WWYD - Transverse baby

may2806

I was really hoping to have a med-free birth but baby is still transverse at 37 weeks. Drs think it is simply the shape of my uterus (possible arcuate) and therefore a version wouldn't have a likelihood of working. I've also tried the spinning babies exercises to no avail. Baby has been transverse pretty much the whole pregnancy so I really don't think it's likely he'll turn. Not really looking for advice on how to turn him, but rather what to do now...

MFM says that often transverse babies turn in labor - which would lead me to just want to wait to go into labor, except that I'm on a prophylactic dose of Heparin because of clotting issues. So if I go into labor and baby doesn't turn and I need an emergency c section, I might need general anesthesia (Heparin and epidurals don't mix) depending on when I took my last dose. There is something they can give you to reverse the effects of Heparin, but GA is still a small possibility.

The other option is to schedule a c section at 39 weeks in which case I would know when to stop the Heparin. This is the exact opposite of what I wanted for the birth. But, my main concern is obviously getting the baby here safely - and hopefully being awake for it! It's very hard to give up the possibility of a natural birth though. I had many losses in the past and this might be my only pregnancy, so all of these considerations are weighing very heavily on me. 

Many women I've talked to don't think a scheduled cs is a big deal, so I thought I'd see what other women who wanted a natural birth would do in this situation.

nodito

One of the things I've found most interesting in my research on natural birth is how labor actually benefits babies.  You hear so much about fetal distress and meconium in the water and failure to progress and all these problems that I think we often overlook the fact that our bodies and our babies were designed to undergo this process.  Because labor squeezes and pushes on the baby, babies born vaginally as well as those who start labor and are later born by c-section, have healthier lung function than babies who never go through labor.

For that reason, as well as the hope that the baby might turn, I would probably elect to wait until labor began naturally if I were in your position. 

Are there no other options besides general anesthesia for an unplanned c-section?  What about having a spinal; would that bring the same complications as an epidural?  Could you stop the heparin early at 38 weeks or would that be dangerous?  How effective are the heparin-reversing drugs?  Those questions would all factor into my decision.

Good luck.

may2806

nodito said:

One of the things I've found most interesting in my research on natural birth is how labor actually benefits babies.  You hear so much about fetal distress and meconium in the water and failure to progress and all these problems that I think we often overlook the fact that our bodies and our babies were designed to undergo this process.  Because labor squeezes and pushes on the baby, babies born vaginally as well as those who start labor and are later born by c-section, have healthier lung function than babies who never go through labor.

For that reason, as well as the hope that the baby might turn, I would probably elect to wait until labor began naturally if I were in your position. 

Are there no other options besides general anesthesia for an unplanned c-section?  What about having a spinal; would that bring the same complications as an epidural?  Could you stop the heparin early at 38 weeks or would that be dangerous?  How effective are the heparin-reversing drugs?  Those questions would all factor into my decision.

Good luck.

Drs advised me not to stop the heparin (wish I could) and I think the spinal is the same issue as the epi. It wouldn't necessarily mean GA; just that there would be a small chance of it depending on how long ago I took the last dose. My OB seemed more concerned about the chance of GA than the MFM, so it's hard to say for sure in terms of the likelihood of needing it or how effective the reversing agents are. I completely agree about the benefits of going into labor first. Thank you for your response!

nodito

And this might be a bizarre question, but what is your biggest fear/concern with GA?  Is it that you want to be awake and present for the birth or are you worried about the anesthesia/complications with surgery itself?

may2806

And this might be a bizarre question, but what is your biggest fear/concern with GA?  Is it that you want to be awake and present for the birth or are you worried about the anesthesia/complications with surgery itself?

I've been under anesthesia and never had any problems before. Of course I know any surgery has risks; but my biggest concern is missing the birth of my child.

robyn2201

I think I would go with going into labor naturally and hoping it doesn't result in a c-section under GA. Did they give you an idea what % of transverse babies move head down during labor?

You mention that they think baby is transverse due to the shape of your uterus and that you have tried spinning babies, but have you looked into seeing a Chiropractor specializing in the Webster technique?  

may2806

@sweettalkin417 I didn't get a percentage although that is a great question - dr said 'most' will turn either head down or breech. Haven't seen a chiro but that's something to consider.

tokenhoser

I think I would probably roll the dice on baby moving during labour, but I don't think there's a right and a wrong here. You should ask as many questions as you can, try to think about how you'll feel after all the scenarios, and know that your baby will be fine. You're giving birth in a place that seems very well equipped to deal with emergencies - they'll take good care of you both.

I would book into a Webster chiro and maybe look at acupuncture, too. It won't hurt, and it might help. Check your insurance to see if you have any coverage.

huntjul

I would roll the dice and hope baby turned head-down during labor.  But I'm anti anyone slicing my abdominal muscles unless there's a damned good reason.  Yes, it does suck being asleep for the birth of your baby, but remember that awake c-section moms don't usually get more than a glance at baby before he/she is taken away.  So a c-section kind of makes you miss out either way

katharine25

As a heparin patient who was dealing with a breechling until 36 weeks or so, I grappled with this issue. In the end, if he hadn't turned, I decided I would much rather be fully present for the birth (scheduled c-section) and retain some elements of my birth plan like immediate skin to skin (my hospital allows that) and straight to the breast than risk going into labor naturally, needing an emergency CS and then having to go under general anesthesia and not be present at all. It took a lot of thinking and hashing put the possibilities for me to get there.
First though, I wanted to try everything possible to turn. I had success with the chiropractor & the Webster technique. I was fully prepared to schedule a version at 38 weeks (and also pre-emptively stop Heparin if an emergency c-section was needed).

Good luck with your decision! The Heparin really does add a complicated element to letting things go "naturally". And while they say they can reverse heparin, that's debatable and if emergency CS is really required, may not be a viable possibility.

JessicaMae85

Congratulations on your healthy pregnancy! I see from your signature that you've already walked a long way to be at this point of making these important birth decisions for you and baby.

Have you considered calling around to doctors in your network to see if anyone is experienced and willing to delivers breech babies vaginally? It may seem like a long-shot, but C-sections have only been the go-to protocol for breech babies since 2000--up until then OBs were still being trained to deliver breeches vaginally. I realize, too, that it may be difficult to change birth attendants this late in the game, but if the option becomes available to you to have a trial of labor even if your baby hasn't/doesn't turn, perhaps it's something to consider.

The other thing I suggest is asking your doctor what these exact time frames are that you have. Could you stop Heparin at the first signs of labor--your first contractions? How long exactly does there need to be between a does of Heparin and an epidural? When is the absolute last day they would allow you to schedule a C-section (so you don't feel unnecessarily rushed to decide)?

If you do decide to allow yourself to go into spontaneous labor, are you aware of what all of your options are at your specific hospital regarding photographing or recording your baby's birth? If not, it might be worth looking into if you can hire a birth photographer to be present in the event of cesarean delivery with epidural or cesarean delivery with general anesthesia. Maybe if you knew you had the birth photographer there, you could feel better about taking the (small, as you said) risk of GA knowing that you would have beautiful photo or video of your baby's birth, even if you were under for the moment of birth. Husbands can be good photographers, too, but they can also be too overcome with their own emotions about their baby and their wife in those moments to focus on documenting. Or, if you have a doula already, perhaps she could be your designated birth photographer?

Also, even though these are hard decisions, I can't help but be excited for you that you are at this moment in your birth journey!

All my best,
Jess

pixieprincss

For what it is worth. I had a successful ECV with DS1 who was transverse and I had an arcuate uterus. I also did moxibustion. For DS2, I used chiro care to help motivate him to turn out of transverse. Both boys ended up OP prior to labor and then turned during labor (one OT and one OA). So, I'd advocate for waiting things out as long as possible to let contractions help your baby turn. But, it really depends on your provider. With a long, non-standard labor, you really want someone who believes in the body's ability to do this to give to make it relaxing and without fear of intervention over your head. But, better yet is to go full in now with motivating baby to move. Chiro care with a person who specializes in pregnancy is my #1 pick when spinningbabies doesn't cut it.

may2806

@jessicamae85 thanks for your response! Unlike breech babies, there is no way a transverse baby can be born vaginally. In answer to the other questions, yes I would stop heparin at the first sign of labor (even if I'm not sure, dr says not a big deal to miss a dose). In terms of how long it takes to get out of your system, it kind of depends - a dose is meant to last 12 hours but it may potentially be out sooner especially if reversing the effects works. Also it might depend on how the particular anesthesiologist feels. In terms of scheduling the section, my OB had said 39w1d but MFM said he'd be ok with going until the following week; but OB might not want to do that. Also if GA is required no one else (not even DH) would be allowed in the OR, so that definitely sucks!

may2806

@smsalat those are all definitely all important things to consider. Such a hard decision - still not sure what we are going to do but I appreciate everyone's feedback.

JessicaMae85

@may2806 Thanks for explaining the transverse baby situation. Your quandary makes more sense to me now! I love how informed you are about your options. I just know that whatever you decide, you will be able to make peace with it. That's the beauty of being so present for these choices!

I look forward to hearing your birth story.

Sending you and your family lots of love from beautiful Hawai'i!!
Jess

atcwag

Would you Dr. be willing to do an US to determine if your uterus is arcuate?  If so, then maybe a better determination on the success of a version could be calculated....

I am anti-CS for a variety of reasons, so I would be doing everything in my power to avoid that.