Scheduled C-section: should I push back? How hard?

August 9, 2010 11:03 AM

After ~37wks of baking, our Little Spark is soon to emerge. Sonogram last week shows breech, size estimates via same sonogram say ~8# so far. Doc is now advising/arranging scheduled C-section. I'm not sure it's the right thing. Can you help me determine if I should push back & how hard?

The pregnancy has otherwise progressed normally (perhaps even ideally). These are the potentially mitigating/complicating circumstances & other details...

Pregnancy:
• The weeks count might be somewhat off - first exam put estimated due date at 8/25, sonogram minutes later put it at 8/30. Doc is now going with the 8/25 date to base things upon. I'll find out this Friday (13th) why that changed, but it's a factor in her decision and it worries me - I may have nearly a full week for development "disappearing". How can I engage with her on this productively?
• She says breech babies at this stage rarely turn. I've found information that says differently. Is she right?
• The size estimate might not be accurate. On same page as above, ultrasound estimates of baby size can apparently be in error. Even if it is accurate, she's estimating ~9# at birth - that doesn't seem so unusual or huge (she has admitted she has no idea about my "pelvic capacity") as to call for C-section automatically...or does it?

Me:
• I'm overweight. This causes many OBs to do just what mine is doing: insist on C-sections. I'm otherwise healthy, though - great BP, normal blood sugar, healthy heart.
• I'm almost 40.
• This pregnancy occurred with no medical intervention nor even specific intent. In fact, I spent 20yrs thinking it utterly impossible and had accepted adoption as my only option long ago.

Why I care:
• No one really wants unnecessary surgery. Aside from increased risk and cost, a few hormonal milestones won't be hit, making the start a bit more difficult (I'm thinking mostly of milk-related & uterine/ovarian issues and not so worried about attachment, as that's been proven to not matter as much).
• If I can give birth more naturally (albeit accepting I'm going to ask for pain management), I want that for me and the baby - this is my one and only biological child happening here, and I don't want to be rushed into a high-intervention birth unless completely necessary.

posted by batmonkey to health & fitness (49 answers total)

Although it is less common than it used to be, it is certainly possible to deliver breech babies vaginally. The difficulty is finding an OB who is willing to do that.

It sounds like you haven't gotten a second opinion. You should consider doing that. You should also compare the C-Section rates of the hospital where your OB practices and other hospitals in the Austin, TX area. Finding a hospital with a low C-Section rate might help you find an OB who is more willing to discuss the possibility of your delivering your baby vaginally.
posted by alms at 11:12 AM on August 9, 2010

What's safest for your child?
posted by KokuRyu at 11:15 AM on August 9, 2010 [3 favorites]

Ultrasounds can be wrong; mine was predicting 10#s by delivery, and she was 8lb 13oz. So, yeah.

Make sure your doctor understands your concerns. Unless there is a medical reason for you to go "early", maybe you could schedule the c-section to be a week after your due date. That at least gives the baby all the time to develop, and time to turn. If the baby doesn't turn, my understanding from friends is that the attempt to manually turn babies HURTS LIKE HELL. (this from one mom who gave birth to five kids vaginally. She hated the turning attempt more.) So, there's that to consider. Seconding alms on asking for a second opinion on the turning, and on whether they will deliver a breach baby vaginally. Also consider what the risk is of attempting to deliver vaginally and having that converted into a c-section on an emergency basis.

Finally, you might consider a midwife/doula who can advocate for these issues for you. It's difficult, sometimes to do that while in the midst of labor/wishing for labor, and partners aren't always very good at helping in that regard, depending on personalities, etc.
posted by dpx.mfx at 11:19 AM on August 9, 2010 [1 favorite]

I can't weigh in on the majority of your questions, but if your OB is unwilling to let you attempt a vaginal birth, he or she might be able to refer you to another OB who would try. Docs often know their community of fellow practitioners, who is willing to take more risks to accommodate patient wishes, etc. Of course if your situation makes you categorically not a candidate for vaginal birth then no responsible practitioner would do it, but it may be that your OB would know somebody who specializes in breech presentations and would be willing to give you a second opinion. Because really what it sounds like your current OB is saying is "I don't feel comfortable that I can safely deliver your baby in this situation," not, "You cannot deliver vaginally." Someone with more experience with breech babies might be able to do it.

As to how to engage the doc productively, just be respectful but firm. You have a right to a second opinion. Make the conversation about assessing all your options and meeting your personal desires for your body, not a question of your doc's expertise.
posted by vytae at 11:21 AM on August 9, 2010 [1 favorite]

I had 2 vaginal deliveries, last one was an emergency C-section because of complications in labor.

C-section (and recovery) was really a piece of cake.

My second kid was breech at about 36 weeks, she turned around on her own.

The only advice I can give you is this: ultimately, you want a healthy baby delivered safely.

Is there any possibility that you can wait until you're in labor (1st babies usually don't come all too quickly), and depending on the position, a decision can be made about a C-section?
posted by dzaz at 11:22 AM on August 9, 2010

Head on over to ICAN and read up.

While the breech may be an indication for a c-section (depending on the kind -- footling? Yes. Other breech? May have time). Still, you could look into having a version done. That would be my personal choice before scheduling a c-section. You can also check out Spinning Babies, try some of the exercises, and see if the kid won't turn.

Even the ACOG's own guidelines state macrosimia (large baby) is not a reason to automatically do a c-section.

Changing your due date at this point in the game to an earlier due date is definitely a bait and switch. Consult another practice at a different hospital. Consult midwives at different hospitals. It is not too late to change your provider. Even if a c-section is indicated, you should have it done with a provider you have full confidence in. If you do not trust this provider, you should not hesitate to switch. Even if other providers tell you a c-section is necessary, it's not necessarily a reason to stay with this one. You can and should have your c-section on your terms if you do need a planned c-section. The ICAN White Papers have lots of information on different things that can be done during c-sections to make them better.

Also, if you haven't checked it out yet, Plus Sized Pregnancy is a great resource, and not just for women of higher than average weight. It's full of great stuff for every woman going through a pregnancy, but there are some very specific resources for larger women.

You have every right to care about having a c-section, and you have every right to make a fully informed decision. Ask for studies. Ask your provider her opinion on VBACs. It says a lot about a provider, and even if you won't be having more children, it will give you insight on how she practices.

Last, you can always refuse and she can't really force you to have a c-section or to even schedule one. If you're not prepared to schedule one, then don't yet. If you live relatively close to the hospital and go into early labor before you've come to a decision about this, you can still have the c-section then if it's warranted.
posted by zizzle at 11:22 AM on August 9, 2010 [5 favorites]

Speaking from personal (but not direct, as I'm a male) experience: If you or your MD think you will probably end up having a C-section in the end, getting the opportunity to schedule one is a godsend. Get a second opinion, but if they concur, then do it! Scheduled surgery beats emergency surgery every time. Doctors are not part of a cabal trying to make C-sections a way of life. They do more of them now for a number of reasons, but in any event, the decrease in mortality rates trumps the increase in malpractice claims (which are usually a result of mortality).
posted by turducken at 11:23 AM on August 9, 2010 [1 favorite]

Don't worry about the weeks count too much, the whole area of exact due date and actual due date are vague to say the least. We just don't know. And once you are past the 37 week date then the baby is fully baked, so it doesn't really matter if the baby comes out 8/25 or 8/30 as long it as after 37 weeks and both of you are healthy. At that point lungs are fully developed, and really all that happens between weeks 37 and 40/41/42 is growing. Growing happens just as well outside the womb, with a caring mama. The doctor is probably going with 8/25 because she is concerned that the baby is large, and birth becomes more difficult as the baby gets bigger. In fact, if you want to push for a vaginal delivery (pun not intended), then the earlier the better if baby is going to be on the large side. You should of course ask her about this, because its good to know what she is thinking. Just ask her "the due date used to be 8/30, now we are going with 8/25, why did that change?".

I have no clue on the breech thing, since neither of mine were breech. In terms of ultrasound weight estimates, yeah they are definitely inaccurate.

I'm getting the sense that you are frustrated by communication between you and your OB, do you feel like she is not telling you enough detail or is glossing over stuff you are interested in, or not listening to your concerns? Perhaps you should discuss that with her. Figure out exactly what it is you are not happy with, and then express that in a calm manner.

As for C-Sections, of course its better if you can have a vaginal delivery, assuming both of you are healthy and it is safe. My first was delivered by C-Section after things started to go awry during very early labor, fortunately it wasn't an emergency C-Section. The second was a C-Section because both the doctor and I decided we didn't want to risk VBAC. C-Section is a MUCH harder recovery. However, you have to counter that with the question of your baby's safety. I definitely agree on getting a second opinion. I did that (sort of) with the VBAC decision, and it really set my mind at rest to feel like I had an idea where on the risk-averse scale my doctor was, and let me feel like I could make an informed decision.
posted by Joh at 11:34 AM on August 9, 2010

"I don't want to be rushed into a high-intervention birth unless completely necessary."

I can't really speak to the more medical parts of your question (although I can tell you that many insurers won't insure hospitals to deliver certain births vaginally, so you may have to find a particular HOSPITAL as well as a different doctor -- only one in my area does VBAC, for example, and only in limited circumstances. The others aren't insured for it.), but I did want to speak to this particular quote.

I had a planned C-section due to an undeliverably breech baby (and, FYI, he was 7 lbs. 13 oz. -- it wasn't his size, it was his position. And it wasn't MY size either). We attempted cephalic external version (CEV) to turn him, which failed, and went ahead with the planned C-section at 39 weeks.

A planned C-section is radically different than an emergency C-section.

You may mean "rushed into" in terms of you've only got 2-3 weeks left to bake the baby and that feels fast to make a decision, but it read to me like your mental picture of a C-section is the emergency C-section. My planned section was quiet, peaceful, calm, and as pleasant as surgery really can be. We went to the hospital, got prepped at a leisurely pace, took lots of pictures, went into surgery, my husband and the anesthesiologist held my hands, the anesthesiologist took pictures for us, and 3 and a half hours after we got to the hospital, we had a baby on our hands. They cleaned him up in the corner of the surgical suite where I could see him, my husband got to trim the cord and participate in the cleanup, and they brought him over to me two minutes after he was born. I was alert for the whole thing. After a few minutes and first family pictures, he went off to the nursery with my husband and they gave me the loopy-making drugs. About 90 minutes after he was born I went from the recovery room to my maternity room, they brought me the baby, and he breastfed like a champ. My milk came in normally.

(I did not ask to attempt breastfeeding right after the birth, though some hospitals allow that; I wanted to get stitched up because, hello, my insides are hanging out! And I was a little panicky about surgery to begin with.)

So there were about 90 minutes where I was getting sewn up and then in recovery where the baby was with my husband but not me, and I barely remember that, it was fine. When I went home, I could climb stairs on the first day. I tell people I got to 80% recovered really quickly, whereas people with vaginal births seem to get to 90% recovered really quickly, and it just took me a little longer to get that last 20% than it took someone who delivered vaginally.

Two of my good friends who gave birth about when I did were having vaginal deliveries when they had to have emergency C-sections (one due to fetal distress, one due to maternal problems). Recovery from the emergency C-section was much more difficult for them -- they felt far more "beat up" having been in long labors and THEN having the C-section -- and the surgery itself felt rushed and frantic and much more upsetting than mine did. But a planned C-section is a much different animal than an emergency one. And while I realize my C-section was definitionally "high intervention," it didn't FEEL that way. It felt very calm and normal and as natural as being cut in half can feel.

And while I know birth is important and can be transformative, I think sometimes the stories we as impending and new mothers get fed these days are like people who focus so much on the wedding that they ignore the marriage -- the wedding, or the birth, is just one event. It doesn't so much matter if you're having a princess wedding or a $40 dealie at the courthouse; what matters is the MARRIAGE. Likewise, what matters is the BABY, not his chosen method of arrival!

Whatever you choose, good luck!
posted by Eyebrows McGee at 11:35 AM on August 9, 2010 [18 favorites]

With all due respect, the information you've linked to in support of your 'I might not really need surgery' argument comes from sources that I would be very hesitant to trust on matters this important. Nothing here is peer-reviewed, and they seem to be relying entirely on anecdotes. For instance, Plus-Size-Pregnancy's author is a self-described "certified childbirth educator and long-time activist in the size-acceptance community;" since 'certified childbirth educator' is not a title to which you should ascribe any credibility, her credentials are the fact that she's given birth to four children. Our Bodies Our Selves mean well, but are a social justice group comprised of marketers and writers, not a collection of MDs. If it were me trying to navigate a potentially-difficult pregnancy, I would hitch my wagon to modern medicine.

I understand that you're trying to avoid unnecessary medical procedures, and I sympathize with that. However, if you're worried that your obstetrician is being overly cautious, find another doctor for a second opinion; don't trust random testimonials on unvetted websites.
posted by Mayor West at 11:39 AM on August 9, 2010 [5 favorites]

This is all I can contribute to this, seeing as I never had a choice about having a c/s or not (I had triplets.) But it still makes me sad, two and a half years later, that I never got to experience labor at all. I really do feel like I missed out on something very primal, and I wish I could have at least experienced a few contractions, at least so I'd know my body was ready to have the babies. My milk never came in, and I suspect that's part of the reason why, but I guess I'll never know.

My vote is to not schedule one (or if you can, schedule it for after your due date) and just go in and have it when you go into labor. I know it's not as calm and orderly as a scheduled c/s, but it might help so that you don't have any regrets later.
posted by pyjammy at 11:45 AM on August 9, 2010

By the way: "She says breech babies at this stage rarely turn. I've found information that says differently. Is she right?"

The page you linked to doesn't say breech babies frequently turn -- it simply says that they CAN turn very late in pregnancy. I think your OB is right; they don't often turn into the proper position if they're not there now. That doesn't mean they NEVER do.

My doctor actually discussed positional ultrasound right before surgery with me when we made the decision on the surgery. He said on a two occasions in his many years of practice the baby had turned the right way, which both times caused much distress since mom had decided on the C-section and now wasn't sure what to do, and we should talk about that now just in case the miracle occurred. They did do a positional ultrasound before the surgery to verify approach, as I recall, but that's not a universal practice.

My son actually turned breech at 38 weeks -- he was head down until then -- and it was so intensely painful, because he was so big and had so little room, that we thought we were going to have to go to the ER because we thought I was in some kind of crazy "Aliens" labor. It was horrific. I think if your little one radically repositions this late, you will probably know about it.
posted by Eyebrows McGee at 11:45 AM on August 9, 2010 [1 favorite]

There are good reasons to avoid a C-section if you can; the World Health Organization's surveys consistently put the sweet spot for mortality and morbidity as having C-sections occur at somewhere between 10% and 15% of births. In this country, we average closer to 33%. So I think you're right to push back, PARTICULARLY on the macrosomia. My friend's baby was estimated on ultrasound to be 8 pound 10 oz, and when born? 6 pounds 5 oz.

Vaginal breech birth is definitely possible, but it requires a practitioner who is skilled in it -- start calling around now. If you can't find a practitioner in your area who is experienced and comfortable with a vaginal breech birth, a C-section may be your best and safest option. Babies can and do turn at 36+ weeks, though; there are a bunch of ways to encourage them to do so, from visualization (which I personally don't find compelling, but what does it hurt?) to sitting in a shallow tub of warm water with a bag of frozen peas on the top of your uterus, to the Webster technique (it's a chiropractic trick that reportedly has up to an 80% success rate), to an external cephalic version.

If you wind up with your scheduled C-section, I would encourage you to schedule it past 40 weeks. According to my midwife, the average term for a first child is actually more like 41w2d anyway; certainly, the post-dates risks don't rise significantly until after 42 weeks. That not only gives you more time to ensure fetal development, but also more time for kiddo to turn.

REGARDLESS of your circumstances or your final decision: These are appropriate questions for you to ask, and it is your OB's responsibility to answer your concerns. It's one thing to be confident that a scheduled section is the best and safest option for you and your baby, but another thing entirely to be dismissive or condescending of your attempts to make sure you agree. So be confident and strong in your questioning! And do whatever you need to do to be comfortable with your final plan.
posted by KathrynT at 11:46 AM on August 9, 2010 [3 favorites]

I had two c-sections-one emergency in the middle of the night after laboring forever and one scheduled. My pelvic capacity is extremely narrow-something we couldn't have known until we tried to deliver. I nursed both my children, so it can be done after a scheduled c-section, it'll just take a little more work.

Get a second opinion. Maybe even get a third. It's worth it to make sure you don't just have a doc who likes to cut. Having said that, a scheduled c-section is ten times easier than an emergency. So if your second (and maybe even third) opinion agrees and the baby doesn't turn, I'd go with the scheduled c-section, personally.

I wouldn't wish an emergency c-section on anyone. The doc was tired, I was tired, my husband was tired, my body was spiraling out of control because I'd wasted so much time arguing about getting the damn surgery that my doctor finally had to appeal to my husband (another doc) to talk some sense into me. I was so obsessed with having the birth experience that I wanted that I waited until we all had no choice. Second time around, the scheduled c-section was no big deal AT ALL.

So if nothing else-if you decide to try to deliver vaginally, do so with an open mind. If you don't trust the doc you have, find one you do trust, because the last thing you want to be doing after hours of unproductive labor is second guessing the people you've asked to look out for you.

Congrats on the baby...and good luck either way.
posted by supercapitalist at 11:46 AM on August 9, 2010

Breech + C section here. We also did two versions (I forget what it's fully called) where they try to move the baby by having a team of people manually push the baby from the outside while you're lying down. That feels pretty much like you'd imagine.

I was so depressed about having a c section but I wish we'd left her alone and I hadn't fought so hard against it. The second version compromised her safety and her heart rate decelerated. We had the c section immediately.

She was 8lbs, 7oz, the fortieth week, with her bum hanging down. I'm short-waisted, and I don't think she had any room in there to do any further moving around regardless.

Trying to do it naturally could have killed me, or her, or wound up with a c section anyway.

I wish I hadn't made such a big deal out it. It was okay in the end. MeMail if you'd like to talk.
posted by A Terrible Llama at 11:47 AM on August 9, 2010 [1 favorite]

Dr. Joseph Tate in Georgia routinely delivers breech babies (not footling breech, though) as long as the mother agrees to birth in the OR in case anything happens.

He may be somebody for you to consult with on the phone. I bet if you spoke with him and faxed your medical records, he would tell you his recommendation for your particular situation. Since he does breech deliveries with regularity, he may be able to offer clearer insights on the risks of your doing so, which may assist you in making a decision you can feel good about.
posted by zizzle at 11:54 AM on August 9, 2010

My first was breech through the last three months and turned just before he was born, full-term, 8+ lbs, so it does happen. Also the sonogram said he'd be 6 lbs, but that was in the early days of sonograms.

As to pelvis size, there seems to be a correlation between large pelvic opening and large feet. I'm 5'5" but wear size 9 or bigger (US) shoes, and popped them both out without pushing. So if you're a tall woman with smallish feet you might have a harder time.

You might try spending a lot of time in the bathtub, getting all relaxed might give the babe space to move.

I'd sa wait as long as you can to schedule a C-section in the hope that the baby will turn. Get a lot of rest.

Good luck and congratulations. Let us all know what happens, please.
posted by mareli at 12:04 PM on August 9, 2010

Do get another opinion. If only to get a sense of what another OB thinks. With my first baby, at 40 weeks he was turned in the right position, but still hadn't dropped, and my OB speculated that perhaps he hadn't dropped yet because his head was too big to fit through my pelvis, and I should start getting my brain around the idea that I might need a C-section. At 41 weeks, 2 days he dropped, and kept right on going, and my labor progressed so fast I wound up delivering at home with the assistance of some hunky firefighters. (First labors often last longer, but not always!!!) And he was 7 lbs 15 oz at birth, after the sonogram predicted 9 pounds something.

However. Having had my own version of an emergency delivery scenario, it's a very stressful thing. The panic and freakout of just randomly beginning labor and then OMG WTF IS HAPPENING CALL 911 meant an adrenaline burst that carried me through delivery but adrenaline is like kryptonite to your milk supply, and so my milk didn't come in for three days, which sucked (figuratively, not literally.)

Every birth is unique. It's really a special snowflake moment, but I also think it is the first lesson in parenting, which is that you can have an idea of what you want to do and how you want to do it, but sometimes your plans get thrown out the window and you just have to roll with what comes. The most important outcome is a healthy mama and a healthy baby, and everything else is secondary.
posted by ambrosia at 12:06 PM on August 9, 2010 [4 favorites]

Just an anecdote here: I am also overweight. My last child was estimated by ultrasound at ~36 weeks to be over 9 pounds already, and was guaranteed to be over 10 pounds at birth. When I delivered her at 41 weeks, she was 8 lbs, 14 oz. Ultrasound size estimates in the third trimester, as I understand it, are notoriously off.

As far as turning your baby - I remember reading different at-home methods you could try, such as putting a bag of frozen peas on your fundus and lifting your legs above your head. My recollection could be wrong - might want to look those up.
posted by Addlepated at 12:08 PM on August 9, 2010

You guys are frickin' fast!

To address general things thus far & maybe refine further answers:
• this question is part of the info/rebuttal case I'm building for this Friday's appointment, so all data help. healthy baby (& me) are precisely what I want, which is why I don't want to push back unnecessarily and need to build my personal knowledgebase.
• I'm pretty sure I don't want to go into labour with a breech baby, due to the potential complications for both of us being quite drastic. If this scenario really does generally call for a C-section & I could risk our health, I'm more than happy to have a scheduled C-section and am fully (!!!) aware of the differences between this and the entirely more high-stakes emergency C-section (which is the primary reason I'd just say "okay" to her current advice).
• as of last week's ultrasound, Little Spark is sideways and face-down. I'm getting another ultrasound on the 13th to check position. If still breech, then C-section the 20th.
• I haven't received a 2nd opinion; I felt I needed to get insigh on whether or not I was overrreacting; even a relatively mild co-pay right now is a Big Deal for us.
• midwife/doula is so far outside of what we can do financially that it's like a fantasy scenario.
• For those mentioning # of wks qualifying as "full development", here's a recent study for your reading pleasure.
http://www.ivillage.com/delivering-babies-even-few-weeks-early-ups-respiratory-risks/4-a-230772?par=ivillage%3Ayth%3Aoutbrain&obref=obnetwork
• Although potentially for entertainment purposes only, I am going to use my nervous energy this week to try every non-invasive recommended "unbreeching" technique you guys linked.

zizzle: thank you for the ICAN link - great resource. PSP is where two of my links above came from and is the source for the third, but I'm unsure about accuracy, as she has some crazy stuff on there, too ("malpositioning", for example).
Eyebrows McGee: I mean "rushed into" as in "due date was 8/30, is now 8/25, and she wants to do the C-section on 8/20". Thank you so much for your anecdote - that really helps a lot! I'm not into the "awww, squishing the baby out is so natural & groovy, must do it at all costs" thing.
Mayor West: that's one of the things I've been wondering - multiple associates/friends have pointed me to PSP and I found myself dubious, despite the large number of citations she's appended to her opinions, which is one of the reasons I made sure to be open about where some of the fuel for concern was coming from. thank you!
KathrynT: because of the immensity of potential for real harm to the baby & myself to go into labour fully breeched, scheduling for after due date is sadly not possible. but I very much appreciate your encouragement to be asking these questions - I was starting to feel like a lousy human being for even wondering.
mareli: I'm otherwise wee - 5' with (pre-pregnancy) 5.5EE feet.
pyjammy & ambrosia: the milk thing is really what I'm finding myself most worried about. really, really, really worried about it. vaginal birth in and of itself I can surrender, despite the harder recovery & other physical effects. not breastfeeding seems wrongwrongwrong to me.
posted by batmonkey at 12:12 PM on August 9, 2010

Mine weren't breech, but I had an emergency caesar with the first (placenta praevia) and a scheduled caesar with the second (for various reasons, none of which were life-threatening... more sanity-threatening).

I just wanted to quietly say don't worry about 'development disappearing'. My first was born at 36.5 weeks which is apparently technically premature - I know the exact date of her conception, thanks to Nick Cave and Michael Hutchence - and she is now 12.

She's as tall as I am (5 foot 7), blonde and beautiful and a lovely caring kid, and has been so advanced all throughout school that she had her own gifted and talented program designed for her in kindergarten.

Whatever you choose will be best. If you're uncomfortable with your doc, a second opinion won't hurt.

Good luck.

(PS: I have never heard of manually pushing a baby to move it from breech. And I'd be mortified to think of someone subjecting a baby in-utero to that stress.)
posted by malibustacey9999 at 12:16 PM on August 9, 2010

I'm going to 2nd Mayor West's comment about website linked to in your question. This website seems focused on natural (low technology) childbirth so it's no wonder that they would discourage c-sections. The idea that doctors who use sonograms to determine age and position are incompetent just seems a little fringe to me.

I had an emergency c-section with my first and a scheduled one with my second. I really wanted a VBAC but my doctor told me that although the risks of actually having a problem weren't huge, the risk of the problem being catastrophic (meaning loss of my life or the child's life) were high. This meant that insurance and regulations are making it far more difficult for doctors to take these kinds of risks even if you are willing to. It's just not worth it to them when they are confident that they can get a perfectly healthy baby and mom by doing a c-section. Anyway, not a 1-to-1 comparison since mine was a 2nd birth but perhaps the risk concerns are similar.

Anyway, it's an exciting time for everyone involved and it's important that you feel comfortable with whatever decision you make. Your OB is on your team, so you need to be very clear about what you'd like to happen and she should be equally clear on why she's making these recommendations. She should be able to provide details and data to back up her recommendations and I agree you should get a 2nd opinion.
posted by victoriab at 12:16 PM on August 9, 2010

Oops, let me clarify...I only think you need a 2nd opinion if it would make you feel better. I think your doctor recommending a scheduled c-section for a breech baby is totally normal and mainstream.
posted by victoriab at 12:20 PM on August 9, 2010

OK, yeah, a transverse positioning is really, really rough for non-surgical delivery. I'd still push for a later scheduled date rather than an earlier one with the understanding that 1) if kiddo turns cephalic, all bets are off and 2) you want a positioning ultrasound *immediately before the section*, like, as part of your pre-op prep, just to confirm. And definitely do all the stuff to turn the baby, from the science to the woo; in my experience, being able to say "We exhausted all our other options" is a really good way to feel comfortable with intervention decisions. (Memail me if you want to hear my story about acting as a sort-of-doula for a very crunchy friend during a very, very lengthy induction.)

As for the milk thing: ask if your hospital has an IBCLC lactation consultant on hand, and if so, ask to speak to her PRIOR to your delivery about your lactation concerns. Lactation experts can be as full of gung-ho and agendas as anyone else, but they can also be really good fonts of information and advice. Having an opportunity to speak with the person you would be working with when you're still pregnant can make a huge difference.

Congratulations on the baby, and good luck! You are SO doing the right thing to make sure you're making the right choices, I can't even tell you.
posted by KathrynT at 12:24 PM on August 9, 2010

batmonkey, my milk did eventually come in, it was just a rough patch at the beginning, which I understand is not uncommon, and why I sing the praises of a good lactation consultant. I know lots of women who delivered by c-section and had zero breastfeeding issues. I know (a very few) women who delivered vaginally who just couldn't make it work.

Breastfeeding is a wonderful thing, but I'd urge you not to worry about it right now. First, there isn't any way to predict if you are going to have issues or not, so not much point in stressing about something that is out of your hands. Second, while I think breastfeeding is great for a whole host of reasons, I'll emphasize again: a healthy, relaxed mama and a healthy, fed baby are the most important things, and please please please don't fret or beat yourself up if at some point nursing is a struggle. It's not an external validation of your competence as a mother, and I've known a couple of women take it really really hard when circumstances prevent them from being able to nurse successfully. Just feed your baby, and don't give yourself (or take from anyone) any nonsense about how you do it.
posted by ambrosia at 12:24 PM on August 9, 2010

The Society of Obstetricians and Gynecologists of Canada recently released revised guidelines on breech birth that may be of interest to your provider.

The change in guidelines was based on peer-reviewed evidence before being written and recommended.
posted by zizzle at 12:25 PM on August 9, 2010

For what it's worth I had a nine pound baby the regular way and I'm only five feet tall. So as far as size goes the only thing that matters there is your pelvic capacity and shape of pelvis.

The issue with breech births is this: the head is the largest part of the baby. If for some reason the head is too large to fit thru the pelvic cavity, you don't want to find it out if the rest of the baby is already on the way out.
posted by St. Alia of the Bunnies at 12:26 PM on August 9, 2010

Yeah, and don't think that having a scheduled c/s is the only reason I think my milk didn't come in. (Not being able to smell or touch my babies until they were 28 hours old probably had more to do with it, but still, I can't help but wonder...) I'm sure having a full-term singleton will make a huge difference.

And yes, congratulations and good luck! :)
posted by pyjammy at 12:28 PM on August 9, 2010

"the milk thing is really what I'm finding myself most worried about. really, really, really worried about it."

Please talk to your ob about it -- my ob assured me it wouldn't be a problem, and the nurses at the hospital told me they saw immediate breastfeeding establishment rates about the same for C-sections and vaginal births (normal births, full term, in both cases -- remember many C-sections are for premies -- and whether breastfeeding continues is of course a different question). The doctors told me sometimes the milk comes in about 24 hours later for C-sections than for vaginal births, but that late milk's not usually a problem. My friends who have had C-sections were all able to at least ESTABLISH breastfeeding, although of course not all of them continued successfully.

My baby latched on on his first try and started sucking immediately. It was just luck that he was a great latcher, but my C-section IN NO WAY interfered with my breastfeeding or with my milk coming in. The hospital encouraged it and provided support -- when they brought him to me the first time (90 minutes after birth), we admired him for 5 minutes or so and then the nurse was like, "All right, time to teach him to eat!" They had techniques for making breastfeeding more comfortable for women with C-sections (involving strategic positioning of pillows, mostly) and both the nurses and the lactation consultant were well-versed in helping women with C-sections breastfeed. The ob and pediatrician were supportive. Even the drugs they give you in recovery play nice with breastmilk. It was NO PROBLEM AT ALL, it was totally normal, and everyone was prepared to provide support. Your ob should be able to reassure you about this, really. My only C-section-related breastfeeding complaint was right after we went home, trying to get into a semi-sitting position in bed to breastfeed in the middle of the night was ouchy on my incision. I missed the mechanical bed doing the work for me! I breastfed for a full year.

(And if breastfeeding doesn't work out, really, honestly, it's not the end of the world. I know it's an emotional thing and it matters a lot to a lot of people, but thank God we live in a time of healthy formula alternatives for women who, for whatever reason, can't breastfeed!)
posted by Eyebrows McGee at 12:31 PM on August 9, 2010 [3 favorites]

And if breastfeeding doesn't work out, really, honestly, it's not the end of the world.

says the woman who didn't have any issues.

I had nothing but problems, and it's left deep hole in my heart and in my finances. Formula is expensive, and especially so if you don't qualify for financial assistance for it but don't have enough money to pay for it and your credit card bill is going up because you're spending $150/month unexpectedly for a year. It's not just an emotional loss that exists when breastfeeding doesn't work out. The world may not have ended, but it sure feels like it's about to every time I think about it.

And c-sections are known to impact milk coming in --- like make it so milk doesn't come in in my case.

Rather than talking to an OB about this, batmonkey, you should consult an LC who will come to your home once you are out of the hospital. And, yes, you want one who will come to your home. It makes a world of difference.

Check with your insurance about renting a hospital grade pump in case you end up needing one. A hospital grade pump can increase supply. My insurance covered the full cost of rental for up to three months or one month and then provided me with my own. Not that any of it helped. But these are things you'll want to have set up and have the information to work with.
posted by zizzle at 12:41 PM on August 9, 2010

I should have put this in when making the breastfeeding remark (in addition to making my link a link & otherwise proofreading):

Definitely going to get with the lactation consultant at the hospital - I'm fortunate that the system I'm qualified for with my insurance provides this resource. I'm prepared to use formula if I must. For health reasons for both of us, I want to do everything I can to ensure breastfeeding remains an option, and I have an extra (somewhat emotional) reason: the only reason I've gone 25 years with breasts I actively revile was to preserve the ability to breastfeed, and it would be Morissette-ironic for that whole purpose to, uh, evaporate.
posted by batmonkey at 12:49 PM on August 9, 2010

I may have nearly a full week for development "disappearing"

My now three-and-a-half year old daughter was born two and a half weeks early. She had some jaundice, which is pretty normal. She also could use over a hundred words before her first birthday, recently got accepted to a gifted kids program, and has started playing football, with the comment from the people who organise the local for-fun kiddies' league that she's part of a group of unusually good-for-her-age players.

She was a healthier baby than I was, for that matter.

A week early is nothing to worry about.
posted by rodgerd at 1:36 PM on August 9, 2010

Just to add to the breastfeeding anecdotes - Our first (now 6 yrs old) was an emergency C-section and happily breastfed until she was 2 -
posted by jalexei at 1:44 PM on August 9, 2010

"says the woman who didn't have any issues."

I know, and trust me, I have wicked survivor's guilt about it.

But none of my maternal female relatives have been able to, due to a genetic issue that I just got lucky on, so I have watched many women I love very much go through not being able to breastfeed. For some it was heartbreaking. For others, it wasn't. But really, truly, honestly, it is NOT the end of the world to use formula, and we SHOULD be thankful we live in a time where safe, healthy, nutritious formula is an option -- as a formula-fed baby myself, I know I'm certainly grateful. (And, if you'd like this ex-baby's considered opinion, I could not care less what my parents fed me when I was an infant. I'm mostly interested in the fact that they did so on a regular basis so I could grow up to be, you know, current me.)
posted by Eyebrows McGee at 1:54 PM on August 9, 2010 [3 favorites]

and, zizzle, that isn't meant to undermine what you went through -- I just wish, having watched people I love go through what you did, that we didn't put so much emotional weight on what is, for many women, a medical issue they have no say in. We treat it like it's a decision, to breastfeed or not, but so often it simply isn't, due to medical issues, or inflexible work demands, or whatever, and it sucks that we have created a culture where women have to feel BAD about feeding their babies!
posted by Eyebrows McGee at 1:58 PM on August 9, 2010 [9 favorites]

Here is a link to a study about C-sections for suspected macrosomia (big baby). Although you can only read the abstract there, the gist is that if your doctor suspects your baby is "large" and schedules a C-section for that alone, the outcome for you and baby is no better than if you had a trial of labor. So, yeah, a suspected 9 lb. baby alone is not a good reason for a C-section.

On the other hand vaginal delivery for breech babies does involve a slightly higher risk to the baby - but that's totally your call and it seems like you are already well-informed in that area.

In any case, there's a wide variety of times when babies tend to be born, and I know a lot of people in the natural birth community believe that labor happens when baby is ready, whether that's at 36 or 39 or 43 weeks. A recent study has seemed to show that the fetus' lungs release proteins to initiate labor when they are fully-formed and ready for the outside world. This could explain why elective C-section babies have higher rates of respiratory problems even if they are technically "fully cooked" in terms of gestation. So unless you are going severely past your due date, or there is some other problem, it seems to be in the baby's best interest to err on the side of waiting longer.

Also, even if you want to give baby time to turn and you postpone scheduling a C-section long enough that you actually go into labor while the baby is still breech, you'll almost certainly have plenty of time to get into surgery before that baby's actually on its way out. It's more convenient for your doctor if she has you in for a scheduled surgery, but this is about you and your child, not about your doctor's convenience.
posted by mandanza at 2:06 PM on August 9, 2010

the milk thing is really what I'm finding myself most worried about. really, really, really worried about it.

One thing I'd suggest on this score, if you have trouble initially, is that while you're making sure the baby is fed by using formula, you can also keep trying to breastfeed, if you'd like to. My sister found that her milk was later with c-section than with vaginal birth, but she used a supplemental nursing system to deliver formula so that her baby was both getting fed and stimulating milk production. The milk came in around day 5, and she had no problems from then on. Just noting that you don't have to just make the switch at some set point in time, but can keep options open while making sure the baby doesn't go hungry.
posted by palliser at 2:15 PM on August 9, 2010

hi there batmonkey, I truly appreciate your concerns.

Just wanted to point out that the study you linked to on iVillage is regarding babies born from 34-37 weeks. Even if 40 weeks was 8/30, that means 8/20 is still beyond 38 weeks, so not very close to the time period cited in that article. I hope that helps reassure you!
posted by treehorn+bunny at 2:42 PM on August 9, 2010

Just for the sake of anyone else reading this thread, I'd like to point out that WIC does provide formula, and at least when I needed it, they weren't all that worried about what your income was-they just wanted to make sure your baby could eat. It's worth checking out, if someone can't or doesn't wish to breast feed (I got pregnant while nursing two different times, and baby number two weaned herself at three months as apparently the flavor changed. Hence, formula. And no, wasn't the end of the world, and she was as healthy as the other two who were totally breastfed.)
posted by St. Alia of the Bunnies at 3:28 PM on August 9, 2010

I'd like to point out that WIC does provide formula, and at least when I needed it, they weren't all that worried about what your income was-they just wanted to make sure your baby could eat.

That's state dependent.

In my state it is income based. Believe me. We looked into it.
posted by zizzle at 4:19 PM on August 9, 2010 [2 favorites]

Not to be a spoilsport, but formula availability isn't an answer to any question in here.
posted by batmonkey at 4:37 PM on August 9, 2010

I will relate my own story, which is similar in many ways to your situation. I am not advocating that you do what I did or do something differently.

My one and only child, conceived and delivered at age 44, (like you, without any assistance or intervention!) was also breech and was estimated to weight 8+ lbs. My OB recommended a scheduled C-section right on my due date. I was inclined to agree with her but for the sake of being thorough, I asked around a little bit. I got opinions from another doctor in the practice, from a family member who is a doctor, and from a close friend who is a doctor.

The vote was unanimous: Have the scheduled C-section. Do not attempt the version, (manipulation to encourage the baby to turn). Do not attempt to give birth vaginally. Everyone said: This is your one and only baby. Do what you can to ensure the safest possible birth. For me that meant going with the scheduled C. I couldn't have cared less about "the birth experience". I only cared about having a healthy baby.

I am telling you, the surgery and the recovery were so easy. I used prescription painkillers the day of surgery and after that I used Advil. I was walking around the next day, without too much difficulty. It just wasn't that big an ordeal at all. My son was nearly 10 lbs so it's certainly possible, maybe likely, that I'd have had a C-section even if he hadn't been breech. Breastfeeding was a little rocky at first (as it is for many women no matter how their babies emerge into this world) but we both got the hang of it and we kept at it for a year.

My son has some significant medical issues completely unrelated to his birth and I have to tell you, I'm glad I did what I did, because now I don't look back and think, "what if I'd done what was recommended, would things be different now?"

That's just my story and I'd be happy to share any more information with you via memail. I wish you and your baby all the best.
posted by Kangaroo at 5:06 PM on August 9, 2010 [2 favorites]

As far as the baby being breech: my first was transverse at... I forget how far along, but at term. He was turned right way around in a procedure called an external version. It was done in the hospital with everyone standing by ready to do an emergency c-section, but it went fine, I was sent home, and he was born vaginally a few weeks later (at almost 42 weeks). It's worth asking your doctor about it.
posted by The corpse in the library at 2:36 PM on August 10, 2010

I say push back.

I had a c-section with my first (because they induced labor and my uterus refused to cooperate under surveillance) which mean that they were going to push for a scheduled c-section with the second. Met an OB I liked, said the practice was fine with trying VBAC/twins. Said that for 7.5 months until suddenly I had an appointment with someone else in the practice who strong-armed me into scheduling the c-section at 37.5 weeks (plus I was tired of being pregnant and wanted to meet my kids already!). But I wished I'd pushed back within days -- nursing a 37.5 week baby ("full-term" for twins) is not as easy as nursing a 40 weeks baby. Ultrasound said they were both over 7 lbs -- they were both under 6lbs. And I was so desperate to nurse them that I fought to move my toes through the whole hour of recovery -- the nurses said they'd never seen anyone recover so quickly.

So, yeah -- 3 babies via 2 c-sections, nursed #1 for 14 mos, nursed #2 & 3 for 36 mos. One thing that helped me 'succeed' with breastfeeding was to just keep doing it -- I counted the wet & poopy diapers and so knew they were getting enough, and jammed a boob in their mouth whenever they made a noise for the first 3-4 months (about every 2-3 hours). With the first, it got 'easy' around 3 weeks, with the twins it happened closer to 5 weeks. Just before it gets easy there's a pain that happens during let-down -- it's normal, it makes you want to kick something when it happens, but it goes away.

Hope that helps --
posted by MeiraV at 4:56 PM on August 11, 2010

I appreciate so much all of the information everyone has provided. I still have a couple of days before I get the answer to my most essential question ("whither 8/30?"), so this is all tucked away into an over-full head ready to meet with the doctor.

After that appointment, I'll update & mark some best answers - since more input would be good, I'd like to keep this is as open-ended as possible for as long as I can.

The reassurance about breastfeeding has helped a lot. I was so worried that the lack of proper physical cues could render it impossible...I hear so much about people who just "couldn't", and it seems so common that it worried me. Everyone apparently has their own feelings on breastfeeding (circumcision, cat declawing, etc.), so I'm glad the brief back-and-forth on that remained fairly low-key. BTW: WIC really is generally income-based, and not only will they help those who want to do formula, they have an amazing program for those who would like to breastfeed - lactation consultants, leads on inexpensive (or even free) breast pumps for those who have to go back to work, and all kinds of terrific resources.

I know the link I provided earlier mentioned weeks earlier than where I'll be during the proposed procedure. It was mostly offered as a reference point for the couple of folks who seemed into that topic and the one person who brought up a date range encompassed by the article's subject. This article, however, adds new information regarding the prevalence of ASD/SEN for babies born prior to 40 weeks, so that's another concern I'll be putting forth. Not because I want to go into labour with a breech baby (nononono), but because I want to make absolutely certain we're doing the right thing for this human being's beginning and their life to follow.
posted by batmonkey at 11:07 PM on August 11, 2010

Results are in: looks like a C-section next Friday, so at least the dreaded wait will be short.

Asked about the due dates, and the answer was firmly based on real science, so accepted that.

Not so easy to accept was that this particular hospital's c-section policies are kind of old-fashioned - no cord cutting, no holding baby right after. Doc encouraged me to go to the nursery this weekend and ask if any of that could be bent, and also said that even if I didn't do that, I should at least let them know this is a disappointment so maybe they can begin making allowances for those things that make sense for the future. Eh. I'm tired. I'm probably just going to go along with whatever happens and just be glad to take home a (hopefully) healthy baby.

On the interesting side, a comment here pointed out Mercury goes into retrograde on the surgery date. That's something.

Thanks again for all of the information. Very much appreciated and made the conversation today easier.
posted by batmonkey at 3:19 PM on August 13, 2010

Sorry to hear the hospital is so old-fashioned, do you have any other hospital options? I understand that probably would mean a different doctor, does your doctor have a colleague who delivers elsewhere? Definitely go to the nursery and ask them to consider bending the rules for you, the "no holding baby right after" is just ridiculous. Good luck, and as you say, if things end up going that way anyway, going home with a healthy baby is the goal, even if the journey to that is not what you had hoped and expected.

You could possibly consider calling the hospital and requesting they waive those policies for you, and threaten to go to a different hospital? Outrageous though it is to me, they are mainly interested in making money, and losing a customer might be a good reason to bend the rules for you.
posted by Joh at 10:29 PM on August 13, 2010

Oh, one other thing, does this hospital have Lactation Consultants on staff? They can help you immensely to get started. If they don't, then I strongly recommend booking a local IBCLC to come and visit you in the hospital and help out. Ideally the same day you give birth, but several hours after to give you time to recover and baby to finish up all the nursery shenanigans.
posted by Joh at 10:31 PM on August 13, 2010

They definitely have LCs right there who will come visit, and then I can also use a local resource center here after that if there are still issues. So that's all good, at least.

As to making requests...if we end up with time between cleaning & hustling this weekend, I may actually stop in. And I'll have another chance on Thursday when I do the pre-op meeting there. But I'll probably only ask if there's a way just to touch the baby before it goes away for all of the stuff they do in the nursery and let them know it's growing in important to other expectant & future moms so they might consider adjusting the policy at some point, if not for me.

For changing hospitals, it's just not possible...not in a way I'd be comfortable with, anyway. Insurance stuff would have to be re-routed, whole new decisions would need to be made, and we'd be further away from the hospital in a way that would be stressful. And so close to the due date...yeah, I think I'm going to have to just cope.

But that's a good note for anyone else following this thread in the future: if you're expecting and you haven't asked your doc yet about their feelings on C-section versus vaginal birth and how specific hospital policies might change for one over the other, do that ASAP. The sooner you know, the sooner you can figure out what means the most to you and come up with a way to solve any gaps.

And if you haven't picked an OB yet, make sure those questions are included in your initial consultations to make the decision. I didn't but should have.
posted by batmonkey at 11:52 PM on August 13, 2010