Most babies these days come out head first. Breech deliveries used to be more common, but medical schools have pretty much stopped teaching them, so most practitioners aren’t experienced enough to do them. By the end of pregnancy, only about 1-3% of babies are breech. Aren’t I lucky?
Baby boy was cooperative and head down at 20 weeks, but by his 28 week growth scan he was breech and stubbornly remained that way. At first everyone said, “Oh don’t worry he has plenty of time to flip,” and at 30 weeks my midwives recommended I do a few exercises from spinningbabies.com, and some passive things like put a cold pack on the top of my abdomen where his head was, play music and/or shine a flashlight down by my cervix. I dutifully did all of these things. At 32 weeks, they suggested going to a pool and doing headstands under water. While that didn’t sound like fun, it sounded easier than getting a C section, so off we went to the pool.
By 34 weeks, they gave me the name of an acupuncturist and I began doing weekly acupuncture sessions and moxibustion several times a week while laying upside down on an ironing board. True story people. I was committed. I found acupuncture pretty relaxing, and the acupuncture and moxa both seemed to make baby boy a lot more active during the treatments but he never fully flipped. So yesterday at my weekly midwife appointment, they got serious and recommended an external cephalic version (ECV) as soon as possible.
The ECV had been mentioned as the option of last resort at previous appointments, and I knew from my own research that I was an okay candidate for the procedure, but I was not super excited about it. The success rate is around 50-60%, but can be higher with a doctor very experienced in performing ECV. It’s “very uncomfortable,” which is medical code for “hurts a lot,” but the risks are extremely rare and lower than those of a C section, and I figured even at 50/50, it was worth a shot if it meant I could avoid surgery. I had pretty much made my peace with probably needing a C section byt this point, but I just wanted to know for myself that I tried every possibility to avoid it first. Truthfully what scares me most about the idea of surgery is recovery with a truly rambunctious toddler in the house.
The day of the procedure I got a little panicky. Brent and I both have really negative feelings and worries about hospitals and “procedures” now, for good reason, and it’s just kind of become second nature for us to focus most on the worst case scenarios. I tried to use the afternoon to keep busy and pack a bag and focus on the fact that it might actually work. So at 5pm yesterday afternoon Brent and I checked into labor & delivery to get ready to try to flip this baby. Some rare problems that might arise would be if my water broke and I went into spontaneous labor during the ECV, or if the baby didn’t tolerate it or something else went wrong and I needed an emergency C section, so we prepared for the very slim possibility we might end up with a baby, which was a little overwhelming to think about even though I’m already 37 weeks along.
To get started, they gave me a non-stress test to monitor the baby’s heart rate and his reaction to my contractions. I have an “irritable uterus” which means I have (usually) painless contractions literally every 2-6 minutes from around 20 weeks until the end of pregnancy. Super fun. After spending 20 minutes on the monitor and making sure everything looked good, the doctor came in and made sure I understood the procedure, went over the risks, and explained exactly what I could expect. The gist of it is, the doctor uses their hands to grab the baby’s butt and the baby’s head from the surface of the abdomen and manually rotates the baby into a head down position (while monitoring with ultrasound to ensure baby’s handling it well). I signed the consent forms and they gave me a shot of terbutaline (used to stopped preterm labor) in the arm to relax my uterus so it wouldn’t contract for an hour. The terbutaline made me super jittery and nervous (the most common side effects), but it wasn’t a big deal. Brent thought it was hilarious I was acting even more hyper than normal.
I laid down flat on the bed, surrounded by the doctor, my midwife, the nurse, and Brent standing behind them all looking rather nervous. I closed my eyes, started my relaxation breathing and hoped for the best. I kept reminding myself that if I managed to give birth to Cormac without any drugs, then surely I could handle this relatively short procedure. It. Was. Very. Uncomfortable. They were not lying. She literally dug her hands several inches into my pelvis and moved his butt out of my pelvic bones. That was uncomfortable but tolerable, but then as she was moving his butt up, she used her other hand to dig under my ribcage to scoop out his head and move it downward. That was really difficult to breathe through. She got him completely sideways with his butt on my left side and his head on my right, but he was not interested in going any further and swung right back into breech. By this time I started getting shaky and sweaty, and they brought me a cool washcloth and we took a 5 minute break.
The first attempt had only taken 5 minutes, but she called him stubborn, and said that because of the position of my placenta (in the front) that she was having a lot of difficulty getting a good grip on his head. She said it was completely up to me if I wanted to try again or not. I wanted to avoid a C section, but if it wasn’t going to work, I didn’t want to waste everyone’s time and go through more of that pain. I asked her if she though she could actually get him to turn, and she said, “Well usually if they’re going to turn, it’s easier than that, but he’s tolerating it really well, so I think it’s worth trying one more time if you’re up for it.” I nodded in agreement and tried to really focus on my breathing for the second attempt. She moved his butt way up and out of my pelvis and got ahold of his head from under my ribs and it just felt… easier the second time. I was laying there with my eyes closed really trying to relax every muscle and focus on my breathing and I could hear everyone start saying, “It’s working! Look at that!” And then just like that she said, “Okay, he’s there. it worked.” They verified with ultrasound that his head was in my pelvis and sat me upright to have gravity try to help keep him there. The entire thing, with both attempts, only took like 10 minutes, and while it was definitely not a pleasant 10 minutes, I am so glad I did it!
They put me back on the monitors for an hour to make sure baby’s heart rate stayed stable and I didn’t go into labor or have any complications, gave me a menu and told me to order food and we just hung out watching basketball for awhile. Before going in for the ECV I looked up a lot of info online and there were a lot of women saying they had opted out of trying it because “it only works half the time” and “it wasn’t worth the pain.” I know every doctor and every woman is different, but I’m so glad I got it done. I think I’d be glad I at least tried even if it hadn’t worked. (I really do not want surgery.) The likely reason baby was staying breech was my constant contractions keeping him in place, so the shot to relax my uterus was really vital according to the doctor. It wore off within an hour or so and my contractions resumed (which will now hopefully hold him head down!) and now we’re at home and we’ll just wait for labor to begin. I’m still sore from the procedure, and it feels a little like some one repeatedly punched me in the ribs and stomach, but it’s not really too bad. I’m also a little paranoid and keep worrying that he’ll flip back to breech, but the doctor said if that is going to happen it will likely happen in the first day or so, so if I make it through the weekend, things are looking pretty good.