Can they force a c/s for breech?

[dogretro]

My daughter was a scheduled c/s for breech presentation. We tried everything, including a version, to turn her and she just wouldnt. The u/s showed that her legs were crossed. I was under the care of wonderful midwives and a scheduled c/s for breech was procedure. I did not question it b/c I was afraid that dd's hips would get injured or something during birth. I had a perfect c/s ~ never went into labor, delivery was perfect, healing was perfect. However, having a c/s has affected my future birth choices. According to the law, I cannot birth at our local birth center, so I am under the care of wonderful midwives at a local hospital. Since it has been over a year since dd was born, and I am going for a vbac, I have had a lot of time to think about dd's birth.

I do not feel traumatized by dd's birth. As I said, it went perfectly and we had no trouble bonding or nursing. BUT, I have been wondering, if I had refused the scheduled c/s and went to the hospital in labor, could they have refused me a vaginal breech birth? I am mainly wondering b/c I plan on this being my last biological child and I want the vaginal birth experience. I do not want to ask any of my midwives yet b/c I do not want to raise their suspicions this early on. If this baby is breech, too, I will be pushing (haha) for a vaginal birth. I'll pretty much be demanding it, actually. I know it's way too early to be thinking about this, but b/c of dd's birth, I am. So, can they really force you to have a c/s for breech?

[MCatLvrMom2A&X]

The short answer is yes theycan force you into a section. Hospital policy usually is very adamant about it. I have heard of woman being 10cm and pushing when breech was discovered and they where rushed to the OR for an emergancy section while the mother was saying no. Not sure how common that is though.

[StephM76]

I'm not sure if they can force you to (they probably could though) but for me personally, I would NOT want an inexperienced provider attempting a breech birth. I'd definitely want to make sure the person attending me had some experience with breech births. You don't want someone who has never seen it pulling and tugging on the baby out of panic, kwim?

[dogretro]

Originally Posted by StephM76

I'm not sure if they can force you to (they probably could though) but for me personally, I would NOT want an inexperienced provider attempting a breech birth. I'd definitely want to make sure the person attending me had some experience with breech births. You don't want someone who has never seen it pulling and tugging on the baby out of panic, kwim?

Yah, that is also one of my main concerns. I dont want my baby to be an "experiment". BUT I also dont want to be cut again for something that I now feel is so normal.

I do personally know 2 women who started pushing & it was noticed baby was breech & hcp went for c/s. One was at our birth center & they had to transfer. That seems so dumb, youd think it would be safer to just allow trained midwives to deliver rather than transfer a breech while in the pushing stage

[hapersmion]

The PPs covered the risks of trying to birth breech in a hospital fairly well. There are a few OBs who would be willing to do it if you worked it out with them beforehand (I'd think you would have a better chance asking upfront than trying to go in to the hospital pushing and fight for your birth), but they are few and far-between, and there's no guarantee they'd use good practices.

I think a much safer option is just to go outside the hospital. Birth centers are usually not allowed to do breech births, but homebirth midwives sometimes are willing to do so. Also, if you can find a good evidence-based care provider, you'll be better off going for a VBAC. A hospital that won't allow breech births isn't very likely to be friendly towards VBACs either.

I'm sorry about what happened with your first child. That was almost my story as well - I called what seemed like every OB in the city looking for someone who'd attend a breech birth, but no one would. If one of my former midwives hadn't mentioned the Farm, I would have been pretty much up a creek, since I'd never heard of unassisted birth at that point. Despite the scramble of switching providers at 38 and a half weeks (and going into labor three days after meeting my new midwives for the first time), it was a great birth. And now that I'm pregnant again, I made sure up front that my current midwife is breech-experienced, just in case it happens again.

Good luck! Remember that you do have options!

[AlexisT]

Originally Posted by hapersmion

A hospital that won't allow breech births isn't very likely to be friendly towards VBACs either.

I think this is a big, big leap. I can name a long list of hospitals that are VBAC friendly and don't do breech. The number of VBAC friendly hospitals, while not as big as it should be, is much larger than the number of "breech friendly" hospitals (a bit of a misnomer, because most of the OBs I hear about doing breech do not have company at their hospitals). Once ACOG issued its breech recommendations, many hospitals stopped doing them because it was outside the standard of care (opening them up to a lawsuit for bad outcomes). This isn't the case for VBAC, even with the restrictions ACOG recommends.

If you come in with an unplanned breech, the vast majority of hospitals will try to get you to agree to a section. What happens when/if you refuse will vary greatly.

My own feeling, when I was facing this situation myself, was that breech might be perfectly safe in theory--but that if I didn't have a knowledgeable provider, the CS was the safer option in that context. (This was not in the US; I would have gotten the OBs and midwives on shift, so they might have breech experience, might not. No way to know in advance.)

Birth centers usually have it in their practice guidelines that they can't handle certain situations, breech being one of them. If they're CABC accredited they can't do VBAC, either (I don't know if CABC has any stipulations on breech--but if doing one could lose them their accreditation, no wonder they don't want to do it!)

[MsBlack]

Finding a doc who is not only skilled in breech birth but is also allowed to help a vag breech birth--this is difficult. I would find a breech-savvy hb midwife to help you.

Yes, women are sometimes forced into csec, under court order. It's a crazy era! Doctors have a huge amount of power/influence, and unfortunately they are under intense pressure to avoid law suits. Csec is not necessarily 'safest' for moms and babies (its most often NOT, comparing risks of vag birth with risks of csec performed for breech or any other reason), but it is definitely 'safest' for OBs when it comes to lawsuits and malpractice premiums. This is terrible, and so sad for women and babies--but it is absolutely true. And a scared ob is an ob who would rather force a woman into csec under court order than acknowledge and serve women's choices at birth.

Whether or not your caregivers' hospital is VBAC friendly, homebirth VBAC (hbac) stats are better than at the hospital--more women, that is, have their VBAC successfully at home than in the hospital. Check it out! And your region has lots of homebirth mws.

[Youngfrankenstein]

Originally Posted by AlexisT

Once ACOG issued its breech recommendations, many hospitals stopped doing them because it was outside the standard of care (opening them up to a lawsuit for bad outcomes). This isn't the case for VBAC, even with the restrictions ACOG recommends.

!)

This is not nec. true. There have been tons of problems getting VBACs from certain hospitals and providers since the ACOG recommended VBACs be attended by OBs with full anesteologist back up. I've also heard of many women "promised" a trial of labor only to be told later that they couldn't. This played a part in some cases for the upsurge in UCs in this country. Women were not given a choice....

OP, this is a tough situation. I don't know how far along you are, but I recommend getting all the info you can. Ina May Gaskin recommends getting all the info you can, even the doc's personal notes, from your first section to see what happened and whether that will make you a good candidate for a breech VBAC. You truly may want to see out many prominent people in the "natural birth" community to help you navigate the best outcome.

[ChetMC]

Insurance

I was under the impression that many American hospital could flat out insist on a c-section for a breech presentation because their insurance required it. If they didn't follow the guidelines set out by their malpractice insurance provider they would be dropped.

I'd actually heard that the reason teaching hospitals stopped teaching breech deliveries even when the presentation was favourable was because the insurance companies said they would no longer insure the hospital if they continued to teach this skill. And of course, that means that now very few providers actually know when a vaginal delivery is possible and how to go about it.

[AlexisT]

Youngfrankenstein, I'm not saying that the VBAC situation in this country is ideal--far from it. All I am saying is that the guidelines have shut down breech almost completely, which they don't do for VBAC. Yes, they have shut down VBAC at many smaller hospitals, and this is wrong, but they haven't stopped it completely. All it means is that a hospital's breech policy isn't indicative of its VBAC stance (although probably, if they can't do VBAC, they can't do breech either).

Chet, their insurance requires that they insist, but the sticky part comes when someone refuses. ACOG's guidelines are actually that a patient has the right to refuse, and that hospitals should not do court ordered CS, but this doesn't stop some hospitals.

[khaoskat]

Even though a hospital's insurance requires them to not offer breech delivery vaginally (on C/S if you are breech presentation) it does not mean that a patient has to accept this. A patient has rights too. A patient has a right to make an informed choice based upon the risks and benefits of each procedures.

This is what American Medicine has seemed to forget.

We have an example of this going on in our local area. About 6+ years ago, there was a VBAC that went horribly wrong. It was not the OB's fault, but the fault of the nurses and staff who were monitoring and attending Mother and reporting back to the OB. (That is the decision the Jury reached.) As a result right after July 4th this year, there was a Jury award just for medicals alone of $31+ million.

As a result, many providers at the hospital are now starting to refuse to do VBAC's and telling their patients that the hospital is going to stop allowing VBACs because of this lawsuit. This lawsuit was decided over 3 months ago, and so far there has been no move to ban VBACs at the hospital, but yet many of the OBs are continuing to tell patients the hospital will be banning them, so they cannot VBAC. This hospital is the major teaching hospital in our area. They allowed and have a high VBAC rate and an 80% success rate for VBACs. They also allow breech delivery.

BTW, the mother in the lawsuit was induced/augmented.

So, if your being told the hospital is going to ban them soon, so there is no other option, how can I make an informed choice based upon the benefits and risks of a VBAC vs ERC?

[Youngfrankenstein]

Originally Posted by AlexisT

Chet, their insurance requires that they insist, but the sticky part comes when someone refuses. ACOG's guidelines are actually that a patient has the right to refuse, and that hospitals should not do court ordered CS, but this doesn't stop some hospitals.

I'm just saying that the ACOG has no legal say in any of this. They make recommendations but it's up to the OBs to practice whatever way they see fit.

We all know there are a lot of "coulds" and "shoulds" but when the rubber meets the road, what are you getting?

[Beccadoula]

Wow, there is a lot of emotion connected with this topic. If I were in your shoes I would look into a couple of options. One would be a doctor and hospital that does breech births - I understand there are still some. Another would be the Farm or a home birth midwife who can do breech births. I understand that water birth can be extremely helpful in a breech birth also. Instead of trying to force a system to bend to your needs I would seriously look into ALL my other options. You might be really surprised at what you come up with. If you find that you really must have a cesarean - plan on having a doctor and hospital that will be family friendly in their practices. Things like: getting to hold the baby while they are closing, breastfeeding, rooming in, etc.

[dogretro]

Wow.

I knew this topic was complicated, but WOW.

FTR, I am only about to enter the second trimester, so baby's position is not important yet. I asked b/c I have been SO curious since dd's birth & I didn't want to ask my midwives yet and have them get all suspicious or something Thankfully, due to the fact that the only reason I had a c/s was for breech (I never went into labor), I do have to meet w/ an ob once, but my chances of having a repeat c/s are the same as a first time mother (So I was told by mw. I have also read this before.). I am not at all concerned w/ my choice or ability to vbac, the midwives are v supportive of it.

Thank you all so very much for sharing your knowledge! It is insane how much gets muddied by legal stuff and insurance! I have read some stories on mdc about moms getting individual ob's to do a breech and I have read enough stories of ob's having no problem delivering a breech twin when it is the second twin (Im not having twins, just saying!), so I know it gets done. B/c of my experience, I am so interested in this topic. Please, continue to share, I'll be reading!!!

[Storm Bride]

Originally Posted by dogretro

It is insane how much gets muddied by legal stuff and insurance!

Yeah. I hear that a lot. But, I live in Canada. We don't have the same levels of litigation, and we have a totally different set-up in almost every respect. And, when I had ds1, in 1993, I was told the baby was breech (he turned during labour, while I was still at home and I didn't realize it), and that I had to have a c-section. I refused. The nurse said, "oh, it's for the best, dear" and they ignored me while they put in my IV and catheter, and then they knocked me out. I was saying "no" until I was unconscious. No court order. They just did it over my refusal.

[Beccadoula]

One last thought - this doesn't always work, but it is always worth trying...look at spinningbabies.com, they have some really good information about positioning a baby before labor. If you haven't checked it out yet, you should.

[Beccadoula]

Originally Posted by Storm Bride

Yeah. I hear that a lot. But, I live in Canada. We don't have the same levels of litigation, and we have a totally different set-up in almost every respect. And, when I had ds1, in 1993, I was told the baby was breech (he turned during labour, while I was still at home and I didn't realize it), and that I had to have a c-section. I refused. The nurse said, "oh, it's for the best, dear" and they ignored me while they put in my IV and catheter, and then they knocked me out. I was saying "no" until I was unconscious. No court order. They just did it over my refusal.

I just wanted to say I'm so sorry!!! Really. That must have been aweful.

[dogretro]

Originally Posted by Beccadoula

One last thought - this doesn't always work, but it is always worth trying...look at spinningbabies.com, they have some really good information about positioning a baby before labor. If you haven't checked it out yet, you should.

I did check it out last pg. Like I said before, I am only 12 wks, so positioning w/ this one is not a concern yet! Last time, we did everything: Moxibustion at accupuncturist and home, lying upside down, using a cold pack, dh talking to baby, webster, and external version. She was head-up since 22 wks, so I think she rather enjoyed it!!!!

[Bluegoat]

I talked about this insurance thing recently with my step-dad who is a GP here in Canada. He told me American doctors and hospitals can be covered for whatever procedures they want - they just have to pay the right price to the insurance companies.But it is sooo steep that the price can't be justified by the revenue created by doing the procedures. And especially in the case of individual doctors, they may just not be able to afford to practice if they were paying out that much to insurance companies.

Since medical insurance here is handled through a co-op, it's just a totally different thing, and doctors have a lot more freedom. But we still seem to take a lot of our maternity care cues from American practices.

[Storm Bride]

Originally Posted by Bluegoat

Since medical insurance here is handled through a co-op, it's just a totally different thing, and doctors have a lot more freedom. But we still seem to take a lot of our maternity care cues from American practices.

The OB I was seeing with dd1 and ds2 told me that flat out. He said that American obstetrics is more conservative than Canadian obstetrics (I still don't get how more interventions is construed as "more conservative", but whatever), so "we" tend to take our cues from them. He was talking specifically about guidelines for going "overdue". He said that, at that time, the Canadian guideline was induction or c-section at 41w, 3d, but that the US guideline was 41 weeks, so we'd probably be changing ours. No evidence. No research. Just "that's what they're doing, so that's what we'll be doing". Ugh.