UMM FULAAN: Assalaam alaykum doctor.
DOCTOR FULEEN: Waalykum salaam warahmatuLlaah, how are you doing?
UMM FULAAN: I’m good ma’am.
DOCTOR FULEEN: OK, great. Hmmm… I can see from your file that you had an ultrasound scan this morning.
UMM FULAAN: Yes doc. I missed the previous appointment, so I rescheduled it for today since I have an appointment with you too.
DOCTOR FULEEN: That’s okay. Your scan report says everything is fine. There’s no abnormality seen. Your baby is growing well Maa shaa Allaah, the placenta is well positioned, the amniotic fluid is optimal and it looks like you’re having a girl, right? Have you chosen a name yet?
UMM FULAAN: Yes AlhamduliLlaah, I really wanted a girl and I’ve already named her Zuhoor. But please, how is the the position of her head? Is it downwards?
DOCTOR FULEEN: No. Her head was up during this scan. Her buttocks are in the lower part of the womb while the feet are extended upwards. This is what we call FRANK BREECH PRESENTATION. But you don’t have to worry about it at this stage. You’re still 32 weeks gone. There is enough room for Zuhoor to somersault every now and then. Most babies who are breech will become cephalic (head down) by full term, and only about 3% will remain breech.
UMM FULAAN: So, when should I do another scan to check for the final presentation of the baby?
DR FULEEN: I’ll give you an appointment of 4 weeks. By then you will be 36 weeks. If Zuhoor is still breech at that time, then we have to choose from 3 options…
1. Planned breech delivery – As you may have learnt, breech delivery is more risky and difficult compared to cephalic. We have some criteria we usually consider. If you fulfill the criteria and you consent to this option, we would allow you to fall into labour spontaneously and deliver the baby as breech
2. External cephalic version (ECV) – This is a procedure whereby we maneuver your baby’s body from your tummy in an attempt to bring the head downward to the cephalic presentation in order to achieve normal vaginal delivery. This will be done anytime from the 37th week and there is a 50:50 chance of success with the procedure.
3. Planned cesarean section – If you don’t fulfill the criteria for a trial of breech delivery or the ECV fails, we will counsel you regarding cesarean section and obtain an informed consent to perform the operation around 39 weeks.
UMM FULAAN: SubhaanaLlaah! This is a lot of information to take in… So, you’re saying that we will make the final decision by 36weeks?
DR FULEEN: Yes, but it depends on the presentation at 37 weeks. If Zuhoor has turned on her own, then nothing more will be done. If she is still breech and you want to try ECV, we will give you an appointment by the time you’re 37 weeks. If you choose CS, we book you for CS. If you want to wait and let labour start before you come to us, it’s your choice.
UMM FULAAN: Do you think I qualify to deliver the baby as breech? What are the possible consequences if I choose to?
DR FULEEN: Well, you’re not a first time mom, that’s a plus. If Zuhoor doesn’t turn out big, that’s another plus. The type of breech also matters – there is a high chance of the umbilical cord coming down first when your water breaks and that could be dangerous. This commonly occurs when the feet are coming down first (as opposed to the buttocks).
Another potential complication is injury to you and/or the baby during the process of delivery. In assisted breech delivery, a lot of handling might be done on the baby, including the use of instruments to facilitate birth.
UMM FULAAN: Hmmm… That sounds scary. I think I should opt for CS then. Oh… How about the ECV, does it hurt?
DR FULEEN: No, it doesn’t hurt but you might feel a little uncomfortable. We will try as much as possible to keep you calm and we will stop the procedure anytime you change your mind. Other possible events may include a disturbance in the heart beat of your baby, thus we will keep monitoring the baby and prepare the theatre for CS immediately there’s a serious problem.
UMM FULAAN: Well, I pray that she somersaults back to cephalic (smiles). Or is there anything I can do to make her turn?
DR FULEEN: Actually, there are no proven methods to make the baby turn to cephalic. It’s mostly a matter of chance. Some people may tell you to do squats, go on all fours, or try acupuncture, moxibustion and other techniques, but these are not really effective.
UMM FULAAN: OK doctor, thanks so much.
DR FULEEN: You’re welcome. Kindly lie down on the couch and let me examine you…