Versions and C Sections

nursejohio, ASN, RN · May 26, 2008

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

NPinWCH · May 26, 2008

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 · May 26, 2008

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 lady partsl breech. Although providers with this skill are few and far between there are still some out there. The risks of lady partsl 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, BSN, DNP, RN, NP · May 26, 2008

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, ASN, BSN, RN · May 27, 2008

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, ADN, RN · May 27, 2008

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, ASN, BSN, RN · May 27, 2008

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:no:?) who go through this process of childbirth.:bowingpur:bow::rckn::nmbrn::rcgtku::thankya: :yeah:

GrumpyRN63, ADN, RN · May 27, 2008

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:no:?) who go through this process of childbirth.:bowingpur:bow::rckn::nmbrn::rcgtku::thankya:

:yeah: :bowingpur Good Man :up: and Good Luck :cheers: on your new baby !!:heartbeat

GrumpyRN63, ADN, RN · May 27, 2008

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!!!

Elvish, BSN, DNP, RN, NP · May 27, 2008

I have also seen more than once a baby that will decide to flip at the last minute - sometimes by something Mom does with that end in mind, and sometimes just for the hey of it.

I have a friend who did all the exercises etc. with baby #2 who was breech, she flipped and they had a great (if long) homebirth. Another's baby flipped spontaneously, great vag delivery.

One time I had an antepartum patient 35ish weeks...can't remember exactly what she was in for. Anyway, I get in report that baby is breech so go to do her NST and can't find the heartbeat. I can hear the kid kicking and carrying on in there, so I know he's in there. But I can't find him.... :eek: I go get another nurse who's good at finding breech babies.....plop! right in her RLQ. Little bugger had flipped between the morning and evening NSTs! Well, that made us all breathe a sigh of relief.

I forgot to tell you this earlier, but congratulations on your bundle!!

All the best of health and happiness to you both!

crysobrn · May 27, 2008

I work at a smaller hospital but one of our OB's does versions pretty routinely and I've never seen him have a problem. I think his success rate is probably 75 or so % if I had to guess. I believe he does leave it up to the mom though as he sometimes secions patients for breech presentation. Oh and we do not induce right away as others have indicated. Mom goes home if stable and then when she presents in labor we do a bedside u/s to confirm presentation.

One of the other OB's does not do versions but she's pretty comfortable doing a breech delivery. She also will give the mom/family the option of a c/s.

I think it's a matter of the providers competency etc.

With my second baby I was told she was breech and I had two weeks basically before they would do a c/s. I had a history of an over 10 lber with my first and my provider was not comfortable doing a breech delivery esp with a h/o macrosomia involved. I literally laid on my couch with my hips up for an hour one night and I just "know" that she turned that night. I had an u/s at my following appt and sure enough she was vertex. Yeah for me.... Nice vag delivery.