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

[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.