Note: To share the end before the beginning, Matthew Elliott Martin was born via scheduled c-section, without labor on December 29th. It wasn’t the birth plan of our dreams but in the end baby and Mom were healthy and Dad was happy and that is the REAL GOAL of childbirth. I never had real contractions and didn’t labor for hours on end or get to use the relaxation methods Robert and I had been practicing. This doesn’t mean we didn’t have our share of labor and work trying to get Matthew out safely, it just wasn’t the physically painful version most women experience. Below is what I am going to call Our Labor Story.
At our 36 week visit, I had my usual list of questions that had come up since our last visit with the OB. My first question related directly to what the doctor discovered when she did my first cervix check…”That’s not a head,” she said.
“Yeah, I was going to ask you if this lump under my ribs was his head. Maybe he’s flipped?”
Yep, Matthew had definitely flipped and he’d done it late in the game. We officially discovered it with our OB’s help at 36 weeks and 5 days. We were given two options at that visit: to schedule a c-section or to try and do an external cephalic version to see if we could get our sweet breech baby to flip back to an engaged head down position. Our OB explained the pros and cons of both options and said that the version success rate was about 30% and that we’d need an ultrasound first to determine safety for baby and me. If we wanted to try for a version appointment, then we needed to schedule it for the 37th week. If we wanted to go for a c-section, they recommended the 39th week of pregnancy.
The major concerns with a version appointment is there is no guarantee it will work or even if it does, the baby could flip back. And then as well as the chance it may not work, the procedure alone could lead to distress for mother or baby and potentially require an emergency c-section. This study shows a meta-analysis of versions with a 58% efficacy and the potential for complications being 6.1% and emergency c-section rate of 0.35%. We believe the 30% efficacy we’d been quoted was our OB’s, her practice, and the hospitals rate so it probably was the best guesstimate for our situation.
We asked for 24 hours to pray and research and consider since we’d really been hoping for a natural childbirth. They agreed. We knew that a version was a painful procedure (s0me doctors/women are even administering/getting epidurals before versions now .
We went home and immediately began talking to wise people in our life who had experienced c-sections, or breech babies, or versions, etc. We researched everything we could on versions from PubMed (my go to place for peer reviewed scientific journal articles and abstracts). We found that every person we talked to and every study showed varying range of results for versions from 20%-80% at best based on a list of contraindications. Feeling that a 1/3 chance of the version working was still a strong chance for a healthy vaginal birth we scheduled the ultrasound to see if Matthew and I were good candidates.
We did investigate one other option, vaginal breech birth. Turns out there were no doctors to be found who still perform breech birth in Washington state and everything we read indicated that midwives could lose their licenses if assisting a breech delivery. Up through the 1970s vaginal natural breech births took place with doctor’s help but now the liability is considered too high and insurance companies hinder medical professionals from helping. Our two options for vaginal breech birth were to either go to OHSU in Oregon, which sounded tiring and expensive since you don’t know when labor will occur and our insurance wouldn’t be accepted OR to have an at home unassisted birth (which I am not prepared to do as a first time mother, if ever). So vaginal breech birth was out.
When doing our research on versions, we did learn about chiropractic, acupuncture, and body poses we could use to see if the baby would flip naturally too. We decided against chiropractors and acupuncturists, not because it doesn’t work well http://www.ncbi.nlm.nih.gov/pubmed/12183701 and http://www.ncbi.nlm.nih.gov/pubmed/23249535 (both work quite well) but because chiropractors wanted approximately 6 sessions to perform the Webster Technique and Moxibustion usually worked best before 35 weeks. We simply didn’t have time for either. We did use http://spinningbabies.com/ for body poses, like inverting my head and chest below my pelvis to open more space for Matthew to feel free to turn. We also used rock music to scare him into flipping, frozen peas to encourage him to turn around, a flash light (to draw him downwards like an insect to the light). We tried these multiple times each day. We also went swimming and I did as many somersaults and handstands as I could handle-which in the end, was way more than I could handle. After leaving the pool I realized I had thrown my equilibrium off and spent the next 45 minute car ride to lunch with friends motion sick and vomiting all over and sobbing. And none of it worked even though he would wiggle some, he always jammed himself back under my ribs and gallbladder. Funny thing was, he was only using half of my uterus at this point, I was distinctly pregnant on my right side but not my left as he was standing straight up inside me without even centering himself in my now giant uterus. We’d recommend any of those methods for other people dealing with a breech baby, ours just flipped too late for some of them to work or even be attempted.
So we had the ultrasound at 37 weeks and 3 days. The perinatologist thought we were good candidates for version, the ultrasound technician thought we were not (and she gave me tips on a healthy c-section), and our personal OB thought we were mediocre candidates.
Here is the pros and cons list we came up with when considering a version AFTER having the ultrasound.
- Decent amount of amniotic fluid, though not plentiful
- The baby is very active and healthy
- His feet were engaged in my pelvis bone-contraindication
- Amniotic fluid wasn’t plentiful-contraindication
- He looked like he was going to be a big baby, he measured at 7 lbs 9 oz (which is funny since he was only born at 7, 5)-contraindication
- He was my first baby, so my uterus did not have a lot of flexibility and give-contraindication
- His cord was wrapped around his neck once (nuchal cord happens in 1/3 of pregnancies and is usually fine, but makes version more nervewracking)-contraindication
- I am an overweight mom-contraindication
- My placenta was anterior, meaning the OB would have a hard time even reaching to try and turn the baby-contraindication
Though we had been pretty positive about the idea of version before the ultrasound as we wrote out our list of pros and cons we realized the cons were winning. Every con was a contraindication that could either lead to the version not working (dropping even below the 30% efficacy we’d been hoping for) plus also increasing the risks for baby and me like emergency c-section or worse. So we decided after a lot of prayer and conversation to NOT have a version but to go ahead and have a c-section. We had real peace about this decision.
One of the last decisions was whether we schedule a c-section or try and go into natural labor first (giving Matthew more time to flip on his own though our OB said there was only a 3% chance of that happening) and then have an unscheduled c-section if he hadn’t flipped already. From what we read and I can’t find a study here but more feedback from other breech parents is that a scheduled c-section is best for mother and baby. We heard the infection rate was lower, the chance of emergency c-section was non-existent, the doctor and the parents were calmer and better rested and thus could have a better surgery. All of that made sense, so we asked to schedule a c-section.
Our doctor said we couldn’t schedule a c-section till Matthew was at least 39 weeks old (more and more studies are indicating that babies born premie or even 37-39 weeks are less healthy than those born later http://www.marchofdimes.com/pregnancy/getready_atleast39weeks.html) because our hospital will not schedule any earlier than that point. This was fine with us, of course baby’s health is most important. We did ask for a Saturday, December 29th delivery date, though our OBs practice usually does not schedule weekend c-sections.
We asked for this date because we had full coverage insurance through 2012. If we could have the surgery on the 29th and meet Matthew, we’d have the regular 48 hours that our hospital gives after c-section under full covered insurance. If we delivered later, we’d be moving to a Health Savings Account with a high deductible. Though Robert’s employer gives a contribution that covers most of the deductible, it is given in two parts (once mid-January, one mid-July). Since birth is an expensive procedure we knew it would eat up the deductible before the employer had even given any portion of it. We HAD saved up for baby expenses, including birth but since we’re working so hard to pay off debt in 2013 it would have been awesome to put more of that money into loans instead of hospital bills.
So luckily for us, when we asked for a December 29th delivery date which was literally Matthew’s 39th week of pregnancy they said yes!
To Be Continued in Our Birth Story