Posted by My OB said WHAT?!?.
Mar
13
Posted by My OB said WHAT?!?.
“We’ll Probably Have To Do A Version…Or Start Thinking About Scheduling A Cesearean.”
“We’ll probably have to do a version… or start thinking about scheduling a cesarean.” -OB to mother with a suspected breech baby at 32 weeks prenatal visit.
There are 31 comments to this post.
My first baby was in a transverse lie until nearly 38 weeks, and my midwife just adviced me to stop worrying and wait. My second baby (now 38 weeks tomorrow) is still doing full range of movement. During the course of the day she can be (and usually is more than once) head up, head down, transverse, facing front and facing back. I figure she’ll settle when she’s ready. I can’t imagine why a baby not being in perfect position at 32 weeks would be a problem!
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Oh my god, an OB is thinking about performing a version or a c-section on a breech baby! OH NO, let’s all freak out!
Scheduling a c-section based on the position of the baby at 32 weeks may be premature. Big deal. All you need to do is say, “No, I’d actually rather wait and see if the baby turns”. It’s not that hard, people. The doctor can’t make you have a c-section.
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Oh my god, an OB is thinking about performing a version or a c-section on a breech baby! OH NO, let’s all freak out!!
Scheduling a c-section based on the position of the baby at 32 weeks may be premature. Big deal. All you need to do is say, “No, I’d actually rather wait and see if the baby turns”. It’s not that hard, people. The doctor can’t make you have a c-section.
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Jane Reply:
March 14th, 2010 at 6:03 am (Quote)
Doctors “make” women have c-sections all the time. That’s not a question.
The question here would be how the mother was during the exam. The response above would be fine (ideal, even) if the mother got panicked. “Oh no! He’s breech? What are we going to do? He’ll never go head-down! He’ll die! I don’t want to die! How can I make him turn? What can we do? You can’t MAKE a baby turn over, right?”
Then saying, “Hey, relax! We can try a version or schedule a C-section” would be a compassionate, appropriate response.
But if it was more like, “Baby’s still head-up,” and the mom said, “Oh, I’m not worried. He’ll probably turn. My sister’s baby turned at 37 weeks,” and the doctor said, “Nah–we’ll just section you. Or MAAAAAYBE try an external version if you’re one of those weird women who wants to try a ‘natural’ birth,” then … rude. 
The format here does make it hard to tell sometimes. But if “innocent” comments are getting the rage treatment from the moms who hear them, then it probably behooves the doctors to think about how they’re coming across, because the compassion and professionalism they want to think they’re exuding isn’t being perceived that way by the moms who hear them.
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Actually, as nice as it would be if it were true that a doctor can’t “make” you have a c-section, why don’t you try talking to women who had docs threaten them in labor with instant court orders, and/or CPS involvement if she disagrees or tries to leave. It isn’t commonplace, thankfully, but it has happened.
So to pooh-pooh all this and insist that all a woman has to do is decline the physician’s advice, is naive. I wish it were true across the board that women retained their rights to medical autonomy during pregnancy, but in practice, that right is being seriously eroded.
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Wendy Reply:
March 14th, 2010 at 7:45 am (Quote)
Exactly, Meg. The words “no thank you” may come easily to those of us you post here. But if you haven’t studied evidence-based maternity care, (and why should consumers *have* to when it’s a doctor’s ethical obligation to know it and practice it?), for all you know this doctor could be conveying a life or death situation. It infuriates me how doctors exploit this power differential to convey misleading information and outright lies to women.
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The Deranged Housewife had this to say,
Mar 14, 2010 @ 8:29 am (Quote)
Well, at least they offered to try and turn the baby. Neither of my OBs did with my two breech babies, so it was off to surgery. However, my last turned at the last minute (transverse), so I told them to leave me alone for a while to see if he turned. I broke out the bag of frozen brussels sprouts 
and he did turn, but just went the wrong way. Troublemaker …. 
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Tomorrow, a friend’s wife is going in for a c-section for a breech baby. The little one recently flipped and she is now 39 weeks. Instead of giving the little one a chance to turn again, or pick their birthday – the doctor decided to go ahead and schedule a section.
I am aghast on the sidelines, but they are too comfortable with the doctor’s authority to listen to a crazy home-birther. That said, I simply offered advice if they wanted, but said they’d be in my thoughts otherwise. My heart is breaking for this lovely woman’s most-likely unecessary c-section.
The issue isn’t that we CAN refuse these interventions, but that most people (even these two biology PhDs) aren’t comfortable having to buck the system.
Another close friend had a c-section for suspected macrosomia (her first child was a nine-pounder), and had a six pound baby. Then, wasn’t “allowed” to VBAC, and had a second section for a seven pounder.
It is for these women that the mainstream needs to be vocal about the flaws in the system.
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My sister had a c-section for a breech baby (after 2 vaginal births) because, and here are the doc’s words: “I don’t know how to deliver breech babies.”
If that was true, then at least he’s honest, but pathetic (and should’ve gotten someone who DID know how, since that was the mother’s wishes) and if he was lying, I have a limited vocabulary to describe him, so use your imagination.
Doc scared the husband into signing the papers – dead baby and/or mom card.
Baby is 5 years old, and mom still cries about that day.
It’s the choice of version or c-section that’s ridiculous. Because why wasn’t a breech vaginal birth an option?
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Jane Reply:
March 14th, 2010 at 1:36 pm (Quote)
Ina Mae Gaskin discusses this in her guide to childbirth, how many doctors have NEVER delivered a breech baby and therefore have no clue how to do it safely. She makes a good case that doctors do need to learn to do it so that in cases where it’s an emergency and they have to, they know whta to do and won’t panic.
(That’s sad, when you hear a story about a doctor who panics because the baby presents bum-first and is coming fast, and does something ridiculous like shoving the baby back up into the uterus so he can do a section. Babies have died because of that kind of panic. And then you also think about if a doctor has to deliver a baby during a power outage: this may be unlikely, but it could happen so it’s really for the best that the doctor know what to do.
Or, in your sister’s case, the doctor could have found someone who DID know how to deliver breech and then watch in order to learn something.)
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When I was pregnant the first time another couple in our Bradley class was being pushed into scheduling a c-section because her baby was breech at their 20 week ultrasound. Baby was vertex at term but still…
For our second birth when we were interviewing homebirth midwives a knowledge of vaginal breech birth was a must. Our midwives that we chose teach at the local midwifery college.
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After one homebirth my second was discovered breech at 39 weeks. My midwife consulted with the ONLY doc in the city who allows trial breech births. He agreed to take me on as a patient. I successfully delivered a vaginal breech 4 days later into the waiting hands of the OB resident…whom I asked to attend the birth. I figured that he might never get another opportunity to experience this, so the attending OB let the resident do it! 1 more person in this world knows how to deliver breech!! YAY!!!
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frootloop79 Reply:
March 22nd, 2010 at 9:43 pm (Quote)
My 2nd son’s birth was almost the same. We didn’t realize my son was breech until I was ready to push. My Midwife, called the OB, they were going to do a c-section but by the time we got to the OR, one leg was already out, so the OB delivered my son breech and my midwife watched. After he was born, she told me he was her first breech! So there is another that learned!!!
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My son was breech from about 28 weeks and at my 38 week appointment the midwife said we would discuss a version and possible breech birth at my 39 week appointment. We never had the convo since he turned before dinner and was born the next day around 3 pm 2 days before the 39 week appointment. if he was butt first she would have let me try if I wanted and she said we would have done an ultrasound to verify that at the appointment.
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Knitted in the Womb had this to say,
Mar 15, 2010 @ 8:19 am (Quote)
My 3rd baby was transverse until 32 weeks, then flipped head down by 34 weeks.
BUT…for what its worth, at least the OB is addressing the issue of breech in time to do something about it. Some don’t address it until 36 weeks, then the mom can’t get an appointment to try an external version until 38 weeks, when it is more difficult to do because the baby is bigger.
Or there are cases like a client of mine, who was SURE her baby was breech from about 32 weeks on, and her care provider kept telling her that baby was head down. She got to full term, water broke, she went into the hospital…and guess what? Baby was breech.
Vaginal breech SHOULD be an option…but when it isn’t, at least lets give women a decent chance at external version or other methods to flip the baby.
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Kat Reply:
March 15th, 2010 at 9:12 am (Quote)
I do agree that mentioning ways to turn the baby is a good thing, but it sounded to me like this doctor was jumping straight to interventions without keeping in mind most babies turn with NO intervention by 36 weeks. Exercises can be effective, and don’t have the level of risk involved with external version.
Most doctors don’t seem to even know about gentle, no-risk, non-invasive chiropractic techniques that encourage turning, much less advise patients to use them.
I am living proof (and my son is sadly deceased proof) that vaginal breech birth with an inexperienced care provider can be tragic. I just wish more care providers WOULD be trained so they don’t panic in a situation where a baby turns the day before labor starts, or during labor, etc.
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32 weeks seems waaay early to start talking about a possible c section for a breech baby. But, couldn’t the mom just say, “no thanks, doc, let’s just wait and see if the baby turns on his own”? If the doc gets an attitude about it, hey, he’s not the only doc in town, is he?
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No OBGYN will deliver a baby at 32 weeks for breech UNLESS she is laboring (changing her cervix)and we can’t get her labor stopped with our preterm labor drugs. Babies lungs are not mature at 32 weeks. Most fetal lungs are mature at 37 weeks, some babies a little earlier. I suspect your OBGYN was talking out loud and trying to prepare you for the possibility of a C/S. On first time mothers, the baby is usually in delivery position of head down between 28 – 32 weeks. OBGYNs in general do not like to deliver breech because the largest part of the baby is the head. God forbid if the cervix closes down on the babie’s neck or we can’t get the babies head out. This is a huge liability issue. We practice defensively. Breech births are only done if the patient rolls in with feet or butt presenting and she has a proven pelvis. I’m merely describing why we do what we do. Ultimately, the decision is yours and with research, go to your MD and discuss viable options and why. Your physician has the right to discontinue your care and refer you to the closest teaching hospital to continue your care. Don’t let any OBGYN intiminate you. Ask questions.
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CCindy Reply:
May 11th, 2010 at 5:10 am (Quote)
We know you practise defensive medicine and not evidence based medicine. We also know that your doctors are not trained to deliver breech. It has become a lost art. That is the whole point of this site and this post. Welcome to the party. Care to learn something?
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You know, even if he had said “If he doesn’t turn by the time you go into labor we will be looking at a cesearan” that would have been acceptable. Not great, but an acceptable heads up. But to whip out the word “schedule” at 32 weeks is just beyond defensive medicine and into to the area of “I don’t give a rip about your health if I can come up with an excuse to get out my scapel and be done in 55 minutes.”
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“…or, we could do some totally safe natural things to encourage the baby to turn. Or he may just turn on his own, but then I don’t get three times as much money for your baby’s birth, do let’s not think about that.”
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