying and there was not ideal room down by the cervix for her bottom or head to settle into. We did everything possible to turn her or get her engaged and she just would not do it. My mw is experienced with frank breech and I would have homebirthed with her if dd had been bottom down, but neither of us was comfortable with footling breech because of the much higher chance of prolapsed cord. She is caring for me this pregnancy also and says that she would be okay with a frank breech vbac.

I would just suggest to just keep on trying everything that you can until that baby turns. Adjust your lifestyle to promote optimum baby position. I plan to stay off of the sofa and anything that reclines me or makes me slouch the last 8-10 weeks of pregnancy. Hope that baby turns for you very soon and stays head down!
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Old 01-29-2009, 10:44 PM
 
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What is a sacral lie?
The position in which the Sacrum (butt) presents first.

There is also the Occiput (head) presentation, the Mentum (chin) and the SCapular presentation (shoulder). There are variations on all of these, as the sacral lie can also be a foot presenting instead; an occiput presentation can also be a brow presentation.


All are variations. The only mentum presentation I know of personally was in a woman whose baby had Prader-Willie Syndrome.

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Old 01-29-2009, 10:48 PM - Thread Starter
 
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The position in which the sacrum (butt) presents first.
Ah, thanks Applejuice! Mine is mostly transverse though (???)

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Old 01-29-2009, 11:45 PM - Thread Starter
 
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All are variations. The only mentum presentation I know of personally was in a woman whose baby had Prader-Willie Syndrome.
Great... one more thing I need to worry myself about Would this be something detected on an u/s? I had one at 20w and a 3D at 33w and nothing abnormal was seen???

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Old 01-30-2009, 12:01 AM
 
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The lie would be seen on a scan; how the baby is lying in the womb, what the presenting part is and the relationship of the axis of the baby's body to the mother, that is anterior, posterior or transverse.

You need to ask what the presenting part of the baby is and what the doctor means by a the baby being transverse. The head could be facing your hipbone and that would be a LOT or ROT left occiput transverse or right....depending on which hip the baby is facing. Ask your doctor since s/he is the one who is the best to interpret it and advise you.

And relax...knowledge is power in childbirth.

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Old 01-30-2009, 12:33 AM - Thread Starter
 
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The lie would be seen on a scan; how the baby is lying in the womb, what the presenting part is and the relationship of the axis of the baby's body to the mother, that is anterior, posterior or transverse.

You need to ask what the presenting part of the baby is and what the doctor means by a the baby being transverse. The head could be facing your hipbone and that would be a LOT or ROT left occiput transverse or right....depending on which hip the baby is facing. Ask your doctor since s/he is the one who is the best to interpret it and advise you.

And relax...knowledge is power in childbirth.
Thanks... I guess I was asking more about the syndrome... that would have been noticed if I have had multiple u/s's, right? Gosh I just worry about everything!!!

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Old 01-30-2009, 12:48 AM
 
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http://www.nlm.nih.gov/medlineplus/e...cle/002060.htm

Maybe this will help explain more.

"The great enemy of the truth is very often not the lie, deliberate, contrived and dishonest, but the myth, persistent, persuasive and unrealistic."
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Old 01-30-2009, 12:56 AM - Thread Starter
 
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Thanks... I got your private message and tried to send you one back but it said you don't except private messages? Is there somewhere else I could send it to you, or should I just post it here?

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Old 01-30-2009, 07:34 PM
 
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Baby is not only head-down, but LOA! I am praising God and crying happy tears. It's definitely a strange kind of LOA lie, and I can't help but wonder if all the palpations have been wrong the last 6 weeks and he's been LOA all along ... Position was confirmed by ultrasound. I'm not a fan of any ultrasound, but I NEEDED confirmation of not only his presentation, but his body position as well.

His head is just about engaged, his shoulders are between my hips, and his upper back is rounded against my left side. But, since I'm so short-waisted (hardly any length between my hips and rib cage) and this kid is measuring long, the majority of his back is actually lying horizontally under my ribcage, with his bum nestled over by my right hip. His legs are wadded up underneath him, mostly on my right side. So, by palpation, he feels either transverse or breech (no one seems to be able to tell this kid's head from his butt). So relieved and happy to charge full-steam ahead with homebirth plans! Ordering my birth pool (the sevylor) today!
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Old 01-31-2009, 12:32 AM - Thread Starter
 
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Baby is not only head-down, but LOA! I am praising God and crying happy tears. It's definitely a strange kind of LOA lie, and I can't help but wonder if all the palpations have been wrong the last 6 weeks and he's been LOA all along ... Position was confirmed by ultrasound. I'm not a fan of any ultrasound, but I NEEDED confirmation of not only his presentation, but his body position as well.

His head is just about engaged, his shoulders are between my hips, and his upper back is rounded against my left side. But, since I'm so short-waisted (hardly any length between my hips and rib cage) and this kid is measuring long, the majority of his back is actually lying horizontally under my ribcage, with his bum nestled over by my right hip. His legs are wadded up underneath him, mostly on my right side. So, by palpation, he feels either transverse or breech (no one seems to be able to tell this kid's head from his butt). So relieved and happy to charge full-steam ahead with homebirth plans! Ordering my birth pool (the sevylor) today!
Yea!!!! That's great news!!! Hopefully I'll get the same news too soon! I may get an u/s this coming week, so send some "good position" vibes this way!

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