WWYD? vaginal breech? - Page 3 - Mothering Forums

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Old 03-09-2007, 03:41 PM
 
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This seems to be the only thing we agree on.

And it's funny you said "baby business" because that's what it has become. It's all about the $$$$ and cover your a**. Where is the "do no harm"?
I think it's gotten somewhat lost in there amongst the 'I'm going to take you for everything you've got mentality' that so many people in our country have when something goes wrong. Doctors are humans too, and they most assuredly have a vested interest in being able to pay their bills just like the rest of the world.

Are they blameless across the board? Heavens no. But surely it's not such a stretch of the imagination to consider the position they are in...mom comes in having a baby. Whether doc agrees or not, current generally accepted practice is to do continuous EFM. Baby shows a blip of distress. Hello c-section.

Necessary? Who knows really? Surely the doc doesn't KNOW that baby is ok, as in beyond a shadow of a doubt, and THAT is how certain they better be cause God help them if they are wrong.

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You're putting the blame on the women. It was not women who chose to make birthing into a business.
No, but *some* parents have decided that nothing less than a perfect outcome will do, and they will sue for anything less.

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Women are losing their choices. Women are suffering.
Yes, they are. And it sucks. And I don't know what the 'answer' is here. But blaming it ALL on the doctors or the system is no better than saying it's all the woman's fault (which I am NOT saying at all...I think it's a great big screw up that's next to impossible to 'fix').

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Who are you going to blame when women start suing for unneccessary csections?
They first have to prove harm was actually done, other than emotional trauma, which doesn't cut it for malpractice. I have no problem whatsoever suing for what is clearly an unnecessary section, I just don't know that you'd get very far with it. If it became a new trend though...well, that might get some attention.



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I don't even know where to start with the rest of what you said.
Ok. Want to think on it and get back to me? Seriously. I'm all for learning and thinking, and find the current birth climate incredibly interesting to say the least.
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Old 03-09-2007, 06:24 PM
 
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Wifeandmom, I get where you're coming from. I do. I lurk on ob/gyn forums and have heard the argument you're making numerous times. I agree it's a problem.

Here's this issue: the U.S. has no system of accountability for medical malpractice other than litigation. There is literally no way to address a problem and make sure it never happens again other than to sue. The only recognition that a patient will ever get that a real mistake was made is in the courtroom.

There have been various proposals floated to introduce some non-litigous accountability into the U.S. healthcare system. Until we have something different, it's really wrong to castigate patients for filing lawsuits when that's the only recourse that is available to them.
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Old 03-09-2007, 07:17 PM
 
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They first have to prove harm was actually done, other than emotional trauma, which doesn't cut it for malpractice. I have no problem whatsoever suing for what is clearly an unnecessary section, I just don't know that you'd get very far with it. If it became a new trend though...well, that might get some attention.
That's right. We have to prove that harm was done. Can you think of any other instance where a woman can be coerced into being cut open against her will (or even forced into it) and have to prove that she was harmed? Can you imagine a mugger leaving a scar across a woman's abdomen, and costing her a significant percentage of feeling in her pelvis...and the woman having to prove that harm was done? No, because that's absolutely ridiculous. If you're not a doctor, the simple act of cutting someone open when they don't want to be cut is considered a criminal offense.

I don't like it when women sue for things that go wrong in a birth, either. But, the bottom line is that women can't prove they've been harmed when they've been cut open against their will. Can anyone explain how the issue of proving harm when surgery has been informed without someone's consent even exists?

Anyway - what is a "clearly" unnecessary section? Talk to the ICAN moms who get cut because their doctor tells them the baby is just too big to birth vaginally...and then comes up with some other excuse in the OR, when they find out that the baby is only 6.5 pounds. Sure - there's a case that it was clearly unnecessary as the official cause was invalid...but you can bet that if it came down to a court case, the doctor would be there explaining how it was lucky that it happened, because they'd have had to do an emergency section for X, Y and/or Z, anyway.

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Old 03-09-2007, 07:20 PM
 
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Wifeandmom, I get where you're coming from. I do. I lurk on ob/gyn forums and have heard the argument you're making numerous times. I agree it's a problem.
Yeah - I've also heard the "wouldn't a 100% c-section OB hospital be great? We'd be able to work a normal work day, blah, blah, blah" discussion more than once. I also don't believe I've seen a single medical professional on the forums mention any risk to a c-section...ever. They treat them as a 100% benign procedure..scary group-think.

:Puke

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Old 03-09-2007, 07:51 PM
 
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Storm Bride,

It is so true.

:

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Old 03-09-2007, 10:23 PM
 
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I don't think the potential for litigation is any reason not to do a vaginal breech birth. Doctors should be responsible for providing the proper care for the situation. If they aren't trained for it that is not the patient's responsbility, it is the doctors'.

I wouldn't recommend asking a poorly trained OB to do a breech birth in the current situation but if more and more women go to mws and OBs lose business because of it, maybe they would start getting the proper training......

but maybe the point would be moot because why are OBs attending births anyway???? they're surgeons, by their nature they are trained to do surgery......I wish to look to conscious mws to change the scene.....and of course they cannot do that without client support and societal change.........

how come all those women who have horrible hospital birth experiences aren't suing? the ones who go in and get churned through the system and are left humilated and disempowered but have no tangible reasons why because they have just followed hospital procedure and think this is the thing to do........everywhere around us the message comes that what goes on in hospitals is normal, even with the high rates of intervention and perinatal mortality.......
people don't have a clue.....

I rack my brains to try to think of a way to help change things and the only thing I can come up with is to get involved at the grass-roots level and speak to pregnant women.....as pp said, OBs and hospitals are not going to stand up for pregnant women, why would they?
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Old 03-10-2007, 12:47 AM
 
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[quote=wifeandmom;7493399]
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Ok. Want to think on it and get back to me? Seriously. I'm all for learning and thinking, and find the current birth climate incredibly interesting to say the least.
Allrighty... I'll take a stab at it...

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Where is the hospital going to get these providers from? What exactly should happen to the hospital if mom shows up with a breech and nobody is there to attend the birth with previous breech experience? Should they be required to have 24/7 coverage with a provider experienced at breech births?
I don't believe the hospitals would need to get the providers from anywhere at all! What they would have to do is provide training to the obs already on staff. And yes, there should be someone with previous breech experience available at all times, at as many hospitals as possible. Just as some hospitals specialize in heart surgery or trauma patients, a hospital in each area could take it upon itself to meet the needs of its pregnant patients.


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Women can't have it both ways. There are RISKS to vaginal breech deliveries (and VBACs since it's a similiar predicament for both women and docs), and those RISKS are very real.
Many of those risks are brought on by the doctors themselves(or the regulations they enforce). What's that word...iatrogenic? (help s.o.- spelling?: )

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I think it's gotten somewhat lost in there amongst the 'I'm going to take you for everything you've got mentality' that so many people in our country have when something goes wrong. Doctors are humans too, and they most assuredly have a vested interest in being able to pay their bills just like the rest of the world.
Of course doctors are humans too, that is exactly the issue- there is often a conflict of interest with the way the system is set up. There's a mom on this board who spoke of obs at a particular hospital performing csections at the end of their 12 hour shifts because if they do so, they will get paid, instead of handing over care to another ob. How sick is that?

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They first have to prove harm was actually done, other than emotional trauma, which doesn't cut it for malpractice. I have no problem whatsoever suing for what is clearly an unnecessary section, I just don't know that you'd get very far with it. If it became a new trend though...well, that might get some attention.
Emotional trauma should already be enough. Doesn't "pain and suffering" ring a bell? But aside from that, there IS physical trauma involved after a csection. This is not a secret, doctors acknowledge this. Many won't "allow" a VBAC for that very reason. The uterus has an incision in it afterall. And while the risks are minimal, there IS an increase in rupture in previous csection patients. Not to mention the risk of death, which is 4 times higher than with vaginal birth. Problems with adhesions, increase in placentia previa and other placental problems all occur. How about the women who have had hysterectomies performed as a result of their csections? Nicked bladders? I could go on.

I'd be happy to paint a picture of the emotional trauma aspect for you.


In any case, it is crystal clear that here are both very, very REAL emotional and physical traumas that occur as a result of csections.


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It's not rocket science here. You can't FORCE hospitals to deliver breech babies so their docs can get practice. That is so incredibly not practical at all.

Why the hell not? We should be demanding that hospitals train their obs to deliver breech. What is so impractical about that? Do you think civil rights and the women's movement just "came about" because people wanted it to happen? Birth is a right, not a privelege.


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Something has to give, that much I think we can all agree on. I envision many hospitals stopping the baby business all together if things continue as they are. We see many hospitals refusing to do breech deliveries, refusing to do VBACs, with 40+% c-section rates, and this is already happening today. Give it another 10-20 years and it's frightening to think of what it will be like.
Well you know what- If hospitals and obs are not up to the challenge, then they should be encouraging midwifery care as a viable alternative, instead of fighting it.

Which is where I believe care is best provided for the majority of pregnant women anyway.

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Old 03-10-2007, 12:55 AM
 
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My baby turned at 34 weeks after several treatments with moxibustion. Have you even looked into this? It has high success rates and is not invasive like version.
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Old 03-10-2007, 02:03 PM
 
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You have my sympathy. Talk about being stuck between a rock and a hard place!
My understanding is that deliverying a vaginal breech, while perfectably 'do-able' is not a common skill anymore. (I know many medical skills no longer teach it)

So even if you waited until the last minute to go to the hospital, and if you were able to avoid the cesarean, you still would likely end up with a care provider who
(a) is upset that you have 'forced' them into doing something they don't want to do/are uncomfortable doing and
(b) may not even have the skills necessary to deliver a baby in the breech position.

I would definately look at going out of state and/or finding an 'underground' midwife who might be in a position to help. I don't know how exactly you go about doing that, but it's worth a try.

Good luck! And keep working on getting that little bundle to flip around - there's still time! All the best.
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Old 03-10-2007, 10:41 PM
 
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OP - My midwife and I talked about this... if I had a breech baby (with my first - with subsequent babies she would be comfortable delivering at home) and transferred to the hospital and NO doctors there would allow vaginal breech birth then I could simply say NO to the c-section and inform them that my midwife would deliver the baby since they refused to.

So... I would find a midwife who would be comfortable delivering a breech in a hospital and you can always refuse the c-section unless your baby is in danger.

I didn't read the whole thread though and realise that may not be an option for you I hope your babe turns or you figure out a good workable option!

You could always go to Tennessee and see Ina May : Though I totally understand why that wouldn't be an option if you live a long way away from there...

love and peace.

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Old 03-11-2007, 03:53 PM
 
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I have to respectfully disagree.

I don't think it can hurt to make a Plan B (Plan Breech?). The OP is trying to make sure she has her bases covered--I think she'll have less stress is the long run if she knows she has a plan in place, whatever happens.

Sorry, but this is kind of a sore subject, as the midwives at the birth center I go to keep telling me it's "too early" to worry about this or that thing... I don't want to be blindsided at 38 weeks with some unforseen issue, KWIM?
I have to say I'm ITA. My MW kept saying, it's too early to worry, it's too early to worry, she'll turn, she'll turn. It wasn't, and she didn't, and I wasted a lot of time that I could've been working on a solution to the problem.

My entire story is at www.breechbirth.ca. I ended up with a c/s, but not a scheduled one because I refused to have one without being in active labour, and the OB on call legitimately didn't have the experience to safely catch a breech.

What I did:
I asked my MW to ask around and identify OBs in town who would catch the baby vaginally if "I walked in pushing". There tend to be some "rebels" around but it takes some bush-beating to find them becuase they're afraid of professional censure if they say out loud that they'll do it. The good news is that ACOG changed their guidelines in July to say that vag breech birth should be offered by experienced OBs.

I tried ECV 4 times, with 2 different MWs, in both home & hospital settings.

I found a chiropractor who did Webster. She also kept me walking.

I did hypnosis, lying on a slant-board with my feet up, scrubbing the kitchen floor on hands & knees.

I found an acupuncturist to do moxibustion but I did this too late. It has an excellent success rate but it can take up to 6X with a couple of days in between so GET ON IT.

What I WISH I had done:

I wish I had gone to each of the hospitals and presented myself to the nurses' desk. I would ask which OBs are the most senior and which ones THEY would trust to catch a breech baby. Because so far as I'm concerned, the OB doesn't need to LIKE my choice, s/he just has t be qualified. And I KNOW there are OBs in town here who I did not have identified at the time, THREE of them, in fact.

I would not trust my MW as much as I did to give me complete information or to stick up for me. She was so scared of breech birth that even though I knew a MW who would have caught the baby at home, I didn't think it was a legitimate choice. I know better now - I'd go home and call the other MW.

Would I personally do UC? Probably not. But I don't know that I'd be comfortable with a UC even with a vertex birth... altho with a vertex if it was c/s or uc I'd go uc. I guess it comes down to trusting birth. If you believe firmly that a labour that goes smoothly results in a birth that goes smoothly (which is what my "alternate" MW said to me after she found out my 75 minute labour wiht my breech babe ended with me puffing off pushes to allow the c/s), then that's something you can monitor at home and only go in if you feel there's a problem.

It's a tough one. But anyway. As many have said, you have time. But use the time. Maybe the babe would turn anyway and it's lots of effort that you didn't need to spend, sure. But if, like mine, the babe just wants to be bum-first... Personally I needed to know that I did everything in MY power.

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Old 03-11-2007, 04:07 PM
 
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WWYD? vaginal breech?
theretohere ~ I was faced with this question for my last birth 7 months ago. I had an unassisted pregnancy and was planning another UC. My babe lay breech for all the pregnancy. I did a lot of research, soul searching and knew in my heart it was the safest thing to birth my baby at home without intervention, attendants, or uneducated professionals. (preferably and particularly those wielding knives). I was committed to birth my breech baby UC.j I did nothing to try to turn her or mess with her in any way. I let her just be.

Then, the day of her birth, my water broke, she turned vertex, and I had a two hour labor in the pool and birthed my 13 pound girl in utter bliss. They really CAN turn at the last minute. :

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Old 03-11-2007, 04:49 PM
 
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In a choice between cesarean or UC I'd *never* knowingly choose cesarean. Way too risky, and puts my body and future babies at risk. I refuse to have unnecessary surgery just because I can't find someone who "knows how" to keep their hands off my breech baby as he's coming out.
I was forced into a cesarean for breech presentation (he was crowning when they realized I was in labour, I went in because I was preterm) - so I feel very passionately about this.

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Old 03-11-2007, 04:56 PM
 
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Well, for me it's not *just* that I want someone who knows how to keep their hands off (though I do), but I also want someone who knows how to safely help the babe out if s/he should have nuchal arm or deflexed head or some other mechanical problem on the way out (and I'm confident that I do, here, too).
But I think it's maybe too simplistic to see the adage 'hands off the breech' and think that means that all one needs to safely attend a breech birth is not to do anything, ever.
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Old 03-11-2007, 06:25 PM
 
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If it were a choice between section and UC? UC, hands down.
but - if there could possibly another choice, I'd certainly try to figure it out....underground midwife, travelling to birth, whatever.

But, if it came down to it....I think hospitals are more dangerous than doing it alone. (not to say hospitals don't sometimes help, they do, but overall, they hurt way more than they help...)

CPST
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Old 03-11-2007, 09:49 PM
 
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Well, for me it's not *just* that I want someone who knows how to keep their hands off (though I do), but I also want someone who knows how to safely help the babe out if s/he should have nuchal arm or deflexed head or some other mechanical problem on the way out (and I'm confident that I do, here, too).
But I think it's maybe too simplistic to see the adage 'hands off the breech' and think that means that all one needs to safely attend a breech birth is not to do anything, ever.
This is where I was at, too. And I actually was somewhat willing to compromise on birthing position, etc to get such a person to attend me. Now, if my official referral OB had been on call all of that was moot, he didn't require any of the "extraction" routine of me, but I knew if I ended up at a different hospital or with somebody I didn't know I might have to bend. But as it turned out, I got somebody who wasn't qualified to help me, and everybody in the room knew that the OB was the only liability. It was so freakin' dumb.

ITA with pp that hospitals need to put priority on ensuring that residents get experienced in breech catching. This may mean they need an exchange programme with another hospital where they have senior OBs with experience who have not retired. It may mean paying somebody to come out of retirement, to be on call just for breech babies. In Ottawa we're trying to set up a "breech squad" - a group of practitioners (obs or MWs, we don't care) who are qualified to catch breeches and are willing to be on call at their own hospital. Then breech mamas can call when they go into labour and find out which hospital to go to. It's not perfect, it's not somebody, all the time, at every hospital, but it's SOMETHING in a town where statistically we have at least 1 breech baby born every day.
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Old 03-11-2007, 11:14 PM - Thread Starter
 
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This is where I was at, too. And I actually was somewhat willing to compromise on birthing position, etc to get such a person to attend me. Now, if my official referral OB had been on call all of that was moot, he didn't require any of the "extraction" routine of me, but I knew if I ended up at a different hospital or with somebody I didn't know I might have to bend. But as it turned out, I got somebody who wasn't qualified to help me, and everybody in the room knew that the OB was the only liability. It was so freakin' dumb.

ITA with pp that hospitals need to put priority on ensuring that residents get experienced in breech catching. This may mean they need an exchange programme with another hospital where they have senior OBs with experience who have not retired. It may mean paying somebody to come out of retirement, to be on call just for breech babies. In Ottawa we're trying to set up a "breech squad" - a group of practitioners (obs or MWs, we don't care) who are qualified to catch breeches and are willing to be on call at their own hospital. Then breech mamas can call when they go into labour and find out which hospital to go to. It's not perfect, it's not somebody, all the time, at every hospital, but it's SOMETHING in a town where statistically we have at least 1 breech baby born every day.
Wow, I'm glad to hear that your town is working out at least a workable situation!

I've been trying chiropractic, moxibuxtion, and inversion. I've been trying pretty much everything that is suggested- this baby just seems to want to be head up.

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Old 03-11-2007, 11:21 PM
 
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I've been trying chiropractic, moxibuxtion, and inversion. I've been trying pretty much everything that is suggested- this baby just seems to want to be head up.
I always felt that there was a good reason why my babe was breech. She was born with a true knot & a very short cord ~ who knows what might have happened if I'd tried to turn her.

What do your instincts tell you about your baby?

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Old 03-11-2007, 11:26 PM - Thread Starter
 
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I always felt that there was a good reason why my babe was breech. She was born with a true knot & a very short cord ~ who knows what might have happened if I'd tried to turn her.

What do your instincts tell you about your baby?
Honestly, that it's meant to be breech, at least right now. At the beginning of my pregnancy I was having frequent, strong, beautiful UC dreams- they've stopped. Now I dream of my baby, but not the birth. Never the birth. I almost feel as if I'm not present for it.

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Old 03-12-2007, 12:11 AM
 
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Honestly, that it's meant to be breech, at least right now. At the beginning of my pregnancy I was having frequent, strong, beautiful UC dreams- they've stopped. Now I dream of my baby, but not the birth. Never the birth. I almost feel as if I'm not present for it.

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Old 03-12-2007, 12:26 AM
 
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I always felt that there was a good reason why my babe was breech. She was born with a true knot & a very short cord ~ who knows what might have happened if I'd tried to turn her.

What do your instincts tell you about your baby?
I've never had a breech baby but reading this post also makes me think, if they're like that, aren't they like that for a reason.....
just a thought......
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Old 03-12-2007, 01:38 PM
 
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Where is the placenta? if the placenta is low this may be why the baby is breech- babies frequently orient themselves to the placenta- if the placenta is in the fundus then their head is usually far from it down low if in front they often move their body to the back and face the placenta -- along with inversion and moxa , walking, ice on the head or bottom dive in a swimming pool , visualization, have someone do deep massage-- psoas muscles -- rule out gallbladder acting up

and for myself I would try to turn my own baby--not a medical version - a bit of guidance a hand on the back of the bottom if not enguaged -- just like when you might put your hand against what ever part is pushing out hard and hurting or when you reach up under your rib cage and protect your stomach from the upward pressure-- a hand on the bottom firmly when I am laying down relaxed- some babies just swim right around-- this should not involve pain or discomfort- what so ever- and if you have a deep sense of no- then don't either--
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Old 03-12-2007, 02:08 PM - Thread Starter
 
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The placenta is anterior. I don't know if it's high or low.
The baby is pretty resistant to being oved like that, I've tried.

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Old 03-12-2007, 03:30 PM
 
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Thinking of you - how far along are you? Have you had any luck with CPMs/DEMs in your area? Or is that not a direction you are comfortable with?

Mwherbs, funny that you should say that about the low placenta, b/c the OB who did my unsuccessful version last week said that he thought the baby was breech because my placenta was anterior/fundal, and he felt that fundal placentas predisposed to breech. Just another instance in the whole breech thing where it seems like there are strong opinions that totally contradict each other.

As another with a breech babe at 38 weeks today - breech since 32 weeks or earlier, and in spite of chiropractic, an ECV attempt, homeopathy, hypnosis, tilts - I believe too that some babies are meant to be that way, or are most comfortable breech because of our body shapes, and will stay that way until birth regardless of what we try. It's good to know that there's a possibility that the baby could turn, but if you hang your hat on turning and are left without a plan at 38 or 39 weeks or labor, options become really limited.
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Old 03-12-2007, 03:44 PM
 
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You've still got time. I remember vividly at 37 weeks my son turning a full somersault around while I was at work. That was the absolute strangest sensation I had my whole entire pregnancy. LOL.

Have you seen the page www.spinningbabies.com? They have some very helpful exercises to help turn a baby, and it's never too early to start.
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Old 03-12-2007, 06:41 PM
 
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Well your doctor is right just looked at the studies and it seems that there are mixed results but cornu-fundal and breech are associated as is previa --

as for versions- frontal placenta is less likely to result in a successful version--
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Old 03-12-2007, 07:21 PM
 
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Ok but if low, high, and anterior all cause breech presentation, what's left? One will only have a vertex baby if the placenta is smack in the middle of the back ? I question his opinion anyway, as I have had a breech baby all the way to birth before with a posterior placenta - I think it's something in the shape of my uterus/pelvis (though it's not bicornuate or otherwise grossly malformed), or genetic.
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Old 03-12-2007, 07:59 PM
 
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Quote:
Originally Posted by theretohere View Post
Honestly, that it's meant to be breech, at least right now. At the beginning of my pregnancy I was having frequent, strong, beautiful UC dreams- they've stopped. Now I dream of my baby, but not the birth. Never the birth. I almost feel as if I'm not present for it.
Oh hon. my heart is so with you.
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Old 03-12-2007, 08:24 PM
 
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sorry sorry sorry-- I meant that if in the front hard to turn or not likely to turn with a version-- I didn't mean that it causes breech, and they didn't look at how many babies turned on their own -- I think I want to hide my head today -- and previa is not just low-- KWIM and we are talking third trimester -- the majority of placentas i guess are mid-front/ mid-back or mid-side--- not what I was taught at all-- and even with high it is only % that is breech but it is the highest % does that make sense-- in the end only about 5% total stay breech--

take care
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Old 03-13-2007, 03:56 PM - Thread Starter
 
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I talked to my mother about this today- she told me that a section is best for the baby if it stays breech. She also made a lot of noise about it being selfish to not be ok with that.

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