37 Weeks: The Gameplan

Yesterday was our 37 weeks (and 4 days, to be exact) appointment.  It actually consisted of 3 separate meetings:

1) Perinatologist - partial ultrasound to measure my amniotic fluid & to discuss an external cephalic version (ECV).
2) Meternal Fetal Ward Billing Specialist - Are ECV's even covered by our insurance?  If not, how much out-of-pocket are we looking at?
3) OB - Layout a gameplan for baby's birth

What is an ECV?  It's a procedure where the doctor manually tries to turn the baby into the necessary head-down birthing position.  The doctor would push baby's head and rump from the outside of my tummy, in hopes of getting baby to naturally react and move along in the desired direction ... until he is finally upside down.

Easier said than done.  If successful, this is considered to be an outpatient procedure performed at the hospital (minimum charge for successful outpatient procedure at our hospital = $3,000 ... does not include physician's services).  Due to the risks, all parties involved (patient, doctor, and medical team) are prepped for surgery AKA emergency c-section. 

Major RISKS:

1. Baby's heart rate decreases (and does not go back up)
2. Water breaks (amniotic sac, specifically)
3. Ruptured placenta
4. Umbilical cord tightens around the baby (reference point #1)

... all of which would result in an emergency c-section to take the baby out.

Minor RISK:
Baby turns back to the breech position, resulting in a c-section birth.

PROS:
If the ECV is successful, then it means I would be able to have a vaginal delivery.  However, this also is not guaranteed.  We're talking about a baby who was in the 73rd percentile for weight as of a week ago...

CONS:

• Major discomfort for the mother
• EMERGENCY c-section (rather than a scheduled one)
• No guarantee that this procedure is covered by our health insurance (details on that in the next post), as it is considered to be elective.

WHY?
... is the baby breeched in this way?  Hard to say.  They did use the partial ultrasound evaluation to look for any genetic defects whch sometimes cause the baby to be breeched, but didn't find any (PHEW!).  Due to this, Dr. suspects that baby is breeched due to my uterus and pelvic bones.

ODDS (%):

• Only 3-4% of babies are born in the fully breeched position.
• 45-50%: success rate of an ECV for us. 

     The fact that baby is our first pregnancy is also factored into this, as the mother's stomach muscles are very tight.  The Perinatologist said that, were this to be our 3rd baby (for example), he could estimate the success rate to be quite a bit higher.
     Size of baby and mother are also factored in.  Back when baby was 2.5 pounds lighter, the Perinatologist had estimated our success rate for ECV to be up to 70%.

Are we noticing a common denominator here?  As you can see, the term c-section is mentioned in just about every factor here.

In the end, we decided not to try the ECV.  We opted to schedule a c-section.  No word yet as to when that will be, as our OB is trying to coordinate with the hospital's delivery operating room schedule.  Hopefully, they get back to us today with some options about when our baby's birth date will be!

** At our last appointment of the day with the OB, we told her our decision.  It was only after we revealed our final choice that she was more candid and told us she personally would not have recommended for us to try the ECV either.  But professionally, she had to let us choose on our own.  She had performed ECVs during her residency, and never "liked it."

We noticed that in the medical world, the term "like" is used very loosely -- often implying something much more dire (as in "if the heart rate decreases, baby doesn't 'like' it" -- WHAT??)

It's a hard decision to make, especially for first-time parents-to-be (we're humbled by this experience, have learned so much, and yet can't help but feel medically-unqualified to make such a big decision). 

We sought as much professional advice as was available to us, and avoided the internet + word-of-mouth "advice" as much as possible prior to making our decision.  The important thing was to go with the option that was safest for baby, first and foremost.