Week 37: Breech Babies

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This is your Pea in the Podcast for week 37 of your pregnancy. I'm Bonnie Petrie joined by Dr. Laurie Swaim, an obstetrician with Houston Women's Care Associates in Houston, Texas.

This week you're officially full-term, but what does that mean? "That the vast majority of babies that are born at this gestation have mature lungs, that's basically what it means and that they've reached other maturity milestones, so things like their ability to eat, etc. But it's really the lung maturity that we're looking for." Now if your baby is still head up, bottom down in the breech position this week you have a decision to make, will your doctor try to turn the baby now or will you schedule a surgery? "We are no longer supposed to do elective breech vaginal delivery and so we're trying to avoid that. I have a discussion with the patient, assuming she hasn't had a prior cesarean or she doesn't have big fibroids, the baby is normal anatomically, she doesn't have placenta previa and all that kind of stuff. So the otherwise healthy pregnant woman who happens to have a breeched baby, she doesn't have a uterine anomaly or whatever, I give her the option of the external cephalic version or plan a cesarean, which we do at about 39 weeks. So if the external cephalic version we would do right about 37 weeks, the reason we do it at 37 weeks is because that's the time where the baby is less likely to turn around on its own again after I turn it, which has happened to me twice and I turned them both again. If the baby has significant fetal heart rate changes and requires emergency delivery at the time of version, it will be fine."

So what is an external cephalic version exactly? Well it's a procedure that involves your doctor using their hands to apply pressure manually pushing from the outside on the mother's abdomen to get the baby into the correct head down position for birth. Now why would a mom choose this? "If we turn the baby then she can avoid a cesarean and it works about 80% of the time, we can turn them. We're more than likely to be successful if she's had children before because their belly is a little more lax. So that's clearly the big benefit and the risk is that it won't work which isn't that big of the deal. The greatest risks are trauma to the uterus, there could be a risk of what we call abruptia of the placenta and fetal heart rate changes requiring an emergency cesarean. I suppose there have been probably some fetal deaths actually recorded in people who've been verted and gone home and maybe not had adequate monitoring or something that happened the next day. But all of those things I just mentioned are very rare, actually the baby's heart rate dropping right after we do it is not that uncommon, sometimes it does drop but it usually comes right back up. I've had to do one cesarean in my life for a version where the baby didn't like it at all and I've done many, many versions."

Now if you're willing to look hard you may be able to find an obstetrician in the United States who will deliver your breech baby vaginally, depending on the position. But they are few and far between. In Canada and Europe, breech deliveries are more common; in the U.S. midwives attending home births may be willing to deliver breech babies. Now the breech position that is most favorable to a vaginal delivery is Frank breech, that's when the hips are flexed and the knees are extended like a diver in the pike position. A complete breech is when your baby's hips are flexed and their knees are flexed too like they're doing a cannonball. A footling breech has one or both hips extended with their foot or feet aiming for the birth canal. But most breech moms in the U.S. are destined for the external cephalic version or C-section. Now as you approach your due date, you're seeing your doctor every week. The appointments are pretty routine, "It's not that different other than besides measuring the fundus, we do what is called Leopold's Maneuvers, check and make sure the baby is in the right position and we check swelling around the eyes and that kind of stuff. Just because we're not poking at the patients eyes doesn't mean we're not looking at her, so part of the physical examination is actually done while you're talking to people and sometimes we check the cervix and then we talk about reasons to call us anytime day or night and that's something I start telling people at about 36 weeks and reiterate every week until their delivery, make sure they know how to reach us, make sure they know what to call us for." At 37 weeks pregnant you'll want to call if you're having any vaginal bleeding or if you have a sudden release of fluid from the vagina now. You'll also want to call if you're having regular contractions from five to six minutes apart lasting more than 45 seconds each. And definitely call if you notice your baby has stopped moving or is moving much less than normal. Your doctor may have additional guidelines; make sure you find out what they are.

Dr. Swaim says she might be checking her patient's cervix at weekly appointments now. That's an internal examine that checks for dilation and effacement. "Dilation is when the cervix opens and effacement is when it thins. The thing is that neither of them actually means anything before labor and it's almost kind of amusing that we do check people's cervixes because it has no predictive value whatsoever. Women can walk around and be centimeters dilated for weeks or women can be closed and go into labor in two days. I guess part of the reason I do it is in the event that the patient is to develop a disorder that will require induction of labor, how induceable will she be." Because an induction of labor may not succeed if there isn't some dilation and effacement going on in there and that could mean your induction will end in a C-section. There's something called a Bishop's score that can help determine if an induction might be necessary or successful. The Bishop's score is figured out based on your baby's station or position in the pelvis. You'll hear your doctor say one station, two station, zero station; well we're talking about position in the pelvis. Also they'll look at dilation and effacement, your baby's position, meaning it is head down, and consistency, whether your cervix is firm or if it's soft. Points are added or taken away for various other reasons and if you have a favorable score based on these factors an induction may be warranted and successful. You can find out more information on Bishop Scores at peainthepodcast.com.

Now this week your baby is gaining weight like it's their job. Well it is their job actually; they're adding half an ounce of fat a day. You may feel like you're adding most of your new weight in your breasts, they're increasing in size and fullness as hormones prepare them for breastfeeding. They may feel heavy and tender and uncomfortable. A sturdy, well-fitting maternity or nursing bra will help you feel a bit more comfortable during these final weeks of pregnancy. Because you're now 37 weeks pregnant, you have three weeks to go until week 40.

That's your Pea in the Podcast for week 37 of your pregnancy. Dr. Swaim and I look forward to talking to you again next week. Enjoy this week. For a transcript of any of our Pea in the Podcasts go to our website peainthepodcast.com. For Pea in the Podcast, I'm Bonnie Petrie, thanks for listening.