Turn Around

I’m currently 38 weeks pregnant and physically feeling pretty good. The main issue at the moment is that spudlet is still breech.

What this means is that his head is up the top of my uterus, when it should be at the bottom by now so that he can be born head first. He seems to be wilful already and has refused all efforts to turn him thus far. These have included:

  • Inversion (kneeling with head down, bum up)
  • Breech tilt (lying upside down dangling off the couch)
  • Somersaults in a swimming pool
  • Putting an ice pack at the top of my uterus and a heatpack at the base
  • Talking to him, singing to him and poking him
  • Chiro (Webster technique)
  • External Cephalic version (having a obstetrician try to physically turn him from the outside at a hospital) x 2

I haven’t tried acupuncture/moxibustion because that strains my credulity a little too far.

Having the ECV done is pretty uncomfortable. I have some impressive bruises to show for it and I don’t bruise easily. Both times, the obs couldn’t find any obvious reason why he wouldn’t turn. Spudlet is a normal size, has plenty of surrounding fluid and my uterus seems to be a normal shape. The obs could turn him 90 degrees but no further and he soon shifted back.

After the first ECV, spudlet was observed with the cord between his legs, clamping down on it. The second time, he visibly had it in his hand and was squeezing it as if to say “leave me alone”! Cheeky baby! Note that there’s been no sign of cord entanglement. The obs was clear that he didn’t have any cord around his neck.

The breech issue has been quite stressful, especially combined with the CMP issues that I wrote about last time. Some of the advice we’ve been given by obstetricians indicates that a caesarian section would be the best idea in this situation, especially as it’s my first baby.

Being the stubborn opinionated people we are, Craig and I decided to look into this a bit more. I started reading guidelines, journal articles and websites (see below) and collecting the opinions of midwives. I was pointed towards the AU/NZ breech birth group on Facebook who turned out to be a wonderfully supportive community. I got a bunch of information, suggestions and personal anecdotes and was also pointed towards more of the literature by them.

As a result of this, when I went in for my second ECV, I was feeling considerably more confident and able to discuss my concerns with the consultant obstetrician in a lot more detail. It really helped, he listened to me, respected what I had to say and was pretty honest about what (and where) my options were.

I now have a referral to KEMH to discuss options around vaginal breech birth (VBB). Armadale hospital where I had my ECVs done were hesitant to accept me for a VBB as they don’t have surgical teams in place at night for emergency caesareans. KEMH have more expertise with VBB and complex births in general, so hopefully I’ll get a better outcome.

We are aware that there are risks associated with a VBB and that there’s a good likelihood that I’ll end up needing a caesarean section anyhow. There are also considerable benefits to letting spudlet arrive when he’s ready and experiencing labour for both of us. If I can have a natural birth, that will also be greatly preferable in terms of recovery time, bonding and options for a future pregnancy.

Our appointment with KEMH to discuss options is tomorrow morning. I hope we meet their criteria for VBB (I believe we should based on their guidelines). Then we will wait to see what happens. One way or another, we should be meeting spudlet in a week or two!

 

If you are interested in learning more about breech birth, here are some of the resources I used.

Useful Groups/Websites:

Breech Birth Australia and New Zealand Facebook Group (this was invaluable to me – closed group, ask for an invite)

Breech Birth AU/NZ

Spinning Babies

Breech Birth Guidelines:

Royal AU and NZ college of Obstetricians and GynaecologistsManagement of Breech Presentation at Term

King Edward Hospital (WA) – Breech Presentation Guidelines and Breech Presentation Planned Vaginal Birth

Royal College of Obstetricians and Gynaecologists (UK) – Breech Presentation Management (interesting to compare with the AU/NZ one)

Society of Obstetricians and Gynaecologists of Canada – Vaginal Delivery of Breech Presentation

American College of Obstetricians and Gynaecologists – Committee Opinion Mode of Singleton Breech Delivery

Journal Articles (you’ll need access via an academic library with the appropriate subscriptions for most):

Term Breech Trial (2000) (there are also lots of follow up studies and commentary papers on this trial)

PREMODA (2006) also a followup analysis

Vistad (2013)

Borbolla (2014) – Australian study

Bergenhenegouwen (2014) – Review of literature for preterm breech delivery

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