Posted by My OB said WHAT?!?.
Nov
14
Posted by My OB said WHAT?!?.
“…There’s A Hole In The Middle Of The Skull…”
“Either there’s a hole in the middle of the skull or that’s not a head.” -OB to mother during an internal exam at 41 weeks. Ultrasound ensued and breech baby was born by cesarean the next morning.
There are 19 comments to this post.
Michelle Potter had this to say,
Nov 15, 2009 @ 10:40 am (Quote)
I had a footling breech baby vaginally, with no warning since she had been head down and TURNED IN THE MIDDLE OF THE NIGHT!, completely unmedicated, UBAC (until EMS showed up), with precipitous labor (45 minutes, total) and shoulder dystocia (is it still shoulder dystocia if the baby comes out backwards? She got STUCK. VERY STUCK.) Even ICAN says, “If you have a macrosomic baby or a footling breech cesarean may be better for you.” I probably would NOT recommend someone having a footling breech baby that way, if they can help it. And yet somehow, between my husband and the paramedic, we managed to deliver my daughter safe and sound with only a minor stretched nerve (Erb’s Palsy, but VERY minor) that healed on its own – without anyone having to cut me open anywhere! If we can do that under such extreme conditions, surely a medical-school-graduate OB in a hospital with forewarning and a normally progressing labor can manage to figure out how to deliver a non-footling breech baby safely.
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Michelle Potter had this to say,
Nov 15, 2009 @ 10:47 am (Quote)
PS, about that quote from ICAN. That’s from their fact sheet on breech babies, so when it says “If you have a macrosomic baby… cesarean may be better for you,” I think the implication is a macrosomic baby who is also breech. I don’t know their position on macrosomic babies who are not breech. And obviously, they are probably talking about TRUE macrosomic babies, not babies who are oh-my-gosh-nine-whole-pounds-are-you-crazy-get-a-c-section!
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Shannon Reply:
November 21st, 2009 at 9:45 am (Quote)
My son was considered a true macrosomic baby, 11lbs at 40weeks(but not breech), he was delivered without problem. Good thing my OB didn’t suspect, she would probably have tried to scare me out of my homebirth(I pushed for 10 min or less to get him out from start to birthing his shoulder which did take work, his chest w/out arms was 16.5″
Anyway, all that to say, you don’t NEED a c/s necessarily b/c you have a big baby either 
He was my biggest by 2lbs..
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Michelle Potter Reply:
November 22nd, 2009 at 5:02 pm (Quote)
Congratulations! Like I said, I don’t know what ICAN’s position is on true macrosomic babies. I’m pretty sure that statement was in regards to babies who are both macrosomic AND breech.
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Wow Michelle,
I am impressed you all were able to do that! I’ve seen some video on Kat’s sight of two breech births in water, one was delivered on hands and knees and they just let baby hang there. The midwife would check on the baby holding it for a moment, but just let it float. It moved and kicked around a bit, and it looked very strange, but baby appeared okay. Baby was born safely this way, but it seemed like forever. The other was not so peaceful and mom was in bath semi reclined, midwife pulled and such, but I would assume baby was fine because the video is out there. I think if I realized I had a breech and I were at home, I’d get on my hands and knees with baby supported by someone, no tugging as long as you could feel movemnt and heartbeat. That’s my plan anyway.
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Michelle Potter Reply:
November 15th, 2009 at 6:25 pm (Quote)
I did deliver on hands and knees. I think it was the 911 operator who suggested it.
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Wow! You are so VERY VERY lucky.
My surprise footling breech birth did not end that well. My son would be about to turn five, and I miss him every single day.
I think situations like mine make it even more necessary for all birth care professionals to have thorough training in breech birth. You can not know 100% that a baby will not turn during labor, and present breech at a point where it’s necessary to complete the birth vaginally. Knowing what the heck to do can be the difference between “mild Erb’s palsy” and “The funeral is next Saturday.”
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Michelle Potter Reply:
November 15th, 2009 at 6:40 pm (Quote)
I am so, so sorry for your loss. I agree that preparation is absolutely vital. Both of our experiences show that a baby known to be head down can turn at the last minute, and that can be disastrous. I was fortunate that we had planned a homebirth, and had prepared for the “just in cases” by learning what to do, and also that the paramedic had experience with babies born breech (though he’d never delivered a footling breech before).
I hope I did not give the impression that having a footling breech baby vaginally was not dangerous. I do believe that I had the best possible situation for the birth I had — if I’d left for the hospital when my water broke, I feel certain my daughter would have been born, and died, in the car stuck in morning rush hour. I do not think it was even possible for us to get to a hospital in time. I’m not sure it was even possible to get to the car. But I would not PLAN to have a footling breech baby at home. Frank breech, maybe, but not footling breech.
It just bugs me that my husband could figure out the method for delivering a breech baby from a BOOK — and make it WORK — and that the paramedic was trained in and had experience in delivering breech babies, but an OB in a hospital can’t figure it out.
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While I think it’s appalling that many of today’s OB/GYNs have little to no training in vaginal breech births, I also want to say…
NICE BEDSIDE MANNER, JERK!
I’m pretty sure no prospective parent wants to hear mention of a hole in their baby’s skull, whether the doctor thinks he’s being funny or not.
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NIcholas Fogelson had this to say,
Nov 20, 2009 @ 10:46 am (Quote)
Ok maybe its a little in bad taste, but have a little sense of humor. The mother is adequately dilated that when the physician did a cervical exam he/she felt the babies ass. There’s nothing incompetent about that.
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Yeah, it’s just our lack of a sense of humor that doesn’t find the phrase “There’s a hole in the middle of the skull” hilarious.
It’s great the doctor discovered the baby was breech. The comment was not the best way to phrase it to an exhausted emotional woman hoping to birth a baby in the next few days.
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Does anyone remember a time when a frank breech did *not* mean an automatic cesarean?!! Such a price to pay for what used to be a variation of normal for a competent provider . . .
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Megan Reply:
November 14th, 2009 at 7:29 pm Megan(Quote)
The key word in that sentence is *competent*.
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