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Re: *Unsuccessful* Version...vaginal breech??From: Garry E. Siegel, M.D. (anonymous@obgyn.net)Mon, 24 Nov 1997 20:35:48 -0600 (CST)
At Mon, 24 Nov 1997, Rebecca wrote: > >Hello. Well, the external version didn't do the trick. Hopes were high >with a small baby, good amniotic fluid, etc. The baby tolerated all the >shoving around very well, though. > >So...now what? My Ob is set against vaginal deliveries for breech. >However he won't be doing the delivery, most likely. (I'm with Kaiser.) >I spoke with the Perinatologist who went through the criteria for >considering a vaginal birth. > >I am very reluctant to go ahead and schedule a c-section. The baby is >expected to be small, in the 5lbs range amd my first delivery was quite >easy and fast. So far, the baby is frank breech. > >Is is unreasonable to *attempt* a vaginal delivery? I am concerned about >just how quickly a breech delivery can turn bad. Can babies go from >frank breech to footling *suddenly*? > >I've read that the mother's motivation is an important factor. How >about the doctor's? I don't really want to push for a delivery that the >doctor is neither comfortable, nor experienced with. > >I should have a couple more weeks to think this over, while trying all >of the "home remedies". (My favorite being handstands in a swimming >pool!) Any advice on how to make this decision would be so appreciated! > >Best Wishes, >Rebecca > >-- >Rebecca Mosher: Ard@sirius.com > Oy Vey! Seriously, if you have delivered vaginally before, and have a small baby greater than 35 weeks (yes, I know the due date is messed up) who is a frank breech, then consideration of a vaginal delivery is appropriate. That said, you absolutely should be cared for by an Obstetrician, not a midwife; the Perinatologist may or may not need to be involved, depending on the Ob. Many would want you to have some imaging of your pelvis, ie Xray pelvimetry or CT pelvimetry (done to measure your pelvis quite precisely) once you are in labor, and if inadequate (it won't be!), C/S! Furthermore, the flexion of the head (ie chin on the chest, not looking up) must be assessed. Lastly, many Obs might want spontaneous, *progressive* labor, and if this doesn't occur, C/S! Well, life is short, and you'll only have 2 or 3 kids. Rarely, even in perfect circumstances in the best of hands, bad things such an trapped heads occur. Many doctors and many patients do not wish to take a slight chance, and opt for a C/S. While you may not agree, I would submit that having a section for a breech in the US is rather standard. If your Ob is not comfy with a breech delivery, you will make a mistake to push him to do it! You will then need to decide whether you wish to shop for a new Ob at this late age (whatever that is) of your pregnancy, realizing that when patients shop docs at 36 weeks, 9.8 times out of 10, the patient is a bit weird (sorry, don't flame me, it's my observation!). Good luck. Garry *Note: Opinions expressed here are for educational purpose only. This information is not intended to supplant the need for you to consult with your physician prior to choosing therapeutic options. **Private emails cannot be entertained due to time constraints, consequently no private emails will receive a response. **Thank you for your understanding ;-)
-- Garry E. Siegel, M.D., FACOG Private Practice Roswell, Ga.
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