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Has anyone had ECV (external cephalic version) for breech baby?

  1. #1
    charade is offline Registered User
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    Has anyone had ECV (external cephalic version) for breech baby?

    Particularly looking for experiences in the public system... but anyone who has had it done privately also, would love to hear from you.

    (This is a procedure to turn the baby if it is in breech position. Can only be done by doctors experienced in the procedure. My private doctor says he is not an expert but suggested that the public system may perform it. I am also registered and following up on public visits so want to discuss this option with them but would prefer to go into the appointment as educated as possible.)

    1. At how many weeks was the procedure performed?
    2. Was it uncomfortable? (would appreciate a description of what happens during the procedure).
    3. Why did you decide to do it vs. go for a c-sec? How did you gauge the risks?
    4. I was told that in the public system, they induce labour after performing the version. I'm not that keen on an induction having been through one already. Is an induction standard with an ecv? Part of my reasons for considering an ecv is so that the baby can stay in longer... but if they do an ecv at 38 weeks, and induce labour at the same time, wondering if it might be better to have a scheduled c-sec at 39 weeks instead.

    PS: I am also doing some exercises to coach my baby to turn but not pinning my hopes on it...
    PPS: I have considered but do not want to have a breech vaginal delivery even if offered.

  2. #2
    MommieMid is offline Registered User
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    Ecv

    Charade,
    As a Mom, I would prefer a trial of ECV to an elective C/S.

    ECV is not usually performed before term (37 weeks) and is performed under ultrasound to confirm the baby presentation prior to the ECV and to exclude any anatomical reasons why your baby has remained breech.
    There may be a reason why your baby remains breech after 37 weeks and an experienced Obstetrician in the procedure will know whether the ECV is being easily achieved during the procedure. The expert will not force an unwilling turn. It is essential that the person performing the procedure is an EXPERT. The baby has to be turned with its' face leading.
    There are risks of possible ruptured membranes or the need for emergency caesarean, which is why the correct Obstetrician will perform the ECV in an appropriate situation and have specific experience in the procedure.

    If you are before 'term' now, then there is a higher chance that your baby, whose head is the heaviest part of its' body will turn to become the presenting part. If your baby is breech, the baby could turn at any time until he or she gets too big.
    I know of elective vaginal breech delivery and I believe that the Obstetrician chosen for the delivery has to be confident in his skills and experience of this. The size of the baby and your pelvis, and build, is crucial in this decision.

    An induction should also not be performed lightly, but if this is the procedure that the hospital follows after ECV, then in my personal opinion as a mother who has had multiple inductions, this is preferable to an elective caesarian.
    I presume that you ended your previous induction with a normal vaginal delivery. If you have had a caesarean previously, then I don't believe that an ECV is indicated. An elective caesarean may be the best solution.

    An accupuncturist may be experienced in turning a breech using his particular skills such as moxabustion. Swimming has also been found to help. It is worth asking an Obstetrician or Midwife to confirm this before you do anyting specific.

    I suggest that you study the private Obstetricians here to determine which one has experience in ECV and breech delivery and also to seek public hospital guidance as you already intend.

    I have had my 36 week breech baby turn spontaneously. You may know when it happens. He was a normal delivery.
    My low birth weight twins were oblique and transverse lie for most of the pregnancy. The lower twin became cephalic, head down, at the crucial time at 36 weeks and the transverse/oblique twin was guided into position (by ECV) when it was her turn to come down, after the delivery of the first twin. She was held in position so that she didn't then go up and turn again.
    My Obstetriacian was one of the best in the world. We drove 2,000 miles to have his care!
    Ensure that you trust your Obstetrician and then trust their judgement.
    That is my mommie to mommie advice.

  3. #3
    charade is offline Registered User
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    Thanks for sharing your thoughts MommieMid. I'll be 37 weeks on Friday (at my last appointment at 36 weeks, baby had not turned) and though I'm doing knee-chest excercises whenever I can, don't think she has turned still.

    Doing the ECV privately is not an option for me, even if I could find a doctor willing to take me on, because if it does end in an emergency c-sec I cannot afford the costs.

    I'm having an appointment in the public hospital tomorrow so let's see what they say. My ideal situation would be to do the ECV after 37 weeks and carry the baby till I go into labour naturally. I understand if membranes break or an emergency c-sec is needed during the procedure but don't see why they must induce and force the baby out early. Anyway, hopefully I am wrong about them insisting on induction.

    My last induction did end in a vaginal delivery - I am a little apprehensive of going this route in the public system again as my last experience was far than joyous (not that I expect labour to be joyous), and I didn't get an epidural, had a huge episistiomy the stitches of which did not heal till three months later. I also have Strep B so for natural delivery I will be on antibiotics through IV. Combined with epidural and induction, I'll be pumped full of drugs through the natural procedure also. I'm also apprehensive of an emergency c-sec in public if it comes to that - I feel my private doctor will be able to do a smaller cut. So lots of things to consider but keeping an open mind right now.

    Thanks again for sharing your thoughts.

  4. #4
    MommieMid is offline Registered User
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    Ecv

    I spoke to the Consultant Obstetrician at a public hospital tonight about your concerns.
    She said that they perform ECV at 37 weeks for ease in turning but can also do it at 38 or 39 weeks. The success decreases, I presume.
    They do not automatically perform an induction of labour after an ECV and this is not a requirement, she reported confidently. There are risks to having an ECV and you need to informed fully, so that you understand any possible consquence. I personally wouldn't question having one performed and would myself go ahead. You may feel differently, that the risks are not worth taking.
    Some old posts discuss the cord around the baby's neck as a reason why their baby remained breech, that is something to discuss with the hospital in the morning.

    The Obstetrician seemed very relaxed about the possibility of ECV, but does not perform elective breech deliveries at her department although she said that some other public hospital units will. Size of your baby and your size and stature are crucial in this decision making.

    With regards to Gp B Strep, the IV antibiotics should, I believe, be given immediately prior to labour so that you have had the full dose well before the delivery, where possible. You will not necessarily have the antibiotics throughout labour. If you choose an Epidural, you should have an IV anyway. I presume that you have had oral antibiotics already. My baby was given IV antibiotics immediately after birth and even before I breastfed her.

    I personally would feel confident to choose my local public hospital in Hong Kong for my own delivery, if I were to have another baby again. I would need to know exactly who was caring for me though, and I am not sure whether women here have that luxury. I would not necessarily choose one of the private hospitals over the public hospital.
    When I delivered my twins, I was prepared for an C/S. I preferred not, but in the interests of safety and knowing that I trusted my Obstetrician, I would have been happy to trust his judgement if a decision was made by him to proceed to C/S at any stage. It is important to be fully informed, but ideally, willing to trust when the experts are using their best judgement.

    Good luck for the morning. Keep us updated!

  5. #5
    charade is offline Registered User
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    MommieMid, thanks so much for finding out the extra information for me. I've found that it really helps to go into appointments with the public system with some background information so one asks the right questions. My baby's chord is not around the neck, as of the last scan, and my placenta is not low-lying so those are not concerns in my case. I'll keep an open mind about what they say at my appointment this afternoon - I'm presuming they'll offer an ECV; maybe they won't! Though my private doctor, in his letter to them, did suggest ECV as an option.

    Public hospitals vary quite a bit in some policies and quality of staff. The one I'll be delivering at - United Christian - is not the best in Hong Kong (for example, if I was registered at QMH, I'd be much more confident) but not the worst either. I have a good sense of what to expect with them because I delivered there in November 2010. One does not have a choice of doctor; the doctors on call are very young (and the one I got last time was insensitive, rough and pretty much tried to avoid saying a word to me whenever she popped in), though the midwives are largely good. I didn't realise how much I dreaded delivering there again until I smelled some soap that was exactly the one they use in United Christian and had this awful negative feeling. Nevertheless, overall, I am confident they would not endanger my baby or my life; just that the whole experience is very rough edged (cervical exams were horrid, episistiomy huge and the stitches didn't dissolve for three months) and being pregnant the year after my son was born, I promised myself I would pamper myself with a private delivery.

    Anyway, let's see how this afternoon goes and I'll update on this forum for anyone else considering this option. Thanks again for digging around for info for me.

  6. #6
    charade is offline Registered User
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    Just an update for those who might consider an ECV in the public system. I had a consultation with a doctor at Tseung Kwan O Hospital yesterday. After doing a very brief ultrasound to ascertain that my baby was still in breech, she discussed options with me. These include:
    1. ECV at 37 weeks. At United Christian where I would have to go, they only do it on a Tuesday so I would be 37 weeks + 2. I don't have the option of pushing it further down, but also she said they don't advise later than 37 weeks because the baby gets bigger and harder to move so I understand that. They do not induce after the ECV; you can wait to have the baby naturally. However, one has to be prepared for an emergency c-sec should things go wrong. UCH has a 50% success rate which is close to the worldwide standard and the procedure is performed by a 'consultant' (by which I assume a senior doctor who does not work fulltime for the HA) or a trainee under supervision of the consultant. One thing to remember is that even after a successull turn there is a higher rate of induction or c-sec later in those who have had an ECV - possibly because they can turn but the baby but not ensure it engages.

    2. Elective c-sec to be scheduled after 38 weeks.

    3. Breech delivery: But neither the public doctor nor my private doctor recommends this. I also would not consider it so it was not discussed further. Not sure if you really want it, they would do it in the public system.

    I am free to choose either option 1 or 2 and the doctor basically does not offer any guidance on which to choose but does explain risks and benefits of both. After considering everything and also my gut feeling that my baby won't budge, I'm leaning towards c-sec.

  7. #7
    miran is offline Registered User
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    Charade - all the best !

    MommieMid - I am in no way involved in this discussion and dont know Charade personally; but I thought it was really nice of you to find out additional info and share it.

  8. #8
    MommieMid is offline Registered User
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    How are you now?

    Charade,
    Thank you for the update. How are you now?
    I hope that you are feeling OK with the delivery, whatever you choose.
    Keep us updated. Best wishes.

    Miran, Thanks!

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