August 15, 2012
My Baby is Still Breech and I’m 37 Weeks. Help!
You’re 37 weeks pregnant with your first baby and your doctor or midwife tells you more than likely the baby is not going to turn. What should be done?
This is a dilemma that pregnant women face on a daily basis. Up until 36 weeks, the position of the baby can vary from feet first (breech), buttocks first (frank breech), head first (cephalic) or transverse lie (the baby is lying in a horizontal position). However, after 36 weeks, the position of the baby normally doesn’t change because there is not enough room for the maneuver.
This becomes a significant challenge for first-time moms who have what we call, an “untried pelvis” meaning there’s never been a birth so it’s not certain whether the pelvis could accommodate a breech presentation. Delivering a breech baby takes a tremendous amount of skill because the baby’s head is the last part of the delivery and could theoretically get “stuck,” something we want to avoid. This is why most first-time pregnant moms have c-sections if their baby is in a breech position.
Some physicians will attempt to do an external cephalic version, commonly known as an “external version” if they think they can manually turn the baby from a breech to a head down position. This is usually done by an obstetrician or family practice physician in rare instances. The procedure is successful in 65% of cases but here are a few things one should be aware of in order to make an informed decision.
- An ultrasound should be done prior to the procedure to make sure they are no fetal anomalies
- There should be enough fluid around the baby but not over 20 centimeters
- The baby should weigh at least 4.5 pounds but not more than 8.5 pounds
- The baby should be in a “back up” position, meaning it’s back is facing the front of the abdomen
- RhoGham should be given if the patient is Rh negative
- The procedure should be done in a hospital in the event of complications
- The procedures should be done preferably by a high-risk specialist (maternal fetal medicine specialist) or someone who has done at least 30 procedures hopefully with a success rate
- The baby should not be in a footling breech position because the umbilical cord could become injured during the procedure
- No more than 3 attempts should be made
- The procedure should be done under ultrasound guidance
- Terbutaline is usually given to relax the uterine muscles before the procedures starts
- The baby should be monitored for 30 minutes after the procedure is finished
Should your provider suggest an external version, you now have the facts. If the procedure is not successful, do not worry. Better safe than sorry. A c-section does not mean failure. It means all options were taken and it is the safest way to have a healthy baby.
October 28, 2009
Pregnancy and Insurance Discrimination: Turn Up the Volume
Do Insurers Discriminate Against Women?
The ABC story, Pregnancy and Discrimination, was repulsive. A previous cesarean section is now considered a pre-existing condition that prevents women from receiving insurance. Women must pay higher premiums or have a mandatory sterilization if they choose to be insured. No, you didn’t misread the statement. The Golden Rule Insurance Company had the temerity to become “Big Brother.” What a blasphemous name.
Contrary to misinformation and propaganda, there are very few cesarean sections that are done based on maternal request. Most are done because of fetal distress when the baby is not receiving adequate oxygen and faces the possibility of death. Once an emergency is detected, the physician has thirty precious minutes to perform the procedure in order to save the baby’s life.
Do you recall the miraculous landing of US Air Flight 1549 on the Hudson River in New York City? We commended Captain “Sulley” for his heroic feat without hesitation. However, would his passengers now have a “pre-existing condition” because they were involved in an airline emergency? Of course not. Why so for women? Why are women charged up to 48 percent more for insurance than men?
According to ABC, there are only eleven states that prohibit health insurers from gender discrimination regarding the cost of premiums. The remaining thirty-nine states are fair game for continued exploitation. Healthcare reform is not a lofty ideal with a partisan agenda. The future of our humanity lies within sacred wombs.
After the ABC interview and article became public, The Golden Rule Insurance Company changed their ruling and will now insure women with previous cesarean sections.
Thank you, Senators John Kerry and Barbara Miluski for not only bring this issue to the forefront but for introducing legislature to bring these egregious practices to a screeching halt. Let’s keep beating the drums and greasing the wheels. Sometimes when the volume is turned up high, people eventually listen.
September 2, 2009
Invoking the Miraculous: A Case for the Public Health Option
If JT had private insurance and not Florida Medicaid, her baby would probably be dead.
JT’s pregnancy was miraculous, considering she had conceived with only one fallopian tube and ovary and she had no prior children. Things went well until her 27th week when she developed vaginal spotting. She went to a local hospital and was discharged home with a clean bill of health although they never ordered an ultrasound.
Bleeding during pregnancy is not a normal phenomenon. When I saw JT three days later during a routine prenatal visit, I ordered an ultrasound although the bleeding had stopped. A few hours later, the radiologist emergently reported that the placenta completely covered the opening to her womb and the baby’s umbilical cord was wrapped tightly around its neck three times. JT had a complete placenta previa and someone at the local hospital had regretfully missed the diagnosis.
I discussed JT’s case with a high-risk obstetrician and we both agreed that she should be admitted to the specialty hospital if only for observation. Thankfully, JT had state-sponsored Medicaid insurance because a commercial insurer would have made us jump through hoops. They would have required pre-authorization, endless forms and an inappropriate premature discharge home where she would have subsequently returned to the hospital with a dead baby.
What was supposed to be a 24-hour admission turned into a sixty-four day hospital stay because JT bled on a weekly basis. The cord remained around the baby’s neck and the prognosis was guarded regarding successfully carrying the baby until it was full term.
At 35 weeks, JT had an amniocentesis to make certain that her baby’s lungs were mature. She was subsequently delivered by cesarean section with the umbilical cord STILL wrapped around her baby’s neck. Because of skill, compassion and medical expertise, both mother and baby are just fine.
Marie Curie once said, “Nothing in life is to be feared. It is only to be understood.”
Please do not let fear cloud your judgment. Support the public health option, America. We need these miracles to continue.
