babys position........just a question

[biglips]

the fetal position is "Oblique" but the presentation is "breech" - what does that mean??

im 34 weeks pg today and had a scan to check if the placenta had moved away from my cervix which it had

the sonographer said everything is normal but it wasnt till i got home that i realised the baby is breech even though its in a oblique position (meaning slightly on an angle)

please explain more...thanks

[biglips]

bump

[lulumama]

the baby is presenting with its bottom nearest the cervix, but on an angle, so not with bottom directly down, but baby partly lying across your uterus? i think !!

baby's position not that much of an issue yet, but you can look into optimal foetal positioning, and ways to turn a breech

due to previous c.s , it is unlikely you will be offered an external cephalic version, where the doctor will turn your baby

[RedHead81]

don't worry about presentation - a baby can be breech until around 37wks and is quite normal. they say to get the baby into a correct position you should sit upright with your legs apart - slightly leaning forward (as you would on the toilet) and to lie on your left side in bed (no idea why!)

[biglips]

right...that makes more sense now.

the baby for ages had been head down and i know that it is too early to worry about it atm as the baby turns all the time, but i will look at that website that you linked for me ages ago about the optimal foetal positioning of what i can do.

i didnt realised that i will be unlikely to be offered to move the baby..

i would like to have this baby early as i was 2 weeks overdue with my dd and im hoping to get things starting at about 37 weeks - i hope!

i am seeing my consultant at 36 weeks to discuss about my birth plan.

[lulumama]

why do you want to have t his baby early? if you need to go over your due date, then that is ok

a normal pregnancy can be between 37 - 42 eweeks

your due date is simply an estimate, and only 5 % of babies are born at 40 weeks, many more are born at 41 weeks

due to previous c.s your options for induction are limited, and you cannot ask for induction or planned c.s just becasue you do not wish to go over due!

also, an elective section will be carried out at 39 weeks, as that is far better for the baby.

who is your consultant?

[biglips]

i havent discuss this to my consultant at all as i last saw him 4 weeks ago and he just checked me over and that was it cos of the placenta that was covered..we couldnt really discuss about the birth plan.

If the consultant prefer me to have an elective c-section that so be it but i would like to have this baby abit early as i hated it being overdue.

And also i didnt know about "due to previous c.s your options for induction are limited" as i said i havent discuss anything to mny consultant but will be talking alot more about it at the next time ill see him cos of the placenta had now moved.

[lulumama]

being delivered early just becasue you don;t want to be overdue might not be the best course of action... you need to discuss all the options of course. do you know who your consultatn is?

some babies need to be in utero longer than 39 or 40 weeks..

if you want a vaginal deliver, tehn your best chance starts with a spontanoues labour, when baby is ready to be born

[biglips]

yes i do need to discuss more options to get more of a clear idea about it. yes my consultant is Geoff Shaw. He hadnt given me any options yet cos of the placenta situation at the time but hoping to have a natural birth.

[lulumama]

righty ho.

good thing to do is to make a list of things you want to ask.

policies re induction do vary from hospital to hopsital where you have had a previous c.s. some will induce very cautiously, i.e prostin only, no syntocinon drip, some won't at all.

if you do want a vaginal birth, you really need to start reading up about VBAC , and your hospital might well have policies about that, i.e time limit on labour, canula in place, CFM

a good place to start is seraching the archives here on MN and also www.aims.org.uk for VBAC info

as is said a spontaneous labour when baby is ready is your best chacne of a succesful VBAC

if baby turns head down and your placenta is out of the way, then IMO you shoudl go for it

definitely have a good think about things though

[biglips]

thanks lulu for giving me some advices..

i will start reading the link now

[lulumama]

no worries, you are welcome, cannot believe you are 34 weeks already!

[biglips]

i know...tell me about it!

[Joeymac]

Sorry to crash this thread but need some advice Lulumama as you seem to be a woman in the know.

I'm going for a VBAC and I am quite specific that don't want to be induced due to the risks. However the registrar and senior MW have told me that I will get syntocinon if I'm not progressing but not the prostowhatsit gel. They tell me the prosotwhatsit stuff is effectively me being induced and syntocinon is not. From what you mention above that's not the case. I'm confused now and as I say I don't want to be induced under any circumstances?

[thisisyesterday]

the syntocinon is given after labour starts to increase contractions isn't it??
I think that's what I had with ds1 anyway

[lulumama]

Hi joey

I was under the impression from what i have read that syntocinon is contraindicated for VBAC due to the risk of uterine hyperstimulation that can increase teh risk of rupture.

if you are not comfortable with synto being used, then you can decline it

the best way to start a VBAC is a with spontaneous labour, and no augmentation, so your body can go at its own pace.

i always recommend women to do their own research and reading around VBAC, so they feel confident and know what sort of care they want in labour

if baby is happy and you are happy, and labour is not progressing at the 'average' of 1 cm per hour, you can decline any augmentation. some women take ages to get going,then go from 3 cm to fully in a couple of hours, some go really quickly to 8 or 9, then ages to get to 10cm

if baby and you are tolerating labour well, and on distress, then labour, should, IMO be allowed to continue at its own pace

if you do not wish to be induced or augmented in labour you can make an informed decision to decline it

you are not really overdue until 42 + weeks. you can ask for expectant management instead of induction

you can proceed to elective c.s at 42 weeks if no sign of baby and you do not wish to be induced due to the risks

www.aims.org.uk is a good resource as i said. and there are lots of VBAC sites out there

search on here for posts by Victoriansqualor and Klaw about VBAC

and good luck !

[greenlawn]

Hi I had a previous cs then a vbac - I was told last time round that any form of induction was a definite no (as was ecv). I was told the problem with induction is it either doesn't work at all or works too well increasing the stress on the scar.

The only form of "moving things along" would be a sweep when I got to being overdue. Luckily that never happened and I had a lovely vbac. Hoping for the same this time. Good luck!

[hedgepig]

Hi Joey
I'm hoping for a VBAC too. When speaking to my community mw she was sying that my hosp will now consider using the prostsglandin gel for induction of a VBAC but she wasn't sure about the synco. I have a consultants appointment week after next when I will find out more. I had understood that induction was not recommened for VBAC but seems like things are changing.
Personally I will not consider induction and would rather have another cs but do think it may be useful in negotiationg about continuos monitoring. ie if they can ignore the guidance on inducion then they can ignore the guidance on monitoring

[Joeymac]

Thanks Ladies for your advice here. I had also thought synotcinon was an induction drug but the registrar I saw said it wasn't however there is NO WAY that I am letting anyone induce me as have been reading lots on the risks.

However I've just checked my notes and they've written "+/- syntocinon infusion 3rd stage". I did have a post partem haemorrage in my first labour and lost 3 pints. Would they be giving me syntocinon to stop any potential bleeding this time around as I have read that they can do this and if so, once the baby is out, am I still at risk of uterine rupture in the third stage so should I be declining it then too?

Also general VBAC encouragement needed here. First labour 48 hours and only got to 4cm with synto for the last couple then emergency c section. He was back to back but also potential small pelvis issue. Although I'm going to try VBAC (almost 38 weeks now) I'm still not convinced I'm going to get beyond 4cm myself. I'm thinking in the back of my mind that my body just won't do it. Please tell me it is possible and that I could get past 4cm if baby is in the right position. People tell me second time is better and your body knows what to do.

off to lean over my birthing ball again.....

[lulumama]

hey joey, if you had a PPH then you could well have been given a drip to stop bleeding .. what does your reg. say is used for inducing / augmenting contractions?

anyway, i just want to say that you need to have faith in your body. a well positioned baby and a confident mother do help.. i had the same fears with my VBAC, labour having stalled at 2/-3 cm with my first, despite ARM and synto.

but also i was immobile for my entire labour

i started spontaneously in labour with DD, and had a 15 hour latent stage, followed by a 3 1/4 hour establised labour, took 2 hrs 45 to get from 3cm to fully and pushed for half an hour

and my baby was persistent OP and born face up!

i was active, mobile and upright for a loooooong time, although i delivered on the bed, i was encouraged to be mobile by the MW

i did a lot of reading and had female birth partners as well as DH and that made a huge difference to

[lulumama]

also there is some evidence that a physiolgoical 3rd stage means less risk of retained placneta and PPH , IIRC. but only an option if you have an unmedicated birth, otherwise you will be given an injection of syntocinon/ergometrine called syntometrine to expel the placenta and midwife will gently pull the cord to remove it . intersting question re risk of rupture in 3rd stage, not sure of the answer, although i think probably less than during the rest of labour as contractiosn not as strong and long ? would like to know that myself!

[ajm200]

Check out www.spinningbabies.com for tips on getting baby into the right position