Breech

Credit to Dr Tan Ee Ping, Hosp Pantai Cheras. 

Breech - please don't hope for baby to turn.

I frequently received cases for ECV to turn the baby. But, they always come very late. Almost everyone will see me at 38 weeks or near to 38 weeks coz it's already time for czer. 

That's not the ideal time to do ECV. Why do we do ecv earlier?

The first step in ECV is to bring the baby's bump out of the pelvic bone before we can turn the baby.

So, if the bump is deeply engaged, it is almost impossible to perform an ECV. 

When will the bump engage? It engages from 36 onwards. Some babies engage earlier. Some babies engage later. 

Can we predict when the baby will engage? No we can't. So, if the baby is already deeply engaged, it's almost impossible for baby to turn on its own and also almost impossible for me to turn the baby.

Why do these mothers come so late? Because they are always hoping that the baby would turn on its own. Is that possible? Of course it's possible. But, we cannot predict which baby will turn on its own and which baby would never turn. Many will wait until they are told that there's no more hope and that they need a Caesarean section, i.e. at 38 weeks.

What is my schedule for breech?

32 weeks - if Breech, I will teach mother certain exercise to encourage the baby to turn.

34 weeks - if still breech, I will perform ECV. If successful, I send you back to your doctor. If fail, I will arrange for ECV at the hospital in one weeks time.

35 weeks - if first ECV failed and still persists as Breech, I will perform ECV with medicine to relax the uterus. This is done at the hospital. If still fail, I would attempt again at 36 weeks.

If all fails, then I would assess for possible of natural breech birth. And, then give mother option of czer or natural birth. If mother opt for czer, I will attempt another ECV before the czer.

On the day of czer, after giving anaesthesia, I will attempt another round of ECV. If successful, I will send mother home after the anaesthesia wears out. And, mother will await natural birth. If ECV fails, I proceed with the czer.

This is my step by step approach. 

So, if you have breech at 32 weeks, please make your early to see me.

Please don't wait until 38 weeks.

Some of you may ask, why do ecv so early, baby still got chance to turn. My answer is 'why not?' . Doing ecv early is easier and higher chance to be successful. And, less stressful for mother. 

If wait until past 36 weeks, it's more difficult to turn the baby, may need to use medicine and anaesthesia and high chance of failure and thus more stressful to mother coz it's near her dateline for Caesarean section.

So, please, please see me earlier. I can't help you if you don't come early.

Pengalaman aku pasal baby songsang ni, masa mengandungkan Auni @36w, kandungan breech. 36 minggu tau! Bukan 32w ke. Dah macam tak de harapan je dia nak pusing balik. Doctor bagi masa 1 minggu untuk baby pusing. Kalau tak pusing, @38w tu kene czer lor. 

Auni pusing jugak @37W tu. Macam miracle juge. Ikhtiar cara sendiri je tu. Aku banyak dan sujud lama serta doa la. Sebab doctor memang pesan jangan pergi urut. Bior baby pusing sendiri. Nasib la dia mau pusing.

Kehamilan baru ni, baby breech memula, lepas tu dia transverse pulok. Masa tu baru 28W. Sib baik masa scan 32w dah pusing balik sampai la ke masa bersalin. Fobia jugak aku bebenor nye.