Four ECV’S and a Breech Baby

The weeks progressed and the news sank in a little. Some days I would feel hopeful and happy. Others I would be full of fear for what was to come. I soon found that working nights in the private members’ club that I managed was getting too much. The loud music, the drunk people and the 4 am finishes left me exhausted. I spoke to HR and started maternity leave early. I was going to miss my job and my friends there but my body couldn’t do the late nights and my mind was elsewhere. So, in late November 2019 I finished work.

I started nesting at home and getting things ready for Zach’s arrival. I wanted to be prepared as well in case Zach was going to come early. So, by Christmas time I had our hospital suitcase packed, the nursery ready and the car seat installed. I had pretty much everything we would need all sorted. I loved standing in his nursery and looking around. I would sit in his nursing chair and imagine what it would be like to be sat there feeding him. I started to find that I needed something to do. To take my mind off things a little bit. So, I got my sewing machine out and made gift bags for my family’s Christmas presents! After Christmas I got into the routine of seeing the midwifes on a bi-weekly basis for regular measuring check-ups.

The local midwifes would measure my bump each week and check Zach’s position. He was in the ‘Breech’ position for the entire pregnancy. Which isn’t a problem, until you get towards the end. At this stage its ideal to have a baby positioned facing down, with their head in the pelvis.

Zach decided that he wanted to stay where he was, with his head sitting under my right rib-cage and his bum sat above my left hip. He was laying diagonally across in utero. This is fine for the pregnancy bit, but not so great for the birth bit. So, I was given the option to have an ECV to try and turn him around. I desperately wanted an all-natural birth. I had been practising my hypnobirthing techniques daily and wanted to use them. With Zach in breech this pushed my ideal labour and birth further away from us. 

What the heck is an ECV? Is short terms two people push your baby around to try and get the head to face down and into the pelvis. It is exactly as it sounds. Brutal. ECV stands for External Cephalic Version. External being from the outside, cephalic being the head and version being turning. So turning the head from the outside as a rough explanation. Here is why they do it and the risks involved.

As Zach is a Cardiac baby, we had to have the go-ahead from his doctors at the Evelina hospital. This also meant having the procedure done at the Evelina/St Thomas’. So, Myself and Emmanuel did the drive into central London the day of the ECV. It had to be done at the Evelina as there is a risk of inducing labour. We needed Zach to be born where his doctors and surgeons were and not need to be shipped across London in an ambulance from our local hospital.

What they actually do in an ECV

They put heart monitors on my belly to listens to Zach’s heart. They monitored Zach’s heart for 30 minutes. He always started moving around when the monitors were on me. I imagined him trying to kick them away from him. The doctor explained that they are really loud for the babies inside. It must be quite a shock, like having your house suddenly start playing loud, bass-filled music. After some time watching the heart monitors they gave me an injection of salbutamol, which works to dilate the blood vessels. This helps to reduce contractions and relax the muscles that are supporting the baby. Salbutamol makes your heart race and your hands shake. It is very unpleasant but thankfully its effects do not last for long. The midwife described it as being flustered. I would say it’s like being high (on life of course) but without the fun bit, just the shaking.

Next my blood pressure and oxygen levels were measured periodically whilst Zach’s heart rate was still being monitored. The midwife and doctor left us alone for a while to let the drugs kick in and the monitoring to continue.

When they came back they checked in with me to see if the salbutamol had taken effect yet. It most certainly had. I felt like I was running whilst laying on a bed. My breath was short and fast and my body was shaking as if I had just squatted 90kg fifty times over. I knew I needed to stay as calm as possible during the procedure so that they had the best chance at moving him. Emmanuel held my elbow (my hand was behind my head) and I started to take long deep breaths. I found a spot on the ceiling to focus on and tried not to think too hard about anything at all. Which is much easier said than done when you have salbutamol and adrenaline rushing through your body. 

The first thing they did was to disengage Zach’s buttocks from sitting in my pelvis, which means they press really hard to try and lift him upwards. They then pushed Zach’s bum up towards my ribs. They paused and the other person moved his head down towards my hips. They did this step by step movement a few times.  This was all fairly bearable. The worst was the hand that was holding Zach’s bum. It was also pressing into me so hard that I felt like my intestines were being squashed down. It was like having a hard-blunt object held in place on a bruise. This was certainly not fun.

They managed to move the Zach some of the way round. Then he must have stuck out his little hands and pushed away or something because that was as far as he would go. He refused to tuck his head in. He refused to let his bum travel any further up. I was in agony from the pressure and they had to stop. The second they moved their hands away he swivelled right back to where he started.

I imagined Zach’s little face in there scrunching up in annoyance at all the disturbance. Kicking his legs out and doing everything he could to stay put. Then when he was back to his favourite position, I imagined him snuggling his head back into where he liked it best. His peace restored. I wanted to explain to him that he needed to help out and move around. But he was comfortable where he was.

It took me a few moments to recover from the first attempt. I soon wanted to try again. It was agony, but I was determined.

ECV take two

They looked on the ultrasound to confirm Zach’s position. He was back with his head under my right rib. This time the midwife and the doctor swapped roles. The midwife took Zach’s bum and the doctor his head. This time round was just as painful but I managed to breathe through it. Again, he got half way around and wouldn’t tuck his head in. They had to move him back to the original position. They can’t leave him half way. So back he went. That was it. The second attempt failed.  

The doctor and midwife advised me that now I needed to speak to my care team and we can go from there to make a decision on what to do for the birth. I knew there and then that it was either going to be a higher risk breech vaginal birth or a C-section that I was facing. I was devastated. We had just been through all of that for what felt like nothing.

Because Zach has a heart condition a breech birth adds more risk. I knew I would be advised against it. These are the statistics. 1 in 1000 babies come into problems in a normal straight forward vaginal birth. Its 2 in 1000 for breech. So the odds just doubled right there. Then with a cardiac baby they go way higher. A caesarean section is 0.5 in 1000. Clearly the odds are in favour of the caesarean section, but I really didn’t want to have major abdominal surgery and need to recovery myself just as my baby will be having his heart surgery himself. There is of course a small chance the baby will then turn by itself. The odds are 3 in 300. I was not happy leaving that hospital. I felt like I had failed somehow. I wanted so badly to be travelling across London back home thinking about my beautiful birth. But no such luck. Not today.

Back at home, laying on my sofa the day after I felt like I had run a marathon. My stomach felt bruised all over and it was painful to move. I was so determined to get him to turn that I spent the rest of that day upside down trying to encourage him to turn. He didn’t.  All I could do was continue to hang upside down and hope. I watched a lot of movies hanging off the edge of the sofa that week.

Risk of an ECV

Just in case you are being offered one here is what they told me about the risks.

Less than 3% of women have an ECV and it causes their waters to break or for the baby to go into distress. If this happens it means you would need to have the baby pretty soon. Possibly via a C-section there and then, or at least within 24 hours.  There is a slight chance that it causes the placenta to come away and cause bleeding. Or it can cause labour to start. The midwife and the doctor where I had mine done at St Thomas hospital in London explained that for them, one woman last year and one five years before that had to have a C-section due to waters breaking at the ECV. That’s it. It is very low odds, but just in case be ready and have you hospital bag with you. That’s what we did. Take some paracetamol for the soreness afterwards and you will be ready for anything. I personally didn’t take any painkillers, preferring to just soldier it out.

It has a 50/50 success rate, some hospitals are slightly lower at a 40% success rate which is the national average. It’s worth trying it if you want to have a natural birth. It’s worth practising those deep breathing and relaxation techniques as well. Be prepared for it to hurt because it does. But so do a lot of things in life. Like labour.

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