# I need advice re: breech baby, cord around neck and C-section



## transylvania_mom (Oct 8, 2006)

It's not about me, it's about my sister who is due to give birth at the beginning of October (we have the same due date







). Her OB just informed her that her baby has the cord around the neck and it might not be possible for him to turn for the birth, so she should be prepared for a possible c-section. Now she is 5 months along and although I don't have much experience it sounds to me that her OB has no way of knowing if the baby won't be able to turn at this point, and even if he doesn't turn she could just go ahead and have a vaginal birth. My sister is of course freaked out (although she doesn't admit it) and of the opinion that if the OB says so, she must actually know what she's talking about. Sis says she's getting a second opinion on this. I told her sometimes OBs schedule C-sections for their own convenience, but she's not willing to listen to me. She really believes her OB because:

- she works in a private hospital and sis says what the client wants, goes (including water births - my sister's preference - and elective c-sections)
- sis says her OB is supportive of natural birth. The OB tried to persuade my sis's friend to have a natural birth instead of an elective c-section. However, when the friend refused, OB performed the elective CS
- my sister has a high risk pregnancy, spotting on and off, kidney infections and UTIs, and she's on bed rest and medication since she got pregnant.

What would you say? I was very lucky with my first pregnancy and birth; besides horrible morning sickness, everything went smoothly and I had an unmedicated birth (thanks to my midwife). What her OB is saying doesn't make sense to me (but who am I to know better, right?) and at the same time I would hate to see my sister try a natural delivery and have something go wrong with the baby. I would really like to support her, but I don't know what would be in her best interest.

Thanks for reading this and if you have any advice, I would love to hear it.


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## Cheshire (Dec 14, 2004)

If she trusts her doctor (and sounds like she has reason to) and is concerned with a c-section maybe get a second and third opinion?

If the other doctors agree that the cord issue is a real threat then go with the c-section.


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## Jilian (Jun 16, 2003)

At FIVE months pregnant he is saying that a cord around the neck can prevent the baby from turning?! Is there more to the story? Because that is completely ridiculous! Approximately 30% of babies are born with the cord wrapped at least once around their neck - it is VERY common and usually does not cause an issue at all. It rarely ever prevents the baby from turning unless the cord is very short. Most babies are not head down at 5 mos along. I'm 27 weeks and my baby is breech. ALL of my babies are breech at this point and the last 2 turned without issue with plenty of time to spare. DS1 had a nuchal hand and DS2's cord was tangled a few times around his leg. No problems either time.

I'd be very leery of an OB who made those statements and also claimed to be natural childbirth friendly. BS!


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## Jilian (Jun 16, 2003)

I wanted to add that it sounds like this OB uses scare tactics and I'd be worried about him finding a reason to scare her into interventions during (or even before) labor. Some OBs just practice fear-based medicine and this sounds like one.


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## Sarahstw (Jun 18, 2006)

no, wait, I think I've heard this one before...
So, is the physician suggesting that her 22 week (or thereabouts) baby is not going to turn in any direction before her scheduled c/section? Not to the left or right (which could easily unravel the cord) nor downward (which will change the baby's position to head first). Interesting really, I wonder if that's ever happened before? Has anyone had a baby that *did not move* (except for arms and legs) for 18 weeks? Is she serious? Does this OB have a license of some variety that could be checked?


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## Robinna (Aug 11, 2003)

The first problem I can see with what the OB said, is that unless the cord is wrapped 3+ times there's no way to even KNOW this. Because an ultrasound can't see the back of the baby. So the cord could easily be seen, floating across the front of the baby's neck, but unless it's wrapped many times there actually is no way to know, because you don't know where it goes once it goes out of sight. (This info courtesy of a u/s tech who was responding to my MW's directive to "check for cord" on the u/s order.. according to this tech, there is no way to know about cord wrapping.)

That alone may be a simple enough and obvious enough observation to cause your sis to ask more questions.

Beyond that, unless we're missing information in what she relayed to you... it just doesn't make any sense at THIS point to be making pronouncements about baby's position and capacity to be born vaginally. I mean seriously. It's ludicrous to make predictions at this point.

What I *do* see is quite possibly an OB setting a mama up for a planned c/s. Because there is no other reason to start talking c/s in May for an October baby unless there are some seriously extenuating circumstances.


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## mwherbs (Oct 24, 2004)

ok so she needs to run away from this provider as fast as possible- this provider is just setting her up for a c-section-
right now how much does this baby"kick" mom? babies at this gestational age are floating all around and swimming from side to side- doing summersaults -- you name it-it is even hard to completely track them down to get heart tones because they move so easily --


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## mamatolevi (Apr 10, 2009)

Quote:


Originally Posted by *transylvania_mom* 
I...The OB tried to persuade my sis's friend to have a natural birth instead of an elective c-section. However, when the friend refused, OB performed the elective CS

That right there would tell me to RUN to another dr. Any dr that will blithely perform an elective c/s is irresponsible and not to be trusted. My old dr in Atlanta would tell his clients to find another dr if that was what they wanted; he just would not do them on request.


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## mwherbs (Oct 24, 2004)

here is a fairly recent article about position fetal position in pregnancy--I bolded a KEY part of this abstract!!! and there are older studies that say the same thing--

Obstet Gynecol. 2008 Apr;111(4):875-80.

Natural history of fetal position during pregnancy and risk of nonvertex
delivery.

Witkop CT, Zhang J, Sun W, Troendle J.

Department of General Preventive Medicine, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA. [email protected]

OBJECTIVE: To examine the natural history of fetal position throughout pregnancy and the likelihood for nonvertex delivery. METHODS: We examined fetal positions at 15-22 weeks, at 31-35 weeks, and at delivery using data from the Routine Antenatal Diagnostic Imaging with Ultrasound trial. Characteristics of women with nonvertex and vertex presentation at delivery were compared. Multivariable logistic regression analysis was performed to determine risk factors for nonvertex presentation at delivery, and odds ratios were calculated for those risk factors found to be statistically significantly associated with nonvertex presentation. RESULTS: Data for 7,045 women who underwent routine prenatal ultrasound examinations were analyzed. _*We found no association between nonvertex presentation at 15-22 and at 31-35 weeks of gestation. A nonvertex fetus at 35 weeks had a 45% chance of spontaneous version by delivery.*_ Multivariable logisticregression analysis found that multiparous women had half of the risk of nonvertex presentation as nulliparous women. Smoking during pregnancy (odds ratio[OR] 1.47, 95% confidence interval [CI] 1.10-1.96), low volume of amniotic fluid at 31-35 weeks (OR 3.74, 95% CI 1.85-7.53), and fundal position of the placenta at late ultrasound examination (OR 1.85, 95% CI 1.23-2.78) were all associated with significant increases in the risk of nonvertex position at delivery.CONCLUSION: Spontaneous version of a nonvertex fetus at 35 weeks of gestation is still likely.

PMID: 18378746 [PubMed - indexed for MEDLINE]


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## transylvania_mom (Oct 8, 2006)

thank you for answering. Yes, her ob says the cord is wrapped around the neck, she is 22 weeks along, and the ob says she *should* be mentally prepared just in case a natural delivery is not possible (baby can't turn). At this point ob is not suggesting a c-section yet.
I just wanted to see if other people see this as absurd as it sounded to me.
I just want to be supportive for my sister...


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## Jilian (Jun 16, 2003)

I can see an OB wanting a mom to be prepared for different birthing scenarios but to mention a cesarean for something as common as a cord being wrapped around the neck would worry me.


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## bluewatergirl (Jul 26, 2007)

It sounds like your sister has a good advocate & support person in you.








If she genuinely likes/wants to stay with this OB, maybe your sister can prepare a list of specific questions for the doctor to get a clearer picture of why she is making these recommendations? - And why at this point/so early?

Maybe the OB has had an experience with a cord issue in the past and is simply trying - albeit in what appears to be a confusing and blundering way - to give the patient all the information/possible scenarios.
(FWIW, my son's cord accident, which, according to a pathologist, may have played out over the course of as much as a week, might have been averted if my doctor and I had made different recommendations and choices in the last week or two of my pregnancy. I know the death of my son hit him hard also, and that it was a learning experience for him, too.)


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## JessicaS (Nov 18, 2001)

I am surprised her OB says he can see the cord that well.

I had a cord issue with my first pregnancy and I did inquire about cords and U/S quite a lot. Many people told me they couldn't tell that much about cords on U/S so I am curious.


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## mumstheway (Mar 5, 2009)

Quote:


Originally Posted by *transylvania_mom* 
thank you for answering. Yes, her ob says the cord is wrapped around the neck, she is 22 weeks along, and the ob says she *should* be mentally prepared just in case a natural delivery is not possible (baby can't turn). At this point ob is not suggesting a c-section yet.
I just wanted to see if other people see this as absurd as it sounded to me.
I just want to be supportive for my sister...

That is crazy! At 22 weeks! Wow. I had one with a cord wrapped around three times with no issues even at term.

The OB sounds like he's completely reaching...fear mongering? Though when you're pregnant of course anything negative you hear from your healthcare provider is going to freak you out.

During one of my pregnancies I had some bleeding in the first trimester. They found that my cervix was covered by the placenta (placenta previa). However this was at 11 weeks. But, they told me that it was a very serious condition, and that I should be prepared for the possibility of a cesarean. Which to me, at the time expecting to have a big family was a large blow.

And, I come home upset, only to discover with my own research that something like 40% of placentas cover at least part of the cervix in the first trimester!

So, why cause me to be upset or think worst case scenario? Why couldn't they have just said that there was a 96% chance it wouldn't be a factor. Yes, the main reason why I transferred care was because of this sort of stuff.

And, these were 'natural birth' friendly doctors too. What I've learned is that some will claim to be natural birth friendly as long as you progress quicker than expected and don't need any interventions. So, if you're a precipitous birther you're fine, but if your water breaks, or you have a slow active stage then get ready for intervention!!! An OB can say that they're natural birth friendly, however their stats really are the only thing that prove their stance. How many births to they augment or induce, what is their cesarean rate, episiotomy rate? And natural birth can mean different things. Most OBs consider natural birth to equal vaginal birth these days it seems.


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## hapersmion (Jan 5, 2007)

My OB said they could hardly even see cords when he did my ultrasound with my breech son. I was wondering if he could find a reason, but he said cords are just too hard to see. *shrug*

It's utterly silly to make any predictions about birth presentation at 5 months. I wouldn't worry about it until 36 weeks, personally, 34 at the earliest.

I had my son breech, naturally, and it was great.







Cords around the neck are also extremely common. Even if your sister was 40 weeks, I would see no reason here for a c-section.


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## kltroy (Sep 30, 2006)

As others have said, this is silly. Cords around necks are so common it's not even funny. My VBAC daughter had her cord around her neck, between her legs, and over her shoulder. Unless the cord is extremely tight it's not an issue, and that is rare. Also as OPs have said, a baby's position at 20 weeks has nothing to do with its term position. Your sister can start thinking about baby positioning around 30 weeks, at which point it should be moving towards or in a vertex position.


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