[joeb1]

My wife is now 37wks with our first baby. I have now worked 1.5 years labor and delivery and have some questions. Our baby is breech and we had the option to attempt external version or schedule a c/s. My wife chose the c/s, can't really blame her. She's of the short stature variety, and there was some question as to could they even turn the baby. How many versions do y'all see successful as opposed to the failures, and how many of those have you seen become a stat/urgent section? Would you personally have opted for the version? Another question, as I am relatively new in OB, there is a limit to how many c/sections they would like a woman to have, correct? How many is it, if there is an acog guideline? I know its a lot of questions fom someone who should know, but I'm learning that for my wife and her own pregnancy I feel like I know about as much as any first-timer. Thanks all!

[phriedomRN]

Congrats on the upcoming arrival!!! I don't know if this is going to violate the TOS, since the decision has been made and it doesn't really seem to me like you're asking for advice *MODS-delete this if I'm wrong*

In the 2+ years I've been in L&D, I've seen about 50/50 where the doc actually gets baby to turn. About 1/2 of them end up flipping back if doc doesn't induce right after the version. At my hospital, it's usually 37ish weeks, amnio for maturity, attempt version in OR with IV sedation, then start inducing (if successful) or schedule the c/s (if not). I've only seen a couple that turned into stat section for distress or bleeding though...

The "opting for a version", recommended number of c/s, and possibility of future vbac stuff should all be directed towards your wifes OB, those seem dangerously close to asking for advice we aren't allowed to give

[rninwch]

OK, this is just my opinion. I wouldn't even consider a version. I'm not saying there isn't a risk with a C/S, but I tend to think that a C/S under control circumstances is much better than the possibility of one under emergency circumstances.

We do versions under epidural anesthesia with a little terb on board. If baby turns induction is begun, if baby doesn't turn then C/S is done. Over 13 years, I've only seen a handful of successful versions, and one of them flipped back to breech even though we started pit almost immediately.

Most of the time the worst you get is a C/S after a failed version, but things can go horribly wrong. Twice I've witnessed crash sections for fetal distress during/after versions and both times there were abruptions. One of those was significant enough that mom and baby both needed blood and ICU/NICU stays. ---I don't think it's worth it.

As far as # of C/S? I don't know...I've cared for moms on their 3rd and 4th C/S who did just fine...and some on their second with a severally thinned out uterus.

[CEG]

Personally I would not even consider scheduling a section without trying a version first. Just my .02 though. The World Health Organization estimates that 60% of c-sections for breech could be avoided if more providers tried versions first. Also check out the website www.spinningbabies.com for exercises to turn baby. The WHO also recommends accupuncture as highly effective for turning breech. Moxibustion is also supposed to be highly effective. The Webster turning technique performed by a skilled chiropractor is also touted as more than 50% effective at turning breech babies.

Another option is to find a provider who delivers vaginal breech. Although providers with this skill are few and far between there are still some out there. The risks of vaginal breech are not incredibly high- about a 1-3% higher risk of morbidity and mortality compared with scheduled c-section prior to labor. That risk must be balanced with the risks of the current and potential future c-sections including hemorrhage, uterine rupture, miscarriage, stillbirths, etc.

Good luck.

[Elvish]

I haven't seen many successful versions.
But most breech moms at our facility opt for a c/s anyway w/o considering it.
The most c/s I've seen a patient have is 5, but what an individual woman's uterus can handle is unique to that woman and her uterus.

And now, putting on the mod hat:
I am ok with leaving this thread open to discuss in general breech vs. version vs. sections as well as for support but please take care not to dispense medical advice. The ultimate question as to how many c/s, or how to manage a breech in this specific situation is best left out. Thanks to all.

[joeb1]

No guys, sorry to sound as if advice was needed. I was just really curious what you have seen and what you may have opted for. The decision is made, and we are happy and comfortable with it. I see how it could have sounded otherwise. Thanks for the response. The curiosity comes from that we do very few versions, maybe 5-6 per year. The one 3 I know about in my career had 2 stat sections and one successful. Thanks again and sory to sound like an advice seeker-we have a great ob/gyn whom my wife can ask anything to, and is always open for my first time father questions when at work. And the number of sections a woman can have, I should have asked how many have you seen personally, as this is a moot point for us now since it is our first. We,ll worry about that if we are blessed with any more.

[GrumpyRN63]

I personally would never have a version, scares the crap out of me, I had one transverse and one breech both turned on their own @ 38 wks, I have seen women who have undergone multiple C/S's, 5,6 and up---how many do you plan to put her thru (ha ha)

[joeb1]

Grumpy, I'll only put her through what she will let me. I promise. It scared the crap out of her as soon as the risk(however great or small) of an emergency situation was explained to her. Heres to my wife and all the other women (and I guess now even men?) who go through this process of childbirth.:th ankya:

[GrumpyRN63]

Originally Posted by joeb1

Grumpy, I'll only put her through what she will let me. I promise. It scared the crap out of her as soon as the risk(however great or small) of an emergency situation was explained to her. Heres to my wife and all the other women (and I guess now even men?) who go through this process of childbirth.:th ankya:

Good Man and Good Luck on your new baby !!

[GrumpyRN63]

My advice is to have her lie on her back w/ her ass propped up with a few pillows and a bag of frozen peas on her belly , 20 min tid, soooo uncomfortable, but hey--worked for me twice--good luck!!!