When pregnancy takes a wrong turn
Some women can avoid a C-section when babies are in breech position
Friday, September 01, 2006
At 37 weeks of pregnancy, your nerves have probably kicked into high gear. Everyone is buoyed by your excitement as you enter the final weeks of pregnancy. But during one of those routine obstetrician visits, your doctor gives you some news you probably weren’t expecting to hear: your baby is in a breech postion.
By your 37th week, your baby should be turned head down, ready to be born vaginally. But some babies, less than 5 percent, are in breech position. This can mean the baby’s bottom is down, a frank breech, or that the baby is sideways, transverse. Since vaginal birth of breech babies is controversial, your obstetrician may give you another option before scheduling a Caesarean section.
"My doctor told me that Alissa was breech and gave me a lot of information on helping her to turn on her own. It didn’t work, so I was offered an ECV," says Kelly Melville, of Bolingbrook, of her daughter’s birth in 2004.
ECV, or external cephalic version, is a medical term for turning the baby while it is still inside the womb. Literally, your doctor, nurses and possibly an anesthesiologist manipulate the baby into a head-down position by applying pressure to your abdomen.
"Generally, the success rate is between 60 and 70 percent," says Dr. Xavier Pombar, director of obstetrics at Rush University Medical Center in Chicago.
Before you consider an ECV, here are some things to discuss with your doctor.
Your weight. Women who are overweight, not counting those pounds gained during pregnancy, may have a difficult time having a successful procedure.
Medical condition. If you have experienced problems during your pregnancy, such as a history of bleeding, a decrease in amniotic fluid or any problems with the baby, you should not be offered an ECV, says Pombar. Generally, only low-risk pregnancies should be considered because there are risks to the baby during the procedure. The placenta could become displaced or the cord could get wrapped around the baby. Because of these possibilities, doctors use ultrasound technology during the ECV to assure the baby’s safety. Any distress to the baby or mom might result in an emergency C-section.
Experience. Ask your obstetrician how many ECV procedures they have performed. If your doctor has a small amount of experience, you may want to consider asking another to stand in or at least to observe.
"Make sure they have ultrasound capability and that an anesthesiologist is around in case of any emergency C-section," advises Pombar.
Pain. We all know that childbirth is usually equated with pain. ECV is also painful for many women, and an epidural may be recommended. Moms who are planning on a natural childbirth may brave the ECV without painkillers, but should be sure to have professionals on hand to help if the baby is in distress.
Hospital stay. For the most safety, an ECV should be performed in the hospital with staff on standby for a C-section. You may need to fast the night before and your bags should be packed in case your baby arrives and you need to stay. If you have other children, make sure their caregivers can stay longer than a couple of hours.
Controversy. There are articles in many women’s magazines discussing elective C-sections. While everyone has an opinion on what is best for mom and baby, your choice may be between an elective C-section and attempting an ECV. While no one should ever need to defend the choices made during pregnancy, be prepared to face questions from nosey people.
Previous C-section. If any of your previous births were C-sections, your doctor may advise against ECV. Some doctors might offer the procedure as an option, but do your research and consider your options. If you had planned on a repeat C-section, you may want to stick to your original plans.
Old wives’ tales. If you ask around, women may give advice on turning the baby yourself at home. Before the birth of my daughter, I attended a session on acupressure and pregnancy. They gave a couple of pressure points that would encourage a baby to flip out of a breech position. Some moms will swear by their hypnotist and others by certain yoga moves. Before using any of these options, consult with your doctor.
Melville’s obstetrician suggested she try lying on the floor with her pelvis in the air or putting headphones on her belly to play calming music. Neither of those options worked and her daughter stayed in breech position.
Failure. While ECV is a great option for avoiding C-sections for healthy moms and babies, it is only successful in 60 to 70 percent of cases. Be prepared that it may not work and that a C-section may be your best option for a safe and healthy delivery.
Success … sort of. After considering all of your options, you should be aware that in some cases, after a successful ECV, a baby may flip back to the breech position. Although rare, it is important to know so you can consider whether you are prepared to have the procedure performed again.
In the end, choosing an ECV is your decision. Speak with your doctor, talk to friends and research your options. Figure out what you are comfortable with and make a confident choice.
Kelly Melville chose an elective C-section instead of an ECV and daughter Alissa was born healthy and happy. She has no regrets, but was glad that the choice was hers to make.
Michelle Sussman is a mom, wife and writer living in Bolingbrook.