Monday, June 18, 2007

The Good News and The Bad News

Today I had my OB appointment and my (long awaited) second ultrasound. The reviews were mixed.

The good news:
We have a beautiful, healthy, perfectly angelic looking baby growing and thriving inside. (All bias aside, we got a glimpse of his face with the 3D scanner and he is gorgeous.)

The bad news:
He's breech and near the 90th percentile of size for dates.

The good news:
My 24 hour urine protein was below the range for mild pre-eclampsia.

The bad news:
(TMI alert) I produce so much urine in a 24 hour period that I filled the collection jug to capacity and was unable to capture my last two voids. (I knew I went a lot but this is ridiculous! That jug is frigging huge!)

The good news:
My OB thinks I may be a candidate for an external version.

The bad news:
But that is subject to change if this kiddo continues to grow to gargantuan proportions.

The good news:
I don't seem to have pre-eclampsia, yet.

The bad news:
I definitely have gestational hypertension (146/90 today) and may have to repeat the 24 hour urine study in the not so distant future.

The good news:
I may soon be able to tell my patients what it is like to have both a vaginal delivery and a C-section.

The bad news:I may soon be able to tell my patients what it is like to have both a vaginal delivery and a C-section (sob)!

All labels aside, I am trying not to flip out too much about the Bean's stubborn streak just yet. I am just shy of 35 weeks, I have great amniotic fluid (18 cm plus) and a little more time. I'm more than a bit discouraged that he is measuring so large, because that can be 1) an impetus to proper positioning and 2) even less pleasant to deliver vaginally, should he decide to turn around. The fact that I am outgrowing scrub sizes in a matter of days despite not gaining tons of weight on the scale (18 pounds total for the pregnancy thus far) should have been some sort of clue to his rapid expansion, I suppose. While a C-section isn't an ideal outcome for me, it won't be the end of the world if if is necessary. There is no guarantee that I would have a vaginal delivery, even if he were cephalic, and if he's ginormous, I'm not too sure that I would be all that keen on a dystocia or a 4th degree over a surgery. In fact, I *know* I would much prefer a C-section over a 4th degree (just repaired one at 2 am this morning, as a matter of fact) some orifices just shouldn't combine. Ah well, patience was never a strong suit of mine, but I will just have to wait to see how this all turns out. For now, I'm (mostly) healthy, he's healthy, and that is all that truly matters. (But if you have any sure fire remedies for flipping breech babies, please do clue me in!)

43 comments:

Judy said...

I've read some ridiculous suggestions, so I won't share those.

My #3 child made some attempts to go transverse on me, keeping his head just above my left hip for the last 3 weeks or so of the pregnancy. OB advised me to press gently on his head whenever I thought about it -- not that it did a lick of good. In the end, he (OB) shoved the head over and ruptured my membranes to keep him in place.

THEN he proceeded to tell me, several times, what a huge head the baby had.

Fortunately, I still don't know what it's like to have a C-section -- or even a tear. 10 lbs and I thought 0.5 oz, but his birth certificate moves the decimal point over.

I hope yours is a little smaller than mine and that you don't get to find out what it's like to have a C-section.

Redspiral said...

Okay I feel weird leaving these suggestions on an OBs site (being 'just' a doula and all lol) but you asked for suggestions... if nothing else *consider it*, it can't hurt to at least try. They're less interventive than a version or cesarean, I swear. :)

The Webster technique in chiropractic is GREAT for adjusting a pelvis and making more room for the baby to turn on their own. Find a chiro who is certified in this technique.

Go to an acupuncturist and talk to them about moxabustion. This has had great success in the things I've read and it's not interventive (no needles). You can even buy the moxa sticks and do the treatments at home so need for repeated visits.

You should definitely find out more NOW about optimal foetal positioning- there's a great book (and you know what, I will *mail you* my copy if you'll promise to mail it back) called "Sit up and Take Notice" by Pauline Scott. She co-authored "Understanding and Teaching Optimal Foetal Positioning" which is written more for practitioners, whereas "Sit up" is more for the layperson. I have "Sit up" and would happily mail it to you tomorrow -- *it can't hurt!* There's a link to my email address on my site if you want it -- seriously, just let me know.

Shoulder dystocias are indeed terrifying (I've attended one and it was by FAR enough for me, there's a photo of it on shoulderdystociainfo.com) but there is so much you can do to work with a larger baby (if it is indeed larger- sizing at this stage is so iffy!) Was your last baby large as well? How confident are you that the measurements are accurate- I've heard (from an OB at a birth I attended) that the measurements can be off by as much as 33% and the sonography techs with whom I've spoken have affirmed this as well. I personally could not schedule a cesarean with that much room for error, but it sounds like you are pretty confident that the measurements are accurate.

Pushing out a large baby doesn't feel different than pushing out a small baby and you can do a lot to avoid a dystocia -- stay off your back, change positions often while pushing (at least 90 degrees of movement, from side lying to hands and knees, etc), and avoid coached pushing. Avoiding that epidural is key because it won't leave you restricted in movement and sensation of contraction but you can certainly have an epidural with someone supporting you on hands and knees, squatting, etc., allowing you to keep moving while pushing but with pain relief as well. (I'm telling you everything I'd tell a client so I do recognize you know this stuff but a pregnant woman is a pregnant woman to me :)).

That same client who had a 10#14oz baby at 40 weeks with shoulder dystocia went on to have a 10#3oz baby at 38 weeks vaginally, with no pain meds or tears, laughing the whole way through her labor.

I'm looking at the possibility of an induction at least, an interventive birth likely, and a cesarean possibly (well who doesn't have that possibility right?) with my history of pre-e and the Atenolol I'm taking now to hopefully stave it off this time around. We'll see how it goes but the docs I'm working with feel really strongly about it and are practically hopping up and down in excitement over the huge reduction of pre-e they're seeing in all of their patient load. Amazing stuff... scary to be on this end of it, I have to admit. So I can totally hear your feelings about 'if I need this, I can live with it' but damn if I wouldn't like to push my baby out in the water at home. *sigh* I guess we'll see.

Either way -- a version for me would be a last resort, there are less interventive things that you can try that can't hurt and still leave plenty of time to schedule a version or cesarean if that is what you wish to do.

Good luck to you no matter which way you go! You've got to be comfortable and feel confident in your choice, no matter which way you go. I can't wait to hear your birth story!

Jennifer said...

You don't know me, but I recently discovered your blog through another blog and have enjoyed reading about your pregnancy experience. I am at 32 weeks myself, in my first pregnancy. Since this is my first pregnancy, I give this bit of information with a "hey, it's worth a try attitude." I don't know yet how open you are to "alternative medicine" (my OB is very open), but I know that hypnotherapy can work (I used it to lose almost 60 lbs last year before I got pregnant).

I have been reading Hypnobirthing: The Mongan Method and just came across the chapter about breech babies. The author, Marie Mongan, M.Ed., M.Hy., cites a study in which hypnosis was used to turn a breech baby prior to birth. I'll quote part of it so you can decide if you want to look a little further into it.

"...included 100 women who were referred from practicing obstetricians and additional 100 who responded to an advertisement. Only women who were found to be carrying their babies in breech position at 36 weeks gestation or more were included... 100 women in the study group uesd hypnotherapy. The comparison group of 100 women had no hypnotherapy, through some did have ECV... In the study group, the mothers, while in hypnosis, were led through guided imagery to bring about deeprelaxation. Suggestions they were then given that they visualize their baby easily turning and see the turn accomplished, with the baby in the proper vertex position for birthing.... The study ended with 81 of the 100 breech babies in the study having turned spontneously from breech position to vertex position."

It feels kind of odd giving this info to a doctor, but I hope it is something you will consider. Best wishes!

Awesome Mom said...

I have giant babies (no gestational diabetes or anything), so I know how you are feeling. I was crushed when I had to have my first c-section but it turned out ok and my nether regions are much better off in my opinion. My youngest was 11 pounds 6 ounces. Yikes! I hope the version works out.

Anonymous said...

I would hate to have a c-section, however, I do believe my OB would do a good job. I've had 5 deliveries so far without epidural/pain meds (except when I had an episiotomy and she put pain meds in but I still felt the cut...pain was gone for the stitching) or c-section. My babies are always small though...from 6 lbs 11 oz-7 lbs 13 oz. I wonder if this one will finally reach the 8 lb mark?

Hope you can have a safe delivery and healthy babe and healthy you!

Blessings!
Dawn

Nine Texans and friends.... said...

I certainly wouldn't lose all hope yet of a SVD although your days of being on your feet most of the day may be coming to an end. Although being as busy and active (and upright) is helping Bean get into a good position.
I had the opposite problem with my 24 hour urine...I produced a whopping 1200 cc's despite being hydrated. I was in full on PIH though with a BP of 180/110 on admission to L&D. Mag + pit really is an unpleasant experience.

http://www.spinningbabies/com has lots of suggestions on optimal fetal positioning.

If this baby is delivered by C-section you could always shoot for baby #3 and try for VBAC and be in the unique position of having experienced vaginal birth, C-section and a VBAC. :-)

Bean said...

Here is an article from the Spinning Babies website on turning a breech baby. Scroll to the bottom for helpful hints (you already know the rest :-)

spinning babies:breech version

The suggestion to seek out a good Chiropractor is a fairly good one (early AM repairs probably equal mucho backpain...) even if the Bean decides to stay put.

And there's always visualization (Turn Bean, turn!) if you feel up to it.

I'm hoping for the best whichever way Bean decides to come.

Anonymous said...

My baby was breech at 34 weeks, vertex by 36 week appt. yesterday. I did inversions (see spinningbabies.com), went swimming and did head-stands in the pool, spent a lot of time visualizing the baby vertex and asking it to turn, and had acupuncture and did twice daily moxibustion treatments for 2 weeks. Moxibustion is more statistically successful than external version (about 70% v. about 50%). See 1998 study by Cardini and Weixin: http://jama.ama-assn.org/cgi/content/abstract/280/18/1580

Chiropractic work (Webster technique) is also supposed to be very helpful (some cite 80-90% success with it, but no clinical trials have been done to support this), but now is the time to start if you want to do this, especially if the babe is big.

All of these efforts are non-invasive, low/no risk, don't involve exposing the baby to pharmaceuticals, and I figured it couldn't hurt to give them a try. If they don't work, there would still be time for an ECV. I know you are maybe not such a hippy, but these are all gentler alternatives to ECV that you can try in weeks 34-37. I can't say for sure if the baby would have flipped if I had done nothing, and I think my baby isn't as big as yours, but these are worth a try, and swimming feels so good this time of year anyway!

Good luck!
A pregnant blog lurker

Type (little) a said...

I had a 4th degree. My daughter was OP (more like sideways) vacuum assisted. It was midline, I healed fine and 3 years later, I feel fine, but for my next, I am afraid to attempt vaginal. Though I am terrified of a c/s.

CappuccinoLife said...

Just an encouragement--my very big baby was still flipping (transverse and breech) at term. He was born vaginally (and vertex!) at 42 weeks 12 day and 10 lb 8 oz.

I'm sceptical of ultrasound weight estimates as they always way over estimate my babies weights and way underestimate my bodies ability.

Anonymous said...

Love your blog! You probably don't hear this too often, but I wish I could go back and have a c-section. Our son wasn't breech, but was measuring quite large, and at our last u/s at 38 weeks, we were told that his head would *probably* fit. I went ahead with my planned vaginal birth and after 4 hours of pushing with a vacuum assist, he was born, perfect and healthy. However, at 32 years old and 22 months postpartum, I now have stress incontinence because my pelvic floor muscles were just decimated by the delivery. I've made some progress with biofeedback and physical therapy, but if my next one measures remotely as large as my first, I'll probably go for elective surgery.

Type (little) a said...

Is he frank? Transverse?

External version. Yuck.

Genevieve said...

Find a chiropractor who is skilled in The Webster Technique. Dr. Webster had something like a 95-97% success rate at turning breech babies (over multiple thousand attempts). My chiro had a 100% success rate when I last asked.

a;so take a good look at spinningbabies.com

Cindy said...

I hope you both continue to remain healthy AND have a safe delivery (one way or the other).

Anonymous said...

Hi,
My second was breech at 36 weeks. First one was SVD of 9"12# with no complications. Oh, and I'm an OB/GYN who really didn't want a c-section. Fortunately, my daughter's EFW at the time was 7 lbs, lots of amniotic fluid, post. placenta. So, we did the version at 37 weeks (after I had spent about two hours/day with my bottom in the air, put headphones on my belly, taken long baths, jumped up and down on a trampoline...and figured out that she wouldn't flip on her own). Successful version, no problem and 2 weeks later SVD of 10 lb 2 oz healthy baby girl!! So much for EFW!! But with two little ones at home and a demanding job to get back to, I am still so grateful that I avoided c/s. I hope all works out as well for you!

Midwife with a Knife said...

The midwives I worked with as a resident had some breech-flipping exercises they'd have their pregnant ladies do. I can't remember what they were though. :(

I agree. A 4th degree is worse than a c-section. I actually think of it as a vaginal c-section.

And, I'm on call tonight. And I get to do a breech with the residents. My favorite thing! :)

Anonymous said...

http://www.ican-online.org/resources/white_papers/wp_breech2.pdf

I know... I KNOW... most docs, especially OB's dislike (yes I'm being diplomatic with that word) ICAN... but here is a great resource for you to help flip that beautiful baby around.
Oh, and the gargantuan baby thing isn't a sure thing, right? Most u/s can be off by a whole pound, read that in a medical journal a year or two ago... Best case scenario... I suggest getting yourself under MWAK's care =)
Please read the paper... It has some great resources and ideas.

Xavier Emmanuelle said...

Sorry about the possible c-section Dr. Whoo. Hopefully your little guy will flip around and you'll be able to deliver him normally after all.

Xavier Emmanuelle said...

Oh, and on the subject of pre-eclampsia, I'm sure you've read all about this, but I just found out:

"Antiplatelet agents during pregnancy are associated with moderate but consistent reductions in the relative risk of pre-eclampsia, of birth before 34 weeks' gestation, and of having a pregnancy with a serious adverse outcome."

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17512048

Amanda said...

No surefire cure for flipping breech babies. Even OFP postures sometimes fail.

My shortest offspring tried to be breech, but flipped around week 35 or 36. He was 8 lbs 14 oz when he was born (not sure if that's ginormous in your estimation or not -- but it sure FELT big!) and I ended up with a 2nd degree tear along the line of my old episiotomy scar.

My cousin's wife's had both a vaginal birth and a c-section. Her take on the c-section was that it really wasn't bad at all. She knew when her daughter was being born (breech, like your bean), she got a good night's sleep, and although the incision recovery wasn't fun she said it wasn't as terrible as she was afraid it would be.

And because she and my cousin are sick people, they deliberately opted for a birthday of Friday the 13th for their child. My family cracks me up :)

ICU too said...

Interesting blog! (I'm from TX and we go call it OB/ GIN) LOL
It's nice to get a OB docs perspective as a patient. I'm pregnant with my first - a boy due Aug. 3rd!
I'm an nurse but I do ICU. No OB experience except for a brief rotation in school. I've been trying to read up on everything like crazy to refresh my memory.
Do you have any experience with perineal massage and stretching? Does it work? I realize you don't want to give out medical advice but maybe you know of some links or studies. I've read it can be helpful in preventing lacerations but it doesn't sound pleasant to perform!

What about circumcision? My husband and I are really on the fence about it. Just when one of us thinks yes, the other thinks no. And then we both have a change of heart and flip sides. I guess we need to hurry up any decide one way or the other. Any advice? So many decisions to make!

Good luck on the remainder of you your pregnancy. I hope that BP stays in check. And I don't know any great ways to get the little one to turn. Maybe you can have a heart to heart with him and convince him to be agreeable! Whatever your method of delivery, I wish you a speedy recovery.
I've enjoyed reading your blog!
Thanks!

Anonymous said...

Thanks for your blog - I had a baby girl 10 months ago and am pretty fascinated with the Ob field in general because of it. It's fun hearing a dr's side of pregnancy.

Sorry to hear that your little guy is breech. After a vaginal delivery where I had "the works" (vacuum, forceps, episiotomy) and recent laparoscopic surgery to repair a lot of damage - I'm wondering if c-sections aren't the way to go. Probably would've been a quicker recovery in my case.

Best wishes as you endure the last few wks of your summer pregnancy. ;-p
-a fellow mommy in Ohio

frectis said...

Get your multip, proven pelvis self hooked up with Midwife with a Knife to get yourself one of those vaginal breeches she is awesome at facilitating ;)

Eliza said...

I turned a 33-weeker who weighed 6 lbs 13 oz two weeks later at birth by scrubbing a floor. My husband opened a can of paint to show me how too-yellow it was for the baby's room, poured some into a cup, then hammered the lid back down, sprayed yellow droplets everywhere. I was on my hands and knees under the kitchen table, swearing like a sailor and scrubbing energetically, when WHOOSH! I felt the baby flip-flop and sure enough the next day at the OB she could feel the head (unfortunately at 33 weeks I was less than thrilled to be dilated at all but at least the head flipped down). So maybe some angry scrubbing?

DisappearingJohn said...

Nope.. The only thing I know about delivering babies is how to push them really fast out of my ED up to OB...

My wife works L&D, and she just told me that most external repositions usually flip back around the way they were used to if they aren't delivered very soon after turning... (yeah, I know.. I'm full of encouragement!)

But all three of my kids were C-section babies... At least they have cute heads right after birth!!!

I am a Monkey's Momma said...

As an OB, don't you know how notoriously inaccurate late term ultrasounds are for predicting size?? A perfect example is a girlfriend of mine who was told she "needed" a c/s for a gigantic ten pound baby. Baby girl turned out to be just six and a half pounds five days past her due date...

Have you seen the website spinningbabies.com? It might help you avoid that most likely unnecessary surgery.

Good luck!

I am a Monkey's Momma said...

Oh, and I hear handstands in a pool works wonders for flipping a baby. I've also met women who have had their babies flip while in labor... Why not wait and let your baby pick his birthday rather than giving him an early eviction notice? You never know, your body (and his) might surprise you.

Erin said...

Hey there! I am so glad to have found your online journal... I am a blogger of 3+ years and have only recently ventured out of the AOL blogosphere... I thoroughly enjoy reading your blog, you remind me so much of myself. I am a former journalist (first career) turned RN (ER, then OB) and mother of three wonderful kiddos. I will definitely bookmark... you do a great job are a great read!
~Erin
http://journals.aol.com/elgeiselman/unwavering-me/

http://journals.aol.com/elgeiselman/Porkchop/

Anonymous said...

http://www.medicalnewstoday.com/medicalnews.php?newsid=74317&nfid=nl

Kirsten said...

I'm not an OB, nor a midwife, but it's my understanding that in certain positions the pelvic diameter (I think even including the soft tissue/ perineal area) is roomier than others... those positions being squatting and on all fours (I know the all fours bit is used in the case of shoulder dystocia) ... but, these positions might be hard to get into if one is under the influence of an epidural. I guess my point is, perhaps there are other factors such as birthing position and your personal anatomy, beyond big baby-ness, that would determine whether/ how severely you would tear?

Angela said...

I just stumbled my way in here. Hehe! A big baby! I had one of those 4 months ago. 4.46kg. Best of luck with him. I needed a LSCS in the end as missy wasn't engaged and well past her eviction date. She was also breech up to about 36 weeks, and then turned. But still needed a caesar in the end. It wasn't bad at all. Don't worry one bit about it! Big babies are lovely and contented things.

Anonymous said...

Had my last sonogram this pregnancy (hopefully). It was a normal sonogram, so I don't trust it for marker checking really. Baby still one week behind, but consistent with the last two sonograms. Fluid good (this was important to me as many trisomy babes have problems with fluid levels). Heart beat 150, and everything looked as good as you can get. I'm measuring 28.5 weeks. Supposed to be 29.5, but that's alright. Baby is around 3 lbs. My bp was 120/70. Very good. Only 1 lb in weight gain in 2 weeks so I am pleased. Baby is almost head down right now but is at a 45 degree angle with legs up under my right ribs. I know you've seen plenty of these, but I think being able to see my cervix on sonogram is cool (I think the internal cervix looks like a heart, or lips about to kiss). Placenta is out of low lying position, still anterior but much higher now.

Hope your little one moves head down without much difficulty.

Dawn

Anonymous said...

Go for the section - I've had 3 vag. deliveries (all had tears, two involved the recturm and then a section b/c of the prior 4th degree tear's after effects). Having had both, I prefer recovering from a c-section than the random surprises that may await a big bad vag. delivery. KWIM?

Crossroads said...

New to your blog, but love your commentary. Congrats on the pregnancy! You must be so busy between work and family, but if you have time to give advice, it would be appreciated. Would appreciate your opinion as I can relate to your blog personality.

Am female, 27 going on 28. Finished med school and 2 years of residency in a field (not Ob/Gyn) I don't see myself practicing and find boring but affords nice lifestyle. Can't seem to squash interest in OB/Gyn since I decided not to enter it 2 years ago. Now debating whether to switch into Ob/Gyn and "bite the bullet" for the next 4 years and just do it. I enjoy the patient population and find the topic fascinating.

But I am torn because I feel like I can't "have my cake and eat it too." I feel that I would be giving up my personal life/time with my husband (also in medicine) and future children. Would be doing Ob/Gyn residency during childbearing years. Definitely want to have at least 2 kids in the next 5 years, and be involved with raising them!

What are your thoughts having gone through it, about my starting Ob/Gyn now in light of all this? Should I give up on this dream and focus on being a mom and not being an Ob/Gyn? I don't think there is another field in medicine I would want to do...Help!

moof said...

Dr. Whoo ... hope you're doing OK, and that the baby has flipped over!

Those last few weeks are really challenging ... hang in there!

When you can, let us know how you're doing!

PE Mommy said...

Havn't seen in a post in awhile and hoping everything is well.

Angela said...

Have you had your baby yet??? :)

kissashark said...

I was doing good following along till the 4th surgery thing, but based on what (little) I do know I am assuming that has to do with a ummm....tear in an area that pains me to even type? YIKES, cut my abs wide open....I do not want to tear myself a new one literally....Glad to hear the bean is good although huge! Only a few more weeks!

kissashark said...

whoops...I meant 4th degree not surgery, but I bet you caught that.

Anonymous said...

Hope you are doing well -- best wishes as the arrival of the Bean gets more imminent!

Mo said...

I have my fingers crossed for you! I got the all-clear from the sonographer two days ago re: my C-section.... the bottom section of my uterus has lengthened sufficently allowing plenty of clearance between my placenta and my dear friend Ms Cervix. Hang in there, all the best for the delivery and post-partum, I am sending happy-happy-joy-joy-no-rippy-ma-hoo-hoo vibes over to you!!!!

Mo from New Zealand

kristina said...

Hey! Just found your blog today and look forward to following it.

"But if you have any sure fire remedies for flipping breech babies, please do clue me in!"

Feels weird for this new doula to be giving medical advice to an OB, but you asked for it ;)

Here is an article on breech babies from spinningbabies.com. Obviously you will know what a breech baby is, why it is a problem, etc....so scroll down a bit and you will see the section on "breech timeline" with ideas:
http://spinningbabies.com/index.php?option=com_content&task=view&id=25&Itemid=32

also you probably know of most of these: play music or talk to baby low in the abdomen, shine flashlight low on abdomen in a dark room, lay in an inverted position with hips higher than head for long time, "tell" baby to move in your mind....there is little to no evidence to back any of these ideas up, but they don't seem to be of any harm, either. And as a doula, I always add the caveat, "check with your practitioner first". LOL.

mabel said...

I recently came accross your blog and have been reading along. I thought I would leave my first comment. I dont know what to say except that I have enjoyed reading. Nice blog. I will keep visiting this blog very often.

Lucy

http://maternitymotherhood.net