Planned C-section - Wait for labor or schedule? - Mothering Forums

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Old 04-14-2004, 11:58 AM - Thread Starter
 
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Does anyone know of any studies that talk about the effect on fetal outcome of waiting to go into labor vs. scheduling a c-section?

I've talked about this extensively on other threads, so I won't go into it here, but I'm currently breech and if the baby doesn't turn I'll very likely end up having a c-section.

Obviously the longer I wait, the greater the likelihood (however small) that the baby will turn on its own. But aside from that advantage of waiting, I've read bits and pieces here and there that indicate that labor is good for babies, and it might be better for the baby's health to wait until I naturally go into labor.

But according to my OB, scheduled sections result in lower maternal infection rates, and he wasn't familiar with any research about improved fetal outcomes from labor.

I'd appreciate any references or information you might have to offer.
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Old 04-14-2004, 01:37 PM
 
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How far along are you? Are you RH negative?

If you aren't RH negative they can try an external version (I assume you haven't already tried this). If you are, however, they can't. There are other things you can do to encourage your baby to turn--handstands underwater (!) apparently work for some women!

And remember, breech babies CAN be delivered vaginally. Many docs just don't want to.

If I were in your shoes, here's what I would do: try some natural version techniques and then yes, allow my body to labor. With close, but not stifling (i.e. without being confined to bed or on your back, God forbid), observation during labor I think you and your doctor will know when things need to be reconsidered.

Good luck!
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Old 04-14-2004, 01:40 PM
 
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I haven't had a c/s, so I can only offer information from everything I've read. (Check out Silent Knife and Open Season.)

Labor contractions strengthen the baby's lungs and force out excess fluid. One reason so many c/s babies are sent to the NICU is that since they didn't experience contractions, their lungs are not strong enough to breathe right away and they need to be suctioned.

Another reason to wait is to be sure the baby is ready to be born. Not all babies are ready at 38-39 weeks, even with amnio and steriod shots. If you wait for labor you will know it's time.

Another reason to wait is that if the presenting part is well engaged in the pelvis, the doctor may decide that a vaginal delivery is safer.
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Old 04-14-2004, 01:47 PM
 
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Originally posted by Greaseball
...Labor contractions strengthen the baby's lungs and force out excess fluid. One reason so many c/s babies are sent to the NICU is that since they didn't experience contractions, their lungs are not strong enough to breathe right away and they need to be suctioned.
I had an unexpected csection with Joe, & I had labored from early in the morning till 3pm when he was born, & he did not have to go to the NICU at all, nor did he have any problems nursing.

I have no scientific data to back this up but it seems to go along with what Greaseball said... I think I would wait to start contracting naturally.
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Old 04-14-2004, 01:52 PM
 
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There are some benefits to waiting. The contractions to help stimulate the lungs. But the fluid is not all forced out because baby is not squeezed through the birth canal. (Bryce was in special care for 30 hours from this very thing). Yes, you know baby is "ready"

Benefits of scheduling: you get to pick your ob that does it. You can be more specific about your anesthesiologist and request certain things happen and certain things don't happen. You are more able to pick the type of pain management. Thinsg are much more calm in the OR. You will feel more prepared.

Some hospitals also require that a certain amt of fluid be through your iv before a c/b so that may be an issue but I don't know for4 sure.

I can list others. I have had an unplanned c/b and a scheduled one. The planned one was a much faster recovery. I had perfect pain management (which wasn't a lot but it was all stuff that would NOT make me loopy). I absolutely loved my planned experience. I awited till 40 weeks to have my repeat.

You could schedule it for after 40 weeks and see if baby turns (gives baby plenty of time) and if you go into labor first then there ya go.

If I were you. I would schedule it. Check out the c/b support thread

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Old 04-14-2004, 01:55 PM
 
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Originally posted by Greaseball
If you wait for labor you will know it's time.
Is this really true?? Some women go into labor because their body says its time..not the baby

When it comes to recovery and such...planned is better. If your recovery is rough then the start of new baby-ness is hard. I labored with Tracy for 14 hours on pit before my c/b and recovery was hell.

My ob said that a uterus that goes through labor first is more likely to infect and cause heakling problems (but I have notheing on hand to back it up)

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Old 04-14-2004, 01:55 PM
 
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since your baby is breech there will be no great hurry to get them out. It won't be an emergancy situation so I think that there would be plenty of time for you to get proper prep, a good long wait for the anastesia to kick in and such. I can't imagine why there woiuld possibly be a hiogher infection rate. The only concern I can think about is that you wouldn't have been able to fast before the procedure. otherwise I would think waiting for labor is the optimal way to go. You lower the risk of prematurity
(I have never met a person, although I am sure there are some, who so much as waited for thioer due date for a planned c-sec. Most go 1-2 weeks early) and lower risk or respitory distress in the baby. I would say wait. also every minute you wait is one more chance for that baby to turn around.

Turn baby! turn baby! Sending turning thoughts your way so that you don't even have to make this descision

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Old 04-14-2004, 02:02 PM
 
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I wanted to add that even if you waited for labor to start doesn't mean you don't have some degre of planning. You know you wil be c-birthing so you can pick you ob assuming he is one who would come at any hour for a regular birth. also you can plan for what ned you use and pain relief options, and make a c-birth specific birth plan so that you are going in with your eyes totally wiode open. Since you will only experiance a little bit of labor it isn't like you have to worry about uterine fatigue like someone who has been through hours and hours of tourterous labor (and all of those women have my deepest respect. I would never make it that long without begging for a operation). And while the baby may not be able to squweeze out all the fluid a baby goes through a ton of phisiological changes between the time labor starts and they come out. every minute of warnign the baby gets is advantagous. My midwife wen over them with me when I was in labor but i was in the middle of a high risk labor and can't remally remember them all (I was 6 weeks early and she was trying to keep me in labor for 5 days :LOL I made it 8 hours. I can't even imagine how fast she would have come had they not been working so hard to slow it down.) but she said for every hour they could keep me in labor my baby would be be better because they kinda go into fuill throtle once labor starts and all those final details get taken care of.

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Old 04-14-2004, 02:10 PM
 
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The only concern I can think about is that you wouldn't have been able to fast before the procedure.
Actually, natural birth advocates say that NOT fasting is better. It doesn't make any difference in whether or not you will vomit. If you are awake and vomit, you are not very likely to aspirate. Most women who aspirate do not die from it, and if you vomit on an empty stomach the fluid will be more acidic and can irritate the lungs more than regular vomit.
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Old 04-14-2004, 02:19 PM
 
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Originally posted by lilyka

(I have never met a person, although I am sure there are some, who so much as waited for thioer due date for a planned c-sec. Most go 1-2 weeks early) and lower risk or respitory distress in the baby. I would say wait. also every minute you wait is one more chance for that baby to turn around.
I waited till 40 weeks and I would have waited longer but decided last minute I was VBAC but unsure so I changed my mind. They will let you schedule a c/b for past 40 weeks.

Oh and you are right about the infection. I think that was VBAC women who end up with a c/b repeat...but I can't be sure. My mind is a little foggy

Like I said, I'd plan for 41 weeks maybe even 42 and that way you already have your "back up" plan and if you go into labor first GREAT! I would defenitely NOT go before your edd

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Old 04-14-2004, 03:02 PM - Thread Starter
 
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Thanks everyone.

I am RH-negative - but I haven't read anywhere that that would contraindicate me for a ECV. (I was assuming they'd give me prophylactic Rhogam just in case.) I will have to ask the doctor about that - I just realized that my RH status did not come up during my appointment yesterday and that is an important piece of information to make sure he has.

Due to the late date at which we discovered all of this, if we decided to schedule a c-section it would probably end up being over 40 weeks (seeing as how I'm 38w3d now and haven't got my version scheduled yet). But thanks for all the thoughts.
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Old 04-14-2004, 03:07 PM
 
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The biggest risk of a scheduled C/S is incorrect dating of the pregnancy. If you are very sure of your conception dates, this isn't an issue. But a week can make a big difference at certain points during your PG, so if you are unsure of your dates, I would wait for labour to begin. If it's your first, you have a greater chance on a longer, more drawn out labour. If it is your second child or more, I would be concerned about rapid labour. You don't want to be rushed through the preparatory work, and you sure don't want to be experiencing labour pains while they are giving you the epidural or spinal, lol. Also, how far from the hospital are you? The absolute last thing you want is an emergency section. They'll anaesthetize you (general) and not only will you miss the birth, but your baby will be much more affected, and you will likely not be awake enough to bond or nurse right after the birth. Finally, if the baby is too far engaged in the pelvis by the time they open you up, they have to reach into the birth canal and push baby back into your uterus. Not only does it give me the heebie-jeebies to even think about this, but I can't imagine how that wouldn't be risky or even painful for the baby.

The benefits of scheduling are: you know who your OB will be. I don't know of any practices where your OB is guaranteed to be there, no matter what time you give birth (one realy nice thing about midwives!). It's nice to have the person who's been caring for you there. Recovery is almost certainly going to be easier, unless you are able to start the process really early on in your labour. It is very convenient if you are needing to arrange childcare for your older children, or for DH to take time off work, etc. You can get a good night's sleep and, if you are scheduled for early in the day, you'll be able to rest during the day and sleep that night - no throwing off of your sleep patterns.

I confess I did not know that labour helped remove fluid from the lungs. I thought it was passage through the birth canal that did this.

I thought that there were midwives who would do breech births? Is there no-one in your area that you can ask?

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Old 04-14-2004, 03:21 PM - Thread Starter
 
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I'm a first time mom. My midwives would do a homebirth vaginal breech delivery if I was really insistent and willing to take on all the inherent risks, but it's beyond my personal comfort level.

At this point I'm probably leaning towards a scheduled section, but schedule for 40w+3 or 4 days. I am very certain of my conception date, so I'm not worried about the risk of prematurity.

Of course, really I'm just hoping that the baby will turn so I can have the homebirth I've been hoping for!
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Old 04-14-2004, 04:14 PM
 
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Originally posted by tammylc
Of course, really I'm just hoping that the baby will turn so I can have the homebirth I've been hoping for!
I just wanted to add-- in addition to what all these wonderful mamas have said-- I second the stand on your head underwater thing. My babe was breech right up until just under 40 weeks (born at 42 and 2 days, though!), and boy did I get funny looks at the public pool! He actually switched positions a few times, but itt was one day, a few hours after my daily pool shenanigans, than I was yelling at the dog for stealing what was to be dinner, and wouldn't you know it? DS flipped.....and stayed.

There's still hope he'll turn, mama.

Have you considered moxibustion as well? I have a friend that had great results with that.

Good luck, and your birth will be magical and powerful no matter what happens!
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Old 04-14-2004, 04:39 PM
 
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Originally posted by Greaseball
I haven't had a c/s, so I can only offer information from everything I've read. (Check out Silent Knife and Open Season.)

Labor contractions strengthen the baby's lungs and force out excess fluid. One reason so many c/s babies are sent to the NICU is that since they didn't experience contractions, their lungs are not strong enough to breathe right away and they need to be suctioned.

Another reason to wait is to be sure the baby is ready to be born. Not all babies are ready at 38-39 weeks, even with amnio and steriod shots. If you wait for labor you will know it's time.

Another reason to wait is that if the presenting part is well engaged in the pelvis, the doctor may decide that a vaginal delivery is safer.
I want to comment becaue I have done some resaerch on this and I posted some articles and studies on this subject on one of the csection threads.
Actually going into labor first and them going to the OR leads to higher mortality rates for borth infants and mothers. Risk of infection is greater, and it can also be less beneficial for baby.
Because your baby is breech, you have additional risks if you go into labor first. One is cord injury. A prolapse cord can be very serious and happened to my neighbor this past summer. She had to have an emergency csection after her water broke.
Also if you plan your csection, if you know you are having one, you can get the doctors you want and also schedule an anest. before hand. I hand picked everyone in the delivery room (except the student nurse) including the pediatrician and my L&D nurses. Also, IMO, it is better to have a scheduled csection during the week than in the middle of the night or on a weekend unexpectedly.
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Old 04-14-2004, 04:40 PM
 
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Originally posted by joesmom
I had an unexpected csection with Joe, & I had labored from early in the morning till 3pm when he was born, & he did not have to go to the NICU at all, nor did he have any problems nursing.

I have no scientific data to back this up but it seems to go along with what Greaseball said... I think I would wait to start contracting naturally.
None of my babies had to go to the NICU and one was an emergency csection.
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Old 04-14-2004, 07:41 PM
 
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Originally posted by tammylc
Thanks everyone.

I am RH-negative - but I haven't read anywhere that that would contraindicate me for a ECV. (I was assuming they'd give me prophylactic Rhogam just in case.) I will have to ask the doctor about that - I just realized that my RH status did not come up during my appointment yesterday and that is an important piece of information to make sure he has.

Due to the late date at which we discovered all of this, if we decided to schedule a c-section it would probably end up being over 40 weeks (seeing as how I'm 38w3d now and haven't got my version scheduled yet). But thanks for all the thoughts.
I'm glad I mentioned this! I too an RH neg and have been told many times that external version is NOT recommended for me, regardless of Rhogam. I could be wrong about this but that's been my experience. I would be interested to know what your doctor says about it!
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Old 04-14-2004, 07:43 PM
 
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Kim,

Doesnt it matter what particular breech position the baby is whether or not you need to worry about cord prolapse? Actually, I know that it does. IF a baby is engaged in the frank breech position that is actually quite safe.

My son was frank breech and I was given the option of scheduling or waiting for labor. I scheduled because I was 19 and SCARED to go into labor at all. My son was born at 7:32 on a wednesday morning without having experienced any labor contraxs and I was unable to see him for 3 hours because of respiratory difficulties. I was not told this could be an issue beforehand and I was stupid and didnt do any research. A postpartum nurse told me that it happens very often with scheduled cesareans and also that babies have a harder time breastfeeding because they are so "sluggish".

I believe it after seeing the difference in him and my dd, who was VBACed.

If I had to make that decision again, I would wait for labor to begin and immediately when it did I would begin making arrangements to get to the hospital. By the time I actually had the cesarean I think that would be enough time to benefit the babies lungs.
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Old 04-14-2004, 07:53 PM - Thread Starter
 
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AnaNicole - in my quick websearch, the strongest language I could find said that external version *might* not be recommended in Rh-neg mothers. And there are several references to routine Rhogam issuance following ECV.

I will certainly ask my doctor what his practice is, but it doesn't seem like the literature supports and out and out ban...
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Old 04-14-2004, 08:40 PM
 
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Kim,

Doesnt it matter what particular breech position the baby is whether or not you need to worry about cord prolapse? Actually, I know that it does. IF a baby is engaged in the frank breech position that is actually quite safe.

My son was frank breech and I was given the option of scheduling or waiting for labor. I scheduled because I was 19 and SCARED to go into labor at all. My son was born at 7:32 on a wednesday morning without having experienced any labor contraxs and I was unable to see him for 3 hours because of respiratory difficulties. I was not told this could be an issue beforehand and I was stupid and didnt do any research. A postpartum nurse told me that it happens very often with scheduled cesareans and also that babies have a harder time breastfeeding because they are so "sluggish".

I believe it after seeing the difference in him and my dd, who was VBACed.

If I had to make that decision again, I would wait for labor to begin and immediately when it did I would begin making arrangements to get to the hospital. By the time I actually had the cesarean I think that would be enough time to benefit the babies lungs.
Actually I have read of prolapse cord with all breeches. My friend had a footling. It is more common in footling and in transverse breech, but it can happen in all of them.

None of my babies were sluggish, and I have been at the hospital and been there when many of a csection baby was born and the planned ones came out very alert and screaming. The only babies I knew of that went to NICU or for observations were after labors, and they were sluggish from other drugs and they were all boys. Boys born vaginally also can have breathing problems because their lungs mature at a slower rate.


I also had no problems with breastfeeding. I think if you are determined to do it, where there is a will there is a way. My son was not as eager to nurse as my daughter was, but he was alert and looking around and he was born at 38 weeks.

To me, I would not feel comfortable at all going into labor with a breech baby, especially as first timer. Now if it was my second or third baby and I could birth vaginally, that would be a whole other story.
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Old 04-14-2004, 08:41 PM
 
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Originally posted by tammylc
AnaNicole - in my quick websearch, the strongest language I could find said that external version *might* not be recommended in Rh-neg mothers. And there are several references to routine Rhogam issuance following ECV.

I will certainly ask my doctor what his practice is, but it doesn't seem like the literature supports and out and out ban...
That would be enough for me not to do it to begin with. An ECV was traumatic enough for me (I ended up in the OR with an emergency csection).

Goodluck with weighing all the risks. Have you had the websters technique done? Are you having any success?
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Old 04-14-2004, 08:54 PM
 
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Kim,

Sorry, after all my time at Mothering I STILL do not know how to quote so I will just try to remember what you said...

Yes, I agree that cord prolapse can happen with any breech presentation, as well as if the baby is vertex, but it is true that if the baby is engaged then the risk is dramatically decreased. So if thats the case for the original poster I would think that cord prolapse was something that she should spend too much time worrying about.

I think that if I have another breech baby (having already labored and VBACed before) I would just seek out a breech experienced midwife in the area and go ahead and plan a homebirth. However I can COMPLETELY understand how a first time mom might not be comfortable with that. Heck, I wouldnt have been either.

We both have our experiences and just because my cesarean born baby was sluggish and had trouble nursing and yours were the opposite doesnt really mean a whole lot. We are only 2 people. And the thing is that I could name a whole lot of women who had sluggish babies after csections, as well as after long labors and lots of drugs. That doesnt really matter either though. All we can really do is educate ourselves as much as possible and try to make the best decision for ourselves and our babies.

And incidentally, my son did end up nursing for 2.5 years. I guess when I was pregnant with him I spent too much time reading about breastfeeding and not enough researching childbirth. :LOL
Live and learn!
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Old 04-14-2004, 09:33 PM - Thread Starter
 
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Originally posted by OnTheFence
That would be enough for me not to do it to begin with. An ECV was traumatic enough for me (I ended up in the OR with an emergency csection).

Goodluck with weighing all the risks. Have you had the websters technique done? Are you having any success?
I'm sorry you had such a horrible experience with ECV. The OB I saw yesterday does about 2 a month, and has never had anyone have to go for an emergency c-s, so I'm totally comfortable getting the procedure from him.

I've been doing Webster, tilt board, underwater stuff, pretty much everything I can. Last night my midwives even did some diaphragmatic release and moxibustion!

I was actually feeling really hopeful about the baby's position today, because the baby was doing gymnastics in the middle of the night last night, and when I went for my Webster adjustment today, I tested Webster negative (pelvis aligned, no indication to do the technique). But my midwife just left and so far as we can tell, the baby is still breech. I go back to the chiro tomorrow.
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Old 04-14-2004, 10:04 PM
 
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I've read that ECV is not very safe or effective, and that most doctors don't know how to do it. I'd be very nervous about it. If I felt the need to change the baby's position, I would do all the "old wives" things - tilt boards, swimming, etc.
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Old 04-14-2004, 10:16 PM - Thread Starter
 
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And I've read that ECV is quite safe. Certainly safer than a c-section.

If you read what I wrote, you'd see that I'm already doing everything natural I can to get the baby to turn (just spent 20 minutes on the tilt board, in fact). Vaginal breech delivery in a hospital isn't an option where I am, and I'm not willing to try a vaginal breech delivery at home (my midwives would do it if I really, really wanted them too, but they're not comfortable with the risk level either).

So I can try ECV and there's a 50% chance the baby will turn and I'll be able to have a vaginal delivery at home. Worst case scenario is that I have to have an emergency c-section (and my doctor has *never* had a version end in a section). When my only alternative is a planned c-section, this seems like a worthwhile option.
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Old 04-14-2004, 10:18 PM
 
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Originally posted by Greaseball
I've read that ECV is not very safe or effective, and that most doctors don't know how to do it. I'd be very nervous about it. If I felt the need to change the baby's position, I would do all the "old wives" things - tilt boards, swimming, etc.
I agree with Greaseball.

I also want to say that in the last seven years if a woman didn't have success with Websters Technique she didnt have success with ECV either. I did all the things recommended by a midwife and it didnt work. I now know there was a reason behind it. I had a deformed uterus. I didn't trust my gut and did the ECV -- it just seems to me that if you are trying all these things, including Websters without success, I would be skeptical of ECV working.
I also wonder how much of the risks your doctor has told you about. I mean two a month, it would seem he would be able to tell you that babies gut bruised, get distressed, and some even poop meconium.
I am just of the belief that if a baby is still breech after all that you have done, then there is a reason for it and why mess with it further. Of course I am very anti-ecv. I don't think doctors are clear on the risks to the mother or the baby.
My friend was faced with this last Friday. Luckily by Monday morning after doing tilts, imaging, and talking to her baby her baby turned.
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Old 04-14-2004, 10:28 PM
 
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So I can try ECV and there's a 50% chance the baby will turn and I'll be able to have a vaginal delivery at home. Worst case scenario is that I have to have an emergency c-section (and my doctor has *never* had a version end in a section). When my only alternative is a planned c-section, this seems like a worthwhile option.
I guess I have some serious doubts about his claim. Also you need to know out of the 50% that do turn how many of those babies are csectioned anyway for other reasons. (like distress in labor, birth injury, cord problems)

I have been where you have been. I was wanting more than anything to have that vaginal delivery so it seemed worthwhile to me too. My doctor said that until me, she had never had an emergency csection happen, however out of all her versions that were successful more than half had csections for other reasons. If I had to do it over again I would have never attempted. I should have listened to my body -- baby was breech for a reason even after all my attempts to turn her. After that I made a promise to myself that if I knew of any other mom in that situation to impart what I learned, the hard way, on to her.

I also read ECV was safe. It was after I got past the surface of the fluff sites and "let me explain this to you in lay terms" on pregnancy or medical sites I began to realize that there was a lot of risk involved to both me and my baby.

My daughter was bruised on her butt and face and head. Many babies experience bruising from the proceedure. My baby pooped meconium and had decels in heart rate. Not only was it painful for me, and stressful, my BP bottomed out and I experienced nausea and faintness. And this is just a small portion of what happened. If I had been told any of these things could happen I would have forgone the proceedure. My doctor didn't forget to tell me these things, she just didnt think they were significant enough to tell me.
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Old 04-14-2004, 10:28 PM
 
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Tammy,

I just want to wish you good luck at the chiro and with the ECV if you choose to do that. It really sucks that you are in this position after planning a homebirth. Im sure that this was the farthest thing from what you wanted. I will be thinking postive thoughts for you!

Also, I know that it sounds kind of hokey but have you tried to ask your baby why he/she is breech? My daughter was breech for a long while and after having a csearean with my son for breech this was terrifying to me. I read on the midwives archives that sometimes the baby just doesnt know he needs to turn and that he just needs to be told... I talked to my daughter in utero often and she turned obviously, she probably would have anyway though... I told you it sounds crazy but maybe you should give it a try? It certainly wont hurt anything!
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Old 04-15-2004, 01:10 AM
 
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A postpartum nurse told me that it happens very often with scheduled cesareans and also that babies have a harder time breastfeeding because they are so "sluggish".
I don't believe this at all. My sons an unplanned and a planned were both c/b and both were terrific nursers. In fact, Bryce was supposed to be another 45 mintues (not sure why. I think it was weighing and such but ths another story) but they brought him in 45 minutes early because all he wanted to do was nurse. Anything that passed his face he tried to latch on

I'd think prolonged exposure to an epidural would make them more sluggish and with a planned c/b normally as soon as the epi takes effect you wait about 10 ,intes before surgery begins. Just because its planned doesn't mean it goes slow.

Single Mom to 2 amazing little men. T(7) and B(5)
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Old 04-15-2004, 01:15 AM
 
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A comment on webster....I had it don with Bryce. He wasn't breech but he was right of center and on my hip. I had the technique done about 6 tiems and each time he slid right into place but didn't stasy that way. Both of my kids were that way. NOt sure why they didn't like my cervix but loved my right hip.

Anyway, webster is a gerat idea. My chiro said that he has had 10 out of 12 babies flip (nopt including mine since he wasn't breech when he did it but he did reposition)

Good luck with everything! I know this might sound a bit snooty but...A c/b is not the end of the world. It has taken me quite a while to finally accept it. But it isn't. I hope your birth experience is a wonderful one!!

Single Mom to 2 amazing little men. T(7) and B(5)
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