Well, crap.

[rivka]

Last night Dorian was here to go over some things in preparation for being our labor&delivery childcare. I let her feel a hard bump of baby sticking out on my right side. "That must be his bottom," I said trustingly. "Because it's round, and we know he's head down."

Yeah.

This morning I had my 38-week midwife appointment. All went well until she put me up on the table to assess Niblet's position, heartbeat, and size. At which point it became clear that he is not head down anymore, and that the hard round thing sticking out on my right side is in fact his head.

The good news is that he's still floating; no part of him is engaged in the pelvis, so he's not wedged in this way. He was transverse (crossways) when the midwife examined me, with his head kind of down by my right hip. She sent me over to the hospital for a confirmatory ultrasound, and the sonographer noted that he had turned breech: his head was still over on the side, higher up, and his feet were on my cervix. Then I was examined again by an OB, at which point he was fully transverse again. So he definitely has room to move.

We've scheduled an external cephalic version for Tuesday, February 3, when I'll be just about 39 weeks pregnant. I'll be seeing the OB I saw today, whom I liked very much. His name is Dr. Atlas, he's the chair of the Obstetrics department, he works with my midwives a lot, and he's very supportive of natural birth. I thought he struck a good balance between being warm and kind, and not holding back any information.

In an external version, the doctor literally flips the baby over into a more favorable position by pressing on the outside of the belly. ("Emphasis should be on gentle persuasion of the fetus as opposed to forceful movements," says the article, fortunately.) The article I linked to is kind of old, but offers a good description of what happens. They cite a 65% success rate. Here's the potential outcome tree Dr. Atlas outlined for me:

1. The baby is successfully flipped and then stays head-down, and I go into labor naturally.
2. The baby is successfully flipped and then flips back to breech or transverse, at which point we either schedule a C-section or wait until labor begins and do a C-section.
3. The baby can't be flipped. We schedule a C-section or wait until labor begins and do a C-section.
4. The baby becomes distressed by the procedure and there is an immediate emergency C-section.

Obviously that last one is a low-frequency outcome, but nevertheless the procedure is done on the L&D floor with an OR and an anesthesiologist nearby.

I've read that the success of ECV is heavily dependent on the skill and experience of the doctor, and it seems like I'll be in good hands there.

So, uh, we'll see what happens. Apparently it's not out of the realms of possibility that he'll turn back rightways round himself. Here's hoping.

Comments

[nex0s.livejournal.com]

I've heard a lot on various communities about using http://spinningbabies.com/ to get their babies go from breech/transverse into proper position. No exterior manipulation - just some exercises that can help.

Maybe try one or two? I don't think they can hurt (like the inversions) and you might be able to get the baby to turn sans ECV.

This is one of my big worries - so! You have my utmost empathy! I bet he will flip. Good niblit!

N.

[sashajwolf.livejournal.com]

I was also going to mention OFP. I used it in my second and third pregnancies and thought it probably contributed to C and R being in a better position than orangebird and thus giving me much shorter labours those two times (beyond the reduction that's usually expected). It helped to keep me active in the latter stages of pregnancy, too.

[treadpath.livejournal.com]

*sends good version vibes*

(Oddly, you're the second pregnant person I know having a version done this month. I guess January is a good month for free-floatin' in the uterus...)

[eeyorerin]

C'mon, Niblet, flip yourself back over! Or stay flipped when the doctor flips you back!

[eeyorerin]

Also, I love that Dr. Atlas is going to move your baby. Moving the world, indeed. :)

[chargirlgenius.livejournal.com]

At 37 weeks, Eddie was flipping daily. I know this, because I had frequent ultrasounds, and I'll tell ya, I could feel it. Can't tell you what happened after that, because we had a scheduled c-section at 37 weeks and a couple of days.

I hope this isn't an upsetting questions (I really don't know), but don't they do any natural breech births? I guess I was under the impression that intervening with c-section for breech wasn't strictly necessary, though what hospitals preferred (kind of like constant monitoring).

When I was pregnant with Eddie, I shared this article on "natural" c-sections with my wonderful OB. While we didn't have lavendar and soft music and all, she did pull him out a bit more slowly, to help clear the fluids a bit better. She shared later with me that she started doing all non-emergency c-sections that way, and was pleased with the results. Henry was my baby in the NICU with fluid troubles, not Edward.

But really, here's to flipping!

[rivka.livejournal.com]

With my weirdly-shaped pelvis, I don't think I'm a good candidate for a vaginal breech. And honestly, I'm not particularly willing to attempt it. Although my midwife did say that there are a couple of providers at my hospital who will do them.

[chargirlgenius.livejournal.com]

Ah, that makes sense (and is completely understandable). I'm right there with you, I scheduled my Cs in order to avoid something that was a small risk, but a potentially debilitating and life changing risk.

[rivka.livejournal.com]

Yeah. The thing about vaginal breech deliveries is that sometimes they go totally perfectly (example: bosssio's son Liam). But when they go wrong, they really go wrong. When I was a kid I knew someone who had permanent serious disabilities from a vaginal breech delivery. That probably colors my thinking.

[ailbhe]

Ah right, that's what I was wondering. So if you wanted to try it you could, so you get to make a real, informed choice.

I like that.

[rivka.livejournal.com]

Yes. Although, honestly, if the positions we caught today are any indication, he's thinking about being a footling breech or a transverse. (Now that I know how it feels for him to be transverse, I can tell that he's been doing it a fair amount, including in between the midwife visits when he was head-down.) A true transverse position is just plain impossible for vaginal delivery, and a footling breech is very, very dangerous.

If his butt was engaged, that might be a different story. As it is, there's not a lot of room for choice.

[ailbhe]

Well, it's a bit like the c-section "choice" I had, in that there's the sensible option and the crazy dangerous option, but that's better than being told what you will be permitted to do, IYSWIM.

I remember reading your positioning stuff for cephalic presentation through your pelvis before, and thinking that it would be difficult with even a frank breech unless it was a very tiny baby.

[morning-glory.livejournal.com]

According to my mom, I was a baby that was successfully turned using external cephalic version 30 years ago.

[kate_nepveu]

Crossing my fingers for you all.

[vom-marlowe.livejournal.com]

I've got my fingers crossed for you and the Niblet!

[bosssio.livejournal.com]

I would also try chiropractic - the webster technique. While it didn't work for Liam, it felt wonderful! Also, there is the "peas on the head, soft music on the pelvis" technique, handstands in the pool technique, and of course, my favorite, moxibustion. I found moxibustion extremely odd. Your mileage may vary.

I totally get you not wanting to try a vaginal breech, despite me having an extremely good experience with it. I would say to weigh the options carefully in terms of when to go for a c-section if that is how it ends up - a friend of mine was all prepped for a c-section due to breech presentation when they did a last minute ultrasound, and found baby was head down, fully engaged (i.e. wasn't going to move again). She was really pressured by her OB and the nurses to "go ahead and get the baby out" even though there was no longer a good reason.

And some now feel that the trial of labor is helpful for the baby, even with the result being a c-section. at least you will know that the baby isn't artificially premature if labor has started. Most OBs want to schedule it, though, and will press you hard to not go into labor before the section.

I hope you don't have to face these decisions at all - sending niblet turning vibes!!!

[geminigirl]

Agreed-there's another technique besides Webster that's supposed to be good for helping babies to flip; I'm drawing a blank on the name, but if you're interested I'll see if I can pull it up. There's a good list of Webster chiropractors at icpa4kids.org. My chiropractor routinely does it as part of her treatment for pregnant women because it's also good for helping optimize space in the pelvic cavity for turning head down-she explains it as helping to keep the space basketball shaped rather than football shaped, which sometimes happens.

I had moxibustion at the end of pregnancy when we were gently trying to evict Naomi before they insisted on a chemical eviction at 42 weeks. It was strange, but actually kind of pleasant.

I will be thinking good, baby turning thoughts for you.

[rivka.livejournal.com]

I totally get you not wanting to try a vaginal breech, despite me having an extremely good experience with it.

Yeah. It's not just my pelvic weirdness, either - he's presenting as either footling breech or transverse, and both of those are very different from Liam's frank breech presentation.

Must stop reading MDC threads about breech babies and versions. I thought I could get some helpful posts describing what a version feels like, etc., and instead I'm seeing people recommend - and I'm honestly not kidding here; someone really said this - that an unassisted breech homebirth would be preferable to a hospital birth, even if the hospital was willing to try vaginal delivery.

Yeah. Unassisted breech homebirth. WTF?!

I would say to weigh the options carefully in terms of when to go for a c-section if that is how it ends up [...] Most OBs want to schedule it, though, and will press you hard to not go into labor before the section.

I really liked that Dr. Atlas said that if the version fails or if Niblet flips back out of vertex afterward, the discussion about whether to schedule or wait for labor will be back in the hands of my midwives. It's clear that he isn't going to jump in and try to take over my birth - he sees my midwives as the primary providers and himself as a consultant. Seriously: I can't believe this guy is the chief of obstetrics at an academic hospital.

Also, I was happy to learn that the midwife on call will be there for the ECV, unless she is actually delivering a baby at the time.

[tammylc.livejournal.com]

Ugh - I'm so sorry to hear that! My external cephalic version didn't
work, but we discovered during my c-section that i had a heart shaped
uterus, and Liam was pretty wedged in there without room to move.
Doesn't sound like that's the case for Niblet, so i'll be crossing my
fingers for you.

There are a bunch of low intervention techniques for turning breech
babies - lying on a slanted board with your head lower than your feet
is one (encourages gravity to work on the baby's heavy head), and
there are a bunch of others. Might be worth trying between now and
your ECV to see if you can encourage him to turn on his own, and avoid
the procedure altogether. Let me know if you'd like to me to dig up
links from when I was going through it.

[hobbitbabe.livejournal.com]

I hope the Niblet gets himself head-downwards one way or the other, settles himself there without too much discomfort for either of you, and then gets out here conveniently so we can meet him.

[redbird]

*fingers crossed*

[pameladean]

Hoping he'll turn himself around all right. I was going to say, Hey, look, here's something you can tease him about for years, but I'm not sure if that kind of thing is part of your family culture.

P.

[ckd]

Best wishes.

[almeda.livejournal.com]

Oh, gah, Beka's done this too.

On Friday, she was *engaged* and *head down* and *pushing on the cervix* and everything and it was good -- and since then, not only has she moved back up, she keeps sliding diagonally-transverse now and again.

It's nerve-wracking ... she's spent THREE SOLID MONTHS with her hiccups coming from below my pubic hair, and now in the middle of week 37 she's suddenly doing flips??

[rivka.livejournal.com]

Argh. Are you going to try to turn her?

[almeda.livejournal.com]

There are no signs of anything laborlike yet, so nobody's even talking about that. My OB and I are currently in the "see me every Friday, feel up my cervix, check her heartbeat" phase of things.

Also, at least every other evening (and sometimes each night), she's at least mostly head-down again, which calms me. A little. She's just swimming around having fun giving me heart palpitations, at this point. I get the impression she's not ready to come out yet.

Edited to add: Note: my hospital considers ECVs "riskier and less effective" than just doing a c-section (*spit*), and largely doesn't do them. Ever. They also have an ironclad automatic-section policy for anything but straight OA or OP.

Which would be fine if she'd just go back to being straightforwardly OA, like she was for weeks on end ...

[nelc.livejournal.com]

Golly. This is too much for my feeble male sensibilities. Wishing you luck, Rivka.

[mjlayman.livejournal.com]

NBHHY

[fitzcamel.livejournal.com]

Best wishes and good luck to both you and the Niblet.

[minnaleigh.livejournal.com]

*fingers crossed*

[aendr.livejournal.com]

When mine was transverse and back-to-back before the birth, I was quizzed about how I spent my days. While at work, I spent a lot of time sitting on an office chair. The midwife (we don't see Obs Drs over here unless we're high risk) suggested that if I needed to sit, I did so on a birthing ball with my knees lower than my hips to tilt the pelvis forward, but to spend as much time as possible on all fours. Both of these would give extra room for manoeuvre and encourage the head downwards and the spine to the front (best possible position for vaginal delivery). He turned around. It's worth your while considering.

[rivka.livejournal.com]

I have a birthing ball, so I will try that. Thanks!

[aendr.livejournal.com]

Kneeling while resting your front on a birthing ball is a lot more comfortable than other versions of all fours too - I even managed to use my laptop from that position.

[shandra.livejournal.com]

My second OB was the lead on this procedure at his clinic and I had a chance to sit in on him lecturing other OBs on it. It sounds like you have really good information from yours (or at least it matches what I heard up here) and I hope it works... and if it doesn't, at least you will be getting the Niblet out okay.

As you know from your breastfeeding experience, sometimes things don't go according to plan and it is just fine to make the decision that you feel best nutures and cares for your child. Not that you needed me to say that, but you know... it's hard.

[rivka.livejournal.com]

I am generally feeling okay about the possibilities. I think I am less utterly emotionally attached to the idea of a natural birth now that I've already had one. Not that I didn't like it or don't want to repeat the experience, because I loved my birth and have been hoping for a similar one. But at least I have had the experience.

My biggest concern about having a C-section would be that it stacks the deck against breastfeeding. I had enough trouble the first time around, and I have so been hoping to do better this time.

[kate_nepveu]

If you mean being unable to nurse right after the birth, I wonder if your midwives will have some way around that, like having someone else position and hold Niblet?

If you mean the awkwardness of doing anything after major surgery, well, I had the world's easiest recovery from a C-section ever so I doubt I'd have much to contribute there even if you asked.

[ailbhe]

A major reason c-sections stack against breastfeeding is that women and babies are separated more after a c-section so they just plain don't get started, and then when they do start and it's hard, the staff say "oh, c-sections often mean you can't breastfeed." Your midwives won't do that to you, I don't think.

I'm currently training - almost finished, actually - to give phone support for the BfN breastfeeding helpline. I've breastfed after a c-section myself (not immediately after, but quite soon) and I've been helping other women with a variety of problems for a couple of years now. I'd be flattered if you considered me a resource.

[papersky.livejournal.com]

Z did this, and it completely changed my centre of gravity. Then he flipped back and all was fine, though it completely changed my centre of gravity again.

Also, the breast feeding thing? Look at Z and Alex. Couldn't really have done any harm, could it, because isn't it hard to think how it might have improved them?

[fairoriana.livejournal.com]

Oh yikes!!!! Grey actually flipped transverse for about a day at 37 weeks. It felt bizarre. Then he re-engaged and that was that.

I hope that Niblet puts his head back down and stays there!

[tendyl.livejournal.com]

I've lit a Candle for you and Niblet that all will work out for the best.

[(Anonymous)]

My DIL had a successful ECV and vag. birth last year. However, while the baby was still transverse, her midwife told her that if she were to go into labor, she should lie down on the floor and have someone else call an ambulance. I'm reluctant to worry you but feel obligated to make sure you know what your team thinks is the safest way to respond in this hopefully unlikely situation.

[rivka.livejournal.com]

The risk is not so much going into labor while the baby is transverse, but having the waters break while the baby is transverse. As I understand it, the concern is that part of the umbilical cord might emerge through the cervix (cord prolapse), cutting off bloodflow to the cord and therefore also oxygen. Which is bad. In ordinary circumstances the baby's head (for a vertex presentation) or butt (for a frank breech position) blocks the cervix and almost always prevents prolapse.

So yes, thanks, I'm aware of the danger, but I appreciate you checking in.

[elisem.livejournal.com]

Thinking of you guys, sending good wishes.

[thette.livejournal.com]

Good luck!

The mother of my nephew had an ECV. Said it was more painful than giving birth, but it worked.

[ex-serenejo.livejournal.com]

I'll be having my surgery on Tuesday. May both our procedures be without incident and successful.