UPDATE - Transverse lie -- help me think this through (x-post in Birth and Beyond) - Mothering Forums

Forum Jump: 
 
Thread Tools
#1 of 10 Old 05-10-2011, 11:19 AM - Thread Starter
 
msmiranda's Avatar
 
Join Date: Apr 2009
Location: Virginia
Posts: 419
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)

Just when I thought I'd gotten everything squared away finally ... met with my new OB yesterday, who is great.  Very patient choice oriented.  Very supportive of natural birth, doulas, the whole nine.  Avoids episiotomies "like the plague."  Supports delayed cord clamping and any position you want to push in.  30-40% of the births he does are without epidurals, which for an OB is rare.  He's a perfect fit for me.

 

And then I find out the baby is transverse lie.  At 35w2d.  At first I didn't think much of it, figured it was a fluke and he would certainly turn.  But I am a worrier by nature, so that sanguine attitude didn't last long.  Got home, started doing research, and here's where I am:

 

* I hope by the time I go in next week he has turned head down.  I believe that he has been moving between transverse and vertex for several weeks now, based on where I feel movements.  Sometimes he's more oblique (diagonal).  I never feel movements that indicate breech -- his head is always in the lower half of the uterus.  But my other babies were firmly head down by this point.  According to Dr. Google, the fact that I no longer have abs of steel is probably to blame for giving him too much room to lay sideways.  I don't have any of the other risk factors (placenta previa, tumors, multiples, prematurity).  Okay, you got me there, I never had abs of steel.  And now in my third pregnancy I really, really don't.

 

* Even if he has turned, though, who's to say he couldn't turn back?  (the dreaded "unstable lie").  So I feel like I have to go into my next appointment with a suggested course of action. 

 

* The crux of the problem with transverse lie is the high risk of cord prolapse should my water break before labor begins (7-15% chance of cord prolapse is what I have read).  OTOH, of women who have a transverse fetus at 37 weeks, under 20% of them will still be transverse during labor (e.g. 80% or so turn vertex on their own).  So I want to give him every possible chance to turn and stay head down since that is most likely what he will do.  But, the risk of cord prolapse is scary.  We live an hour from the hospital I am planning to birth at, where this OB delivers.  The closest hospital to my house is 10 minutes away, though ... but even that distance (I think it is 6-7 miles as the crow flies) worries me for something like a cord prolapse.  If I was going to have to have a c-section, I would rather it be with my doctor.  But, I certainly don't want to schedule one at 38 weeks, which is standard of care for transverse lie.  (Note: this is not what he said to me that he would want to do -- he said, make that baby turn and we'll check again next week, so he is not that worried yet.  I am just thinking out loud about what if the baby is still transverse next week and the following week). 

 

So I guess right now my thinking is this:  if baby stays transverse for the next two weeks, my suggestion to the doctor will be to schedule a version for 39 weeks, and then an immediate induction if it works (and if it doesn't, I don't know ... a scheduled c/s at 40 weeks maybe?).  That means my natural birth is out the window, but it's a damn sight better than a c-section, which I would prefer to avoid for many reasons.  And of course if at the time of the version appointment he was head down then I would just go home. 

 

In the time between 37 and 39 weeks, though, I am worried about my water breaking.  If there was a cord prolapse the baby could easily die if I was at home alone with my two kids, as I usually am during the week (between calling 911, waiting for them to get here, getting to the hospital and getting into an OR, that seems like too many minutes to me, and I wouldn't have anyone to help me hold the baby off the cord while we were waiting for EMS).  I would be more comfortable being at the hospital that whole time, although I am not sure that my insurance would pay for it because of the availability of elective c-section.  So maybe the version/induction should be scheduled at 38 weeks?  I don't know.  (For reference my previous LOs were born at 39w6d and 38w6d respectively, so I am not worried about the baby being majorly preterm at either 38 or 39 weeks, and it is why I am worried about my water breaking around this point). 

 

Any thoughts?  (please no suggestions for spinning babies, chiropractic, moxibustion, or any of the usual suspects -- I am just trying to think through what I will do if the baby does NOT turn).

 


SAHM to Bird (6/07) and Bear (7/09), and now enjoying our newest additionbabyboy.gif, born June 1, 2011!  bfinfant.giffamilybed1.gifsigncirc1.gifcd.gif

msmiranda is offline  
#2 of 10 Old 05-10-2011, 11:35 AM
 
tracymom1's Avatar
 
Join Date: May 2008
Posts: 2,453
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
If the baby does not turn, you will need a c-section. I would prepare mentally for that, but really, don't schedule if before 39 weeks. If your OB can do a version, I would definitely go that route. I am a big advocate of spinning babies, but I can understand why you might want to try something else. As far as being home with your kids and your water breaking, well, just do your best to tighten up your network of friends and family. Do you know your neighbors? Can you get out and meet them just in case you need any help?

It is sooooooo rare for a baby to stay transverse. I bet he flips when you least expect it!!!

hh2.gif Proud Mama to DS1 09/07 ribboncesarean.gif, DD 07/09 hbac.gif, and DS2 06/11 uc.jpg.  Feeling more and more blessed with each day!

 

 
 
 
  

tracymom1 is offline  
#3 of 10 Old 05-10-2011, 11:53 AM - Thread Starter
 
msmiranda's Avatar
 
Join Date: Apr 2009
Location: Virginia
Posts: 419
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)


 

Quote:
Originally Posted by tracymom1 View Post

If the baby does not turn, you will need a c-section. I would prepare mentally for that, but really, don't schedule if before 39 weeks. If your OB can do a version, I would definitely go that route. I am a big advocate of spinning babies, but I can understand why you might want to try something else. As far as being home with your kids and your water breaking, well, just do your best to tighten up your network of friends and family. Do you know your neighbors? Can you get out and meet them just in case you need any help?

It is sooooooo rare for a baby to stay transverse. I bet he flips when you least expect it!!!


You'd think as wordy as I am that I could convey what I'm thinking!  Yes, of course a c-section is necessary for a persistently transverse baby -- not thrilled about that but I accept it.  My dilemma is about how long to wait and whether I should try to hold out until labor begins or schedule it, and dealing with the fear/risk of cord prolapse in the meantime if I try to hold out.  And like you say it is rare so hopefully this is all moot ... I just like to have all my ducks in a row. :)

 


SAHM to Bird (6/07) and Bear (7/09), and now enjoying our newest additionbabyboy.gif, born June 1, 2011!  bfinfant.giffamilybed1.gifsigncirc1.gifcd.gif

msmiranda is offline  
#4 of 10 Old 05-10-2011, 12:07 PM
 
jshannyn519's Avatar
 
Join Date: Apr 2008
Location: Fort Worth, TX
Posts: 974
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)

Did your water break on its own with your other labors? If so, did it break early on in labor or more towards the end? Of course every labor is different and there is no guarantee that your water breaking would follow the same pattern as with your previous labors, but it's pretty likely.

 

If you are concerned about the risk of prolapse then it might calm your fears more if you have a scheduled date. I would probably go for the version option first, and then do a wrap or something around the belly to keep the baby in the proper position until you go into labor. A friend of mine had a breech baby (4th baby) and she did a version and then did a belly binding with a wrap of some kind to keep the baby vertex. It worked and she gave birth a few weeks later.

 

My last birth was a c/s for a footling breech. My primary concern with her was that my water would break and the cord would prolapse. In hindsight, it probably wouldn't have happened that way because I have yet to have my water break on it's own. So I scheduled the c/s. But I also didn't attempt a version, or moxi, or chiropractic or anything else first. In hindsight I would throw everything I could at the positioning issue and if baby still wasn't turned by 40w then I'd have scheduled the c/s.


Jenni
Momma to my boy (1/99) & girl (7/00), Birthmomma to my Ladybug (8/09), the new baby monkey boy born 6/6/11!
Student nurse, doula, future midwife, and breastfeeding, bedsharing, babywearing, organic gardening, God-loving single momma

jshannyn519 is offline  
#5 of 10 Old 05-10-2011, 02:08 PM - Thread Starter
 
msmiranda's Avatar
 
Join Date: Apr 2009
Location: Virginia
Posts: 419
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)

It did not break until pushing with my first, and it broke a little (like I soaked about three pads, so not anywhere near all of it) the second time during early labor, a few hours before active labor started.  I've never had a puddle on the floor, and I would hope not to under any circumstance.  But I know that it can be different each time.
 

Quote:
Originally Posted by jshannyn519 View Post

Did your water break on its own with your other labors? If so, did it break early on in labor or more towards the end? Of course every labor is different and there is no guarantee that your water breaking would follow the same pattern as with your previous labors, but it's pretty likely.

 


SAHM to Bird (6/07) and Bear (7/09), and now enjoying our newest additionbabyboy.gif, born June 1, 2011!  bfinfant.giffamilybed1.gifsigncirc1.gifcd.gif

msmiranda is offline  
#6 of 10 Old 05-11-2011, 01:57 AM
 
Smokering's Avatar
 
Join Date: Sep 2007
Location: New Zealand
Posts: 8,610
Mentioned: 1 Post(s)
Tagged: 0 Thread(s)
Quoted: 4 Post(s)

Wouldn't a cord prolapse be less risky/dire.time-sensitive with a transverse baby than any other presentation? I mean, yes, obviously not a good thing, but if the baby doesn't have a presenting part, there wouldn't be much pressure on the cervix and therefore there'd be less risk of the baby cutting off his oxygen supply... no? I recently read a story about a planned HB (UC?) turned C-section due to cord prolapse - it wasn't exactly a happy-bunnies story, but everyone agreed that the baby had essentially saved his own life by flipping transverse. That mother did have a partner present to help hold the cord back inside the cervix, though.

 

Any possibility you could get your mother or a friend or someone to shadow you for a few weeks at home, just in case an extra pair of hands is needed? It might make you feel more comfortable..?

 

Here's hoping he turns in time! Not a nice situation for a worrier to be faced with - you have my sympathies!


If decomposition persists please see your necromancer.

Smokering is offline  
#7 of 10 Old 05-11-2011, 07:42 AM - Thread Starter
 
msmiranda's Avatar
 
Join Date: Apr 2009
Location: Virginia
Posts: 419
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)


 

Quote:
Originally Posted by Smokering View Post

Wouldn't a cord prolapse be less risky/dire.time-sensitive with a transverse baby than any other presentation? I mean, yes, obviously not a good thing, but if the baby doesn't have a presenting part, there wouldn't be much pressure on the cervix and therefore there'd be less risk of the baby cutting off his oxygen supply... no? I recently read a story about a planned HB (UC?) turned C-section due to cord prolapse - it wasn't exactly a happy-bunnies story, but everyone agreed that the baby had essentially saved his own life by flipping transverse. That mother did have a partner present to help hold the cord back inside the cervix, though.

 

Any possibility you could get your mother or a friend or someone to shadow you for a few weeks at home, just in case an extra pair of hands is needed? It might make you feel more comfortable..?

 

Here's hoping he turns in time! Not a nice situation for a worrier to be faced with - you have my sympathies!


I wondered about this too!  It's something I have never looked into about cord prolapse -- I know that it is an obstetrical emergency, but how often does the cord get compressed?  I guess what I was thinking yesterday was that if my water completely broke that the weight of his back/shoulder/whatever on the cord could still cause compression and brain damage/death even if it wasnt the usual "head in the cervix" situation.  I don't know that for sure, but all the online resources I found seem to take it very seriously.

 

By paying very close attention to his movements and positioning, at this point I think that he still has enough room to move into any position at all.  I felt him move from head down to oblique to transverse during the night last night when I laid down to go to sleep, and I think he totally could move into breech position if he was so inclined.  This is one situation where having small babies is a disadvantage, apparently.  So I don't think he's going to get stuck transverse, he's just still able to do a lot of moving around.  If that persists, I guess we will have to decide about scheduling something or just accept that he could be in any position when I go into labor.  I hope that in the next few weeks he grows enough that he has to stay put in one position (and hopefully vertex, but not knowing is right up there with knowing of a malposition in terms of unpleasantness).

 


SAHM to Bird (6/07) and Bear (7/09), and now enjoying our newest additionbabyboy.gif, born June 1, 2011!  bfinfant.giffamilybed1.gifsigncirc1.gifcd.gif

msmiranda is offline  
#8 of 10 Old 05-11-2011, 09:17 AM
 
AnnieA's Avatar
 
Join Date: Nov 2007
Location: Virginia
Posts: 2,777
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)

DDC-crashing.

 

If I were in this situation and my water broke before I knew for certain that baby was vertex, I would immediately assume a deep knee-chest position getting my hips as elevated as possible to relieve any pressure the baby could be putting on the cord. I would then have one of my kids bring me my cell phone and I would call 911. I would stay in that position until help arrived.


Annie wife v2.0 to DH and joyfully parenting DSS 18 jog.gif, DSD 15 knit.gif, DSD 14 banana.gif, DSS 12bikenew.gifand heart hero DD 2superhero.gif. angel1.gif 8/2010

AnnieA is offline  
#9 of 10 Old 05-11-2011, 04:55 PM
 
Daisy420's Avatar
 
Join Date: May 2006
Location: Pa
Posts: 252
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)

Having had a previous successful ECV due to a frank breech presentation, I'd like to give some input here.  First of all, the longer you wait to try a version, the larger the baby,and the lesslikely it will be successful.  Also, in the event that a version is successful, which is at best 50/50, they will NOT inducelabor because that in itself will increase your chances of a c-section,, which is why you would want the version in the 1st place, to avoid one ; ).  Most docs recommend a ECV around 37 weeks, when the baby will be old enough to do ok outside the womb in the case of an emergency (which is why they are done at the hospital,)  but still small enough that they can "manipulate" the baby.  I do hope that the baby turns for you on its own before you need to worry about your options, but I wouldn't wait until 38 weeks to talk version.  It can be painful, but very rewarding!


Jessica knit.gif and familybed2.gif mamma to dd 9/09, ds 10/07, ds 2/05, angel1.gif10/03, ds 3/03, dd 12/00, expecting #6  2ndtri.gif  in June 2011. Furrbabies: 2 dogs, 4 cats, and 5 guinnea pigs
Daisy420 is offline  
#10 of 10 Old 05-16-2011, 03:02 PM - Thread Starter
 
msmiranda's Avatar
 
Join Date: Apr 2009
Location: Virginia
Posts: 419
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)

So today at my 36 week appointment baby was head down and anterior.  By this afternoon he had turned again (I believe, but can't know for certain -- I think he turned breech based on feeling the hiccups at the very top, which had never happened before), but my OB does not seem that worried about the unstable lie right now.  When I told him about the hospital admission at 37 weeks thing, he said that was "old school" and that as of right now, if I went into labor I should just come in early so they can check the position.  I'm still hopeful that he will settle head down in the next week or two.  I do have plenty of amniotic fluid, but not too much, according to the BPP, and the baby is doing great.  So I'm going to let it ride for now and if he's not head down next week, then maybe I'll start worrying again, lol.


SAHM to Bird (6/07) and Bear (7/09), and now enjoying our newest additionbabyboy.gif, born June 1, 2011!  bfinfant.giffamilybed1.gifsigncirc1.gifcd.gif

msmiranda is offline  
Reply

Quick Reply
Message:
Drag and Drop File Upload
Drag files here to attach!
Upload Progress: 0
Options

Register Now

In order to be able to post messages on the Mothering Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
If you do not want to register, fill this field only and the name will be used as user name for your post.
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



User Tag List

Thread Tools
Show Printable Version Show Printable Version
Email this Page Email this Page


Forum Jump: 

Posting Rules  
You may post new threads
You may post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off
Trackbacks are On
Pingbacks are On
Refbacks are Off