Friday, February 4, 2011

One More Week or Less...

We are no more than one week away from meeting Baby G!  At my 38 week prenatal visit the midwife confirmed what I have known (but been in denial about) for some time...this little one is breech.  Since then, we have tried almost everything to get this baby to turn - I have been to the chiropractor, tried various inversion positions, ice on my fundus (the top of the uterus), music and a flashlight near my pelvis, pressure on the acupressure point for the uterus, and an external cephalic version (the MDs tried to flip baby by pressing on him/her through my belly).  Today I am 40 weeks and 1 day and Baby G is still breech.  Therefore, we have had to schedule a c-section for one week from today (Feb. 11th).

The past two weeks have been tough...processing the likelihood of a birth that is entirely different from the one we had planned for and envisioned.  We had our last prenatal visit with one of our midwives today (she also happens to be the director of the midwifery program I just finished at Vandy).  She discussed ways that we can make this birth special and reinforced that this is still a birth even if it is a surgical one.  I came away from this last visit feeling hopeful and more positive than I have felt for the past two weeks.  I am grateful that this pregnancy has been otherwise healthy and normal and I know that this experience will make me a better midwife.

If you are interested, I have included information about breech presentation from Up to Date Clinical Reference:

How common is breech presentation?
The incidence of breech presentation decreases with increasing gestational age. It is a common occurrence in early pregnancy when the fetus is highly mobile within a relatively large volume of amniotic fluid. While 20 to 25 percent of fetuses under 28 weeks are breech, only 7 to 16 percent are breech at 32 weeks, and only 3 to 4 percent are breech at term.

Why does the baby adopt a breech presentation?
It is hypothesized that a normally proportioned active fetus in a normal volume of amniotic fluid adopts the cephalic (head down) presentation near term because this position is the best fit in the intrauterine space. If any of these variables are disrupted by underlying maternal, fetal, or placental conditions, then breech presentation becomes more likely. In most pregnancies, however, breech presentation appears to be a chance occurrence. Abnormalities of the uterus and/or fetus account for less than 15 percent of breech presentations. 

Birth of the breech fetus - vaginal birth or C-section?
In the United States, cesarean delivery for breech presentation rose from 12 percent in 1970 to 87 percent in 2001. This change in clinical practice was largely due to evidence from randomized trials, particularly the Term Breech Trial,  that showed a policy of planned cesarean delivery for term breech presentation was associated with a large decrease in perinatal/neonatal mortality and neonatal morbidity, with only a modest increase in short-term maternal morbidity, compared with a policy of planned vaginal delivery. There are limited data that the worldwide change in clinical practice has also led to a reduction in the morbidity and mortality of breech presentation. There may be clinical situations in which the risks of cesarean to the mother, or the mother's desire to avoid cesarean delivery, may outweigh the risks of vaginal birth to the baby. Vaginal delivery, if elected, should be performed by an experienced provider and meet specific criteria.

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