Vaginal Breech Birth in the Triangle | Raleigh Durham Chapel Hill

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Jun 10

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Vaginal Breech Birth in the TriangleThree years ago I gave birth to my second son. We had planned a homebirth with him since the start. We had everything set up and ready for his arrival. At 35 weeks – we were thrown a HUGE curve ball. He was sitting quite comfortably in a Frank Breech position. My head was in a fog – and everyone kept saying that we had time to turn him; don't worry. True, we did, but I also didn’t want to just wait it out and see. It took me a couple days to come out of it; my birth was taking on a different turn and I was trying hard to buckle up for the ride. I hit the ground running and started setting up appointments and doing research to learn more about the Breech Options in the Triangle (Raleigh/Durham Area). What you can do to try and turn your baby: Check in on your Emotions – Take a step back and try and analyze what is going on in your life. Are you busy with work? Is the nursery done? Are you feeling guilty because you opted out of prenatal yoga this pregnancy? How much time have you devoted to this pregnancy? I found that I wasn't giving my baby and body my full attention. I had a 2 year old that kept me busy and I was working a lot; putting my clients first. Is there a chance that this is your baby's way of trying to get your attention. Have you considered the possibility that you may have an emotional or intimate block that you need to work through. Try to start each morning with a meditation, or maybe even seek out someone who does Reiki. If you see a therapist, now would be a great time to make an appointment. Take time out of your day to talk with your baby, and do some gentle labor benefiting exercises - try getting down on hands and knees, tilt your pelvis (like cat-cow in yoga). Chiropractic Care – This is a great first step if you haven’t already been going to see a Chiropractor during your pregnancy. If your baby is breech or transverse you should set up appointments with a Webster Certified Chiropractor. The Webster Technique is most commonly used with expecting women. Here are four in the area that are very well known for the Webster Technique.Triangle C.R.C – Lindsay MummaKeystone Chiropractic – Donna Hedepath.Davis Family Chiropractic – Alisha DavisVerve Holistic Health - Lauren Scott Acupuncture & Moxibustion – Consider going to see an acupuncturist. She will insert tiny needles on your pinky toes - these acupressure points stimulate the uterus to encourage baby to move into a head down position. This seems a bit out there but I can’t tell you how many people I know who find success with this. Here is the information and link to Dr Dishman, she is wonderful!Bloom Integrative Health - Meaghan DishmanMoxibustion can be done during acupuncture or on its own at home. The goal here is to stimulate the pressure point on the pinky toe with heat from the Moxibustion Stick - Pure Moxa Rolls. Have someone light the stick (it is a slow burn but I advise that you have an ashtray or glass dish ready to knock off the ash as needed) and hold it as close to the outside of your pinky toes as you can stand. Be careful not to burn your toe. You will feel so much movement from you baby as they wiggle around inside. The goal is for them find their way to the head down position. Inversions – These are positions you can do that put your hips higher than your chest. There is quite a range of intensity here so I encourage you to find the best version for you. You can start by laying two pillows on the ground, one for your knees and one to rest your head. Kneel down onto one pillow and then bend forward and relax onto the second pillow; keeping your hips high in the air (similar to child’s pose in yoga). You can also lay on your back with a stack of pillows under your bottom to raise your hips (similar to a supported bridge pose in yoga). A more extreme pose is where you can place your knees on the edge of the couch or bed and then have someone help you into a hand or arm stand on the ground. This is extreme so I would not recommend doing this without help – up and down. It is also not a position you should hold for long – 10-30 seconds. Lastly, if you have access to pool, you can do handstands in the water – a great buoyant option. External Cephalic Version (ECV) – This is a procedure done (most likely) in the hospital by a trained OB. A fetal ultrasound will be done first to ensure the position of baby, placenta and amniotic fluid levels. They will typically start by monitoring you and the baby for a short while prior to the procedure to ensure both are well. You will be given a medicine that relaxes the uterus so that it doesn’t have contractions during the version. If I remember correctly, it can make your heart race a little. The Doctor will use a gel or oil externally to help keep things slippery. Using two hands or forearms they will work towards manually turning baby from the outside. As far as the comfort level of this – it depends on many factors. I had two versions done and with both I tried to practice staying relaxed and concentrated on my breath. After the ECV, you and the baby will be monitored for a little while longer to ensure that there were no complications and that you don't end up in labor with all the stress to your uterus. If successful, they may suggest you stay for an induction to ensure baby doesn’t flip again. You also have the option to bind your belly to encourage baby to settle and stay in this new head-down position. Lets get Triangle Specific: I am very thankful that I have had the opportunity to speak with a fellow in the University of North Carolina Chapel Hill (UNC) Maternal Fetal Medicine (MFM) Department, Dr Sarah Dotters-Katz. The best Doctors to perform an ECV are Dr. Strauss and Dr. Boggess. They typically only schedule these procedures with the listed names above on Tuesday and Thursday and are done at UNC Women’s Hospital in a triage room. I had mine done with Dr Ivester, he is currently the head of OB so he will be doing less clinical appointments however. If we were to find ourselves in need of another version, I would not hesitate to schedule it with either of the two mentioned above. Your provider can call the MFM department at UNC to set up the appointment – but be sure to have them specify which doctor. The ECV are best done at/around 37 weeks gestation. Dr. Dotters-Katz also mentioned to me that in the event that the ECV was unsuccessful the first time, they are now offering to try a second ECV under anesthesia for the mom. Vaginal breech birth options in the Triangle: Believe it or not, vaginal breech birth is an option in the triangle. Currently, UNC is the only hospital in the area that will extend this option. Most of their vaginal breech deliveries are from twin births (Baby A is head down but baby B comes through breech). But they will attend a vaginal breech singleton birth if the patient strongly desires. First and foremost, UNC believes that a cesarean is the “recommended” route for breech delivery. You will be faced with this suggestion when you first approach them about options. If it is possible, try and set up a consultation with a MFM Doctor beforehand. The four that have the most experience and will attend a vaginal breech birth are Dr. Ivester, Dr. Strauss, Dr. Goodnight and Dr. Boggess. Meeting with one of them will allow you to start to develop a relationship and develop a plan. (This was our plan as well but I ended up going into labor the morning of my appointment with the MFM doctor – so I went into the hospital and tried my best to stay calm and nicely, effectively, and humbly tell them my wishes and they were very respectful towards my desires). Here are just some things to think about as you approach this option. UNC does have some standards and negotiables. They very much prefer that the mother has, what they call, a proven pelvis. Meaning, she has already had a vaginal birth before. Mom will be asked to sign an AMA (Against Medical Advice). They require you to deliver in the operating room. This is for many reasons, one so that they have it readily available in the event of an emergency. The MFM Doctors will highly recommend an epidural. The reasoning behind this was because, after the body is born they will more than likely have someone pushing down on Mom's belly while simultaneously using forceps to help deliver the head in a timely manner. They explained to me that their biggest fear is Head Entrapment, so they do their best to get the head out as quick as possible. They did mention to me (and I am only saying it here so that you have time to process it – in my case this really freaked me out as I was not anticipating this) that if they can’t get the head out they may have to cut the cervix. I just want to mention this again, they make it very clear to the family that cesarean is the recommended route as there is a very real chance that the baby may not survive. These are conversations you have to be prepared to have. If this is the path you are looking to go, make sure you read up on as much as you can and be sure to have your questions ready if you have any.