When I found out I was pregnant with baby number 4, I had a gut feeling she was going to be a little different from my past babies when it came time for birth. For background, all three of my previous babies went into labor at 39 weeks and were born at exactly 39 weeks and 1 day. All had fairly similar pregnancies and labors, each progressing quicker than the last. So, I felt like I was due to have a pregnancy or labor that somehow looked a little different. But having a breech baby wasn’t exactly on my bingo card.
Throughout this process, I found a lot of help in reading other women’s stories about breech babies and listening to birth stories involving breech deliveries. I wanted to share my experience in hopes of helping others. While baby girl isn’t born yet, and we still have no idea how she’ll join the world, I wanted to take a minute to share the experience of having a breech baby and opting for an ECV, which was successful. And, when she is here, I’ll get to that story, too.
What’s a Breech Baby?
Having a breech baby simply means their head is up and feet are down. Typically, somewhere between 28 and 34 weeks, babies in the womb will find their way into a head-down position, which is the ideal way for a baby to be born.
Finding Out My Baby Was Breech
I had a 34-week growth scan scheduled because I had COVID in my first trimester. I had a feeling from how she felt in my belly that she might be head up. Still, never having had a breech baby, I didn’t think much of it. I didn’t know any of the risks or implications that having a breech baby meant at the time.
I arrived at my growth scan. They did the usual stuff, and the tech informed me she was breech. Again, at the time I didn’t know exactly the implications this meant. At the appointment with my midwife afterward, she explained that at my 36-week appointment, they’d “check again.” If she was still breech, they’d discuss scheduling “a version.” I left that appointment not knowing what any of that meant.
Getting Informed
The first thing I did was learn about breech babies. The experience of having 4 babies in 6 years (plus two added years of infertility before that) has taught me that the best thing you can do when it comes to your fertility and pregnancies is to become informed. Most doctors will only give you so much information, and you need to know the right questions to ask.
There are so many things that can happen in trying to get pregnant, being pregnant, going into labor, and delivering a baby. And all these “things” usually come with choices you need to make. The more informed you can be, the better equipped you are to make the right choices for you. Even the best OBs don’t always do a fantastic job explaining all the options. And some OBs will have their own preferences. By being informed, you can ask the right questions at appointments, advocate for yourself, and feel more empowered in your choices instead of feeling like you’re being pushed in one direction.
So, what did I learn? I learned that at 34 weeks, about 7-10% of babies are breech, and by full term, about 3-4% remain breech. I learned that you can deliver a baby in the breech position, but there are some risks (as there are with basically any kind of birth). Since about the 2000s, 90% of breech babies are born via cesarean section. This large percentage of cesarean deliveries for breech babies has arisen due to concerns about the safety (for both baby and mom) of vaginal breech births. Vaginal breech deliveries can be safe in some instances and under the care of experienced practitioners. But many healthcare providers and hospitals prefer cesarean sections for breech births to minimize these potential risks. This means they aren’t really equipped or trained in how to deliver a breech baby properly. When a breech baby is born vaginally but treated like a normal head-down birth, the risks increase.
Once I was equipped with some information, I was able to make the choice that was right for me, and I decided I wasn’t comfortable delivering a breech baby. First, the hospital where I deliver recommends a c-section for a breech baby. I knew this meant they weren’t prepared to deliver a breech baby vaginally. I could look around for a practice and hospital that does. However, I also know I like my OB practice and the hospital where I deliver for many other reasons. It’s also the closest hospital to my home, and since I labor pretty quickly, trying to drive farther to a hospital that may accommodate a vaginal breech delivery opens up a whole new set of risks.
Trying to Get Baby to Flip on Her Own
Once I knew that a vaginal breech delivery wasn’t going to be my choice, the next thing to learn about was methods for getting my baby to flip. I have a labor doula for this pregnancy, so I contacted her for information and did my own research as well. There are a lot of ways people encourage their babies to flip. Like, a lot. And I don’t know that I need to bore you with every method available in this post, but I did try a lot of them. My thought process was that I would give it a good college try. I quickly learned you could easily spend hours a day doing things to make baby flip. But I’m a mom of 3 small kids and run a full-time business. I couldn’t burn myself out over it, either. I started doing yoga specifically for positioning the baby 4-5 times a week, I started seeing a chiropractor for pregnancy, I did Spinning Babies, The Miles Circuit, and even tried a few of the more “out there” methods, like putting a bag of frozen peas on the top of my belly and a heating pad at the bottom to encourage her to flip toward the warmth.
I also started listening to birth stories about breech babies. Listening to birth stories is, hands down, one of my favorite pregnancy and labor prep activities. I have learned so much from birth stories, and it’s nice to hear about the many, many, many outcomes that can occur. It makes me feel more prepared and knowledgeable. I listened to breech birth stories involving emergency c-sections, planned c-sections, babies that flipped on their own, babies that had successful ECVs, and babies that had unsuccessful ECVs (more about an ECV shortly). It helped me come to peace with the many ways my baby could be born and the different ways other moms navigated their breech baby situations.
Electing to Get an ECV
After about three weeks of trying many different methods, baby girl was still very comfortably head up. At my 36-week appointment, we discussed having an external cephalic version (ECV). An ECV is a medical procedure where a qualified healthcare provider manually tries to turn a breech or sideways-positioned baby into a head-down position from the outside, mainly by applying pressure to the mother’s abdomen. The success rate varies but is somewhere between 50-65%. I had taken a lot of time to learn about ECVs before the appointment to be prepared. I listened to every ECV birth story on The Birth Hour Podcast and the Evidence-Based Birth podcast on ECVs (I highly recommend Evidence-Based Birth as a resource for anything and everything you want to learn about in pregnancy).
Essentially, what I came to understand is that the ECV procedure can vary greatly. Some providers are a little more aggressive about the procedure than others. (I don’t know if aggressive is the right word; I just can’t think of another way to explain it.) Some providers will have you get an epidural before the procedure, and they will try harder and longer to flip the baby. While these might have a slightly higher success rate, they tend to be more painful and also have a slightly higher rate of fetal distress (which could mean an emergency c-section). Some providers might take a slightly softer approach. They don’t provide an epidural. They give it a good try, but they aren’t going to go over the top forcing the baby’s head down. Maybe a slightly lower success rate, but also a lower rate of fetal distress. I also learned that some providers will want to induce you if the ECV is successful to prevent your baby from flipping again. So, I knew a lot about the varying degrees of an ECV and arrived at my appointment with questions:
- What is your process for an ECV?
- What’s your success rate?
- What percentage of babies do you typically see go into fetal distress?
- If my ECV is successful, will you induce me?
After discussing with my OB, they informed me they are a little more on the soft side for ECVs. She said they would try, there would be pressure and some discomfort, but that they wouldn’t be overly forceful. She said they generally believe that if a baby is going to flip in an ECV, they will flip, and they don’t over-push it due to the risks. They also let me know that if my ECV was successful, they would not induce me. These were all the answers I was hoping for. After this discussion, I decided to try for an ECV, and one was scheduled for a week later.
But Wait…Why Does It Matter? Why Not Just Schedule a C-Section?
I want to be clear that I was and still am, totally fine with whatever way baby girl comes into this world. I’m not anti-cesarean delivery. I think sometimes people get a little defensive when I share that I tried so many things to get my baby’s head down in hopes of a vaginal delivery. In preparation for all of this, I listened to many positive c-section birth stories. And I was, and still am, at peace if that’s the way she’s born. But, I had also had three vaginal deliveries that went into labor spontaneously. Two of those were unmedicated births. I knew how much better I felt after an unmedicated birth versus a medicated one. I also know that recovery from a c-section is much harder on the body. I have three other small kids at home. The prospect of navigating that recovery time with not just a newborn that needed me, but also three other little kids, was a lot. So for me, since I had a history of successful, spontaneous vaginal births, I really felt like it was worth doing what I could in hopes of achieving that again. In addition, because I also labor quickly, I was worried about going into labor spontaneously while she was still breech, and then being faced with delivering her breech with people who maybe weren’t equipped for that.
Again, this is why I think being educated helps. It’s not that there is one right choice when it comes to having your baby. For some people, choosing to schedule a c-section could be the right choice. For others, a vaginal breech delivery might be the right choice.
The ECV Procedure
On the morning of the procedure, I did some yoga to stretch my body. I arrived at the Labor and Delivery unit at about 8 a.m. Because there is a small risk of fetal distress, the procedure is almost exclusively done in a hospital in case intervention is needed. I was checked in quickly and brought to a room.
I had heard a wide range of stories about people getting an ECV—from those who said it wasn’t too bad to those who said it was very painful. I wasn’t expecting it to be overly painful, considering my OBs had told me they weren’t overly assertive about it. But it was still in the back of my mind. I used many calming techniques I’ve practiced for unmedicated labor to prepare myself. I focused on being as calm as possible, deep breathing, etc.
They monitored the baby briefly, took vitals, and explained the procedure. I was given a medication that would prevent my uterus from contracting and help with the success of the procedure. I was told it might make my heart race or make me feel anxious. After the injection, they left and said they’d return shortly for the ECV. I just tried to focus on staying calm and breathing and even fell asleep for about 10 minutes. Luckily, I didn’t have any issues with the medicine making my heart race.
The doctor and two nurses arrived for the procedure. I knew the best thing I could do was remain as relaxed as possible, loosen my body, and just let them do their thing. I could hear them discussing their plans. The doctor took baby girl’s head, the nurse was on her bottom, and they attempted to roll her. The first attempt lasted maybe 30-45 seconds. It involved pressure and some discomfort, but I would not describe what I experienced as “painful” at all. It was completely tolerable. They stopped, and I heard them say she was sideways. The nurse mentioned my uterus was contracting a little, so they waited about a minute for it to loosen again before trying the second attempt. This attempt was a little longer, maybe a full minute or so. There was more pressure and discomfort this time, but again, not something I’d describe as intense pain. I focused on taking big, deep breaths, keeping my eyes closed, and my body as loose as possible. I could feel her moving in my body, which was a very bizarre experience. Having a 6+ pound baby in your belly fully flip is quite a sensation. After this attempt, I still wasn’t sure if she was all the way head down, but the doctor grabbed the ultrasound, did a quick check, and confirmed to everyone that she had flipped! I honestly couldn’t believe it. It seemed so quick and easy. I knew that ECVs were typically quick, but I was expecting 7-10 minutes, and I’d say my entire procedure was done in under 4 minutes.
It’s not that I was pessimistic going into it, but I just didn’t have super high hopes because I didn’t want to be disappointed. I also didn’t think it would be that fast and smooth, so I was almost shocked that it happened and was over already.
Now What?
Now, we just hope she stays head down. There’s always a chance a baby could flip again, but that is a low percentage. I’m trying to spend time on my yoga ball every day, doing some yoga, standing when I can, and being mindful of how I sit—all the things someone would do when trying to engage a baby’s head (but just a little extra aware about it, lol). The hope is that I can continue the course as is, ideally go into labor spontaneously like I did the last three times, and hopefully try for another unmedicated birth. But baby number 4 has already proven to be quite different than the last three…so we will just have to wait and see how it all pans out!
