I’m really excited – I will be attending a great friend’s birth soon. Â It will be my first in about 1.5 yrs!!! Â Hard to believe I have been out of the doula scene for that long, and I won’t really be taking on “clients” until early 2014, but I’m attending births of close friends with the understanding that I will be there if I can, but I have 4 kids & life is a bit unpredictable right now!
SO – my friend is going for an ultrasound. Â She is in her 3rd trimester, and her midwife wants to double check the baby’s position before she goes into labour – to make sure baby isn’t breech. Â As I’m writing this, I’m thinking ‘what if baby is breech? We all know what will happen then – she will be sent for an OB consult, then likely scheduled for an ECV, hopefully that would be successful, and then a plan would be formed based on the result.
Now – it is the care providers job to ensure mom & baby are healthy. Â This means checking for any abnormalities of any kind along the way. Â For many people this can be re-assuring, and for many it can be stressful. Â I have a bit of an issue with late pregnancy ultrasounds myself…let me explain.
My philosophy around birth is to trust – put faith in you and your baby (in addition to educating yourself and gathering an excellent support team of course), go in with a deep trust, and question whether things are going smoothly ONLY if there is something indicating that.
My concern with my friend going for a 3rd trimester ultrasound is the range of things the ultrasound might uncover that could unnecessarily freak a mama out! Â They are going for a position check, but generally at an ultrasound – since you’re there – they will check the baby’s size, and amniotic fluid level etc. etc. while they are at it. Â As a friend, doula, and midwifery administrative assistant I have seen many many women get stressed & freaked out by discoveries on ultrasounds that, in the end, are completely benign. Â Now, I have also seen a handful of women have fore warning about complications prior to delivering from ultrasound results – and this is undoubtedly very valuable for many.
This friend of mine has already had a great detailed ultrasound (the standard one done at around 20 weeks, generally abnormalities in baby’s development would show up at this ultrasound) it revealed everything appears normal, her blood pressure is beautiful, her gestational diabetes screen came back negative, all her lab work & measurements are looking good.
So – if all is well and the only thing we are unsure of is if baby is in fact head down – would you want an ultrasound?
There have been cases of babies turning from breech in the last days / weeks of pregnancy, AND there have been many healthy babies born in a breech position, there have also been many healthy women go into labour, discover their baby is breech while in labour, and then having a caesarean delivery at the time their baby and their body have chosen for delivery!
Here is my beef with this 3rd trimester position check ultrasound:
- they may comment that her baby is looking big
- they may comment that her amniotic fluid is looking too low
- they may discover that the baby is not in an ideal position
The problem I have with any of these discoveries / comments is this: Â all of these observations will create worry and stress in an otherwise healthy & confident pregnant woman. Â Again this comes back to my beliefs about birth.
Baby too big? Â Maybe if you were not exercising and eating ice cream every day I would consider that to be a cause for concern. Â But if you are taking good care of your body, exercising and eating well – I BELIEVE YOUR BODY WILL GROW THE PERFECT SIZED BABY FOR YOU TO BIRTH. Â I was lucky enough to support a mother through an un-medicated, vaginal delivery of an 11 lb baby boy! Â Had anybody (including the mother) known just how big her baby boy was going to be, I don’t know if she would have laboured and delivered him as beautifully as she did. Â I believe our mental state in labour has a huge impact on the way our labour progresses. Â If she’d been thinking ‘this boy is so big, how will I push him out?’ she may have held back in opening to the birth experience. Â Instead she virtually danced around the room singing “I can do this! I feel good!” and she pushed out her baby with tremendous strength & positivity. Â What if her care provider or the hospital staff had known his size in advance? Â Might they have pushed for her to get an epidural “just in case”? potentially causing a cascade of medical interventions? Â This is why I get my back up about “baby too big” comments. Â Yes – sometimes an assisted delivery or a caesarean delivery become necessary – this can occur for any number of reasons, but pondering the size of the baby is not going to impact a labour in any positive way. Â In our society where women have been fed so much misinformation or are lacking information about childbirth – such a comment or observation can be VERY detrimental to her mental state & her birthing energy. Â Take care of your health & your body and you will grow a baby just right for you!
Amniotic fluid too low?Â This is something that can often be observed when a care provider is feeling your belly….if amniotic fluid is very low, babies limbs feel a little too poky and…exposed. Â Amniotic fluid levels ARE important, but I know first hand that the measurements of the fluid pockets on an ultrasound can be incredibly inaccurate causing much unnecessary stress. Â This is certainly something a mama would have to educate herself about before making any decision, but after seeing many inaccuracies in amniotic fluid measurements (made evident by drastically different results a couple of days later, and then again days later) I reached a personal decision to decline any of these measurements in my own pregnancies.
Discovering baby in a position that is not ideal for delivery? Â Now – while knowing baby’s position late in pregnancy CAN be helpful, I prefer to encourage women toÂ focus on optimal fetal positioning regardless of current position. Â Encourage baby to get, and or stay in an ideal position. Â Having said that – I do also see the value in knowing if a baby is breech so that you can use moxibustion or other natural approaches, followed by an ECV if you wish to try and turn your baby… I know some people that hold the belief one should not try to alter the baby’s position so forcefully. Â Of course as always I recommend the spinning babies website. Â Prior to an ECV I suggest using moxibustion, use homeopathics, use a rebozo, do inversions, go for acupuncture, go for chiro – do whatever you feel best suits you to encourage your little one to turn. Â But what if baby doesn’t turn? Â You would likely be sent for a consult with an OB – some doctors at some hospitals are comfortable with breech deliveries, but it has become somewhat of a lost art, and many are not. Â This would lead to a conversation about caesarean delivery and generally – the physician prefers to schedule this. Â I hold a strong belief that babies emerge when they are ready. Â Unless there is a medical indication (such as hypertension, or a distressed baby with an abnormal heart rate) to schedule a birth (vaginal or caesarean), I am of the belief that a breech presentation should still wait for a mama to begin her birthing time NATURALLY. Â This is where I think that if the hospital you are working with is very uncomfortable with the possibility of a vaginal breech delivery you may be better off left uncertain of your baby’s position. Â Even if the hospital you are attending does not support vaginal breech deliveries, you can at least let your baby and body decide when it’s time for baby to come, and go in when labour has begun – baby may have surprised you with a somersault, or a quick delivery, or you may go in for your caesarean knowing that your baby has chosen his or her time to be welcomed earth side. Â And if the hospital you are attending DOES support vaginal breech deliveries – all the better!
Here’s what I propose as a solution if you are faced with a similar situation:
- find out your hospital’s policies for breech deliveries
- find out your care provider’s course of action if your baby is breech (ie induction / scheduled caesarean / continue as before & allow labour to begin & progress naturally)
- look inside yourself & decide what your preferences are – around how labour begins & how delivery progresses
- from there you can a) decline the ultrasound b) specifically request that your care provider write on the ultrasound requisition for a position check only, without measurements of baby etc.
- know that although things aren’t always presented as a choice – you DO have choices
- unless you or your baby is at immediate risk, I strongly recommend leaving appointments without a plan of action set out -go away & research whatever you are presented with, think about it, and talk over the various possible scenarios with your care provider
Thanks for reading – I welcome you to share your story, comment or leave feedback Â about this post