Well, crap.
Jan. 27th, 2009 05:10 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
rivkaLast 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.
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.
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no subject
Date: 2009-01-28 04:22 am (UTC)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.