Anterior Placenta, Breech, and C/S

[GoldmanBaby09]

So, I have a friend who is 37 weeks with a stubborn breech baby. She has tried all the tricks to get the baby to turn, including an ECV. The baby would turn transverse during the version but would not move any further. They suspect her anterior placenta is in the way and keeping the baby from moving.

So now my friend is trying to decide between a homebirth (she originally planned a hospital birth with a CNM but she won't attend a breech) with a midwife she doesn't really know but is experienced with breech (has attended more than 20 breech births with no adverse outcomes) or having a c/s with what ever doc in the practice happens to be on call (she wants a trial of labor if she goes the c/s route). I'm trying to help her sort through her options and choices.

My question is this--does having an anterior placenta make a difference in a c-section? It seems like that would require them to cut through the placenta before the baby could be pulled out, which seems more dangerous to me. I would also think that a doc doing a c/s for a breech should be experienced in doing a c/s with a breech. When my friend asked about both the anterior placenta and the breech c/s experience when she had her version, the doc dismissed her, and said it was no more complicated than a regular c/s. Does anyone have any experience with this or know if that is true? I have a pretty big distrust of the medical community and homebirthed, myself, so I'm not quick to believe that it is just so easy peasy.

Thanks!

[CorasMama]

It's my understanding that unless the placenta is anterior AND really, really low, it should be fine. The low transverse incision is very low on the uterus. And breech presentation by itself doesn't really complicate c/s.

[MsBlack]

I agree with CorasMama, this is also the way I understand it.

But I'd be more likely to choose the homebirth, myself! For so many reasons

[catters]

Agree with Corasmama. I had an anterior placenta, breech then c-section with my first. They wouldn't even consider a ECV due to my placenta being anterior for fear of it possibly tearing away, or whatever. Who knows, all I know is they wouldn't try it for that reason. Anyway, yeah, no issue with the c -section regarding placenta and incision, etc.

[ann_of_loxley]

Honestly - Id stick with the home birth. Breech is just a variation of normal. I wouldn't risk my life of my babies just because of something like that - so for me, there would be no need for a c/s and I would stay away from the hopstial at all costs!

[nikirj]

Breech c/s have higher rates of complications than vertex c/s, and usually OBs like to have a few special tools on hand, so no, it's not the same as vertex c/s.

[GoldmanBaby09]

Originally Posted by ann_of_loxley

Honestly - Id stick with the home birth. Breech is just a variation of normal. I wouldn't risk my life of my babies just because of something like that - so for me, there would be no need for a c/s and I would stay away from the hospital at all costs!

This is how I feel as well! The midwife she is considering was my midwife, so I already trust her implicitly. I plan on birthing any future babies with her, breech or no. I'm hoping my friend reaches the same conclusion. It is just difficult for her because neither a c/s nor a homebirth were really in her "plan" and she has such a short time to commit to either. I think she is leaning towards the homebirth, currently. Any real research I have come across pretty much points to the skill of the practitioner as the greatest contributing factor for outcome and I do think she knows her stuff.

[GoldmanBaby09]

Originally Posted by nikirj

Breech c/s have higher rates of complications than vertex c/s, and usually OBs like to have a few special tools on hand, so no, it's not the same as vertex c/s.

This was what I thought, as well. And that the OB should be an experienced in breech c/s. The dismissive attitude of the doc would be a red flag to me. Seems like they gloss over a lot of procedures as "no big deal" but the evidence doesn't support this, and I don't think that a breech case would somehow be an exception.

[MaterPrimaePuellae]

Originally Posted by nikirj

Breech c/s have higher rates of complications than vertex c/s, and usually OBs like to have a few special tools on hand, so no, it's not the same as vertex c/s.

Yes, that's what I thought, too-- IIRC, Henci Goer talks about this in the Breech chapter of The Thinking Woman's Guide...

[MiaMama]

I think that the recent decision by Canada's SOGC (their version of ACOG) to support vaginal breech with experienced providers tells a lot.

The original decision to recommend c-section was based on the fact that breech babies tend to have more problems than vertex babies. But subsequent research found that the complications from surgical breech occur at roughly the same rate as complications from vaginal breech. This may be because the incision is low in the uterus, so the baby STILL comes out butt-first.

http://www.theglobeandmail.com/life/...rticle1186104/

It now appears that there is no difference in complication rates between vaginal and cesarean section deliveries in the case of breech births.

I would think it would be important to select a provider based on experience with breech, regardless of which type of delivery was chosen.

[CorasMama]

I think I would base the decision on two things: the experience of the provider with breech birth, and the proximity to emergency equipment. I would say that the order of preference for me would be 1: midwife with breech experience, in a hospital, 2: c/s with an OB with breech c/s experience, and in an emergency, 3: midwife with breech experience, at home.

I hate the anti-breech birth environment prevalent in the US right now. Frank breech is really relatively safe, especially if done with an experienced provider in a hospital. It's how I was born, and my mother had me quickly and easily. But her doctor, back in the 70s, had plenty of breech experience. My daughter was breech until the day before she was born, and my doc was fine with letting me have her vaginally. But that was 12 years ago. Due to his malpractice insurance, he no longer does vaginal breech births. (Nor do any OBs in my state.)

[GoldmanBaby09]

But subsequent research found that the complications from surgical breech occur at roughly the same rate as complications from vaginal breech. This may be because the incision is low in the uterus, so the baby STILL comes out butt-first.

That makes sense. A c/s doesn't eliminate any issues with the baby being "upside down". They are still coming out the wrong way!

I think I would base the decision on two things: the experience of the provider with breech birth, and the proximity to emergency equipment. I would say that the order of preference for me would be 1: midwife with breech experience, in a hospital, 2: c/s with an OB with breech c/s experience, and in an emergency, 3: midwife with breech experience, at home.

From her house to the hospital of transport is just under 10 miles, mostly freeway. A midwife in a hospital is not an option. There is only one CNM here, who she is already seeing, that won't attend a vaginal breech. And if experience is the next determining factor, I might bet the hb midwife has more. She could at least give hard numbers about how many she has attended, when asked, unlike the OB who brushed my friend off.