Perinatologists attending vaginal breech deliveries?

[rparker]

So I had a conversation today that surprised me...

I was interviewing my family practice MD today at my 9 week appointment about possible birth scenarios and his preferences. I asked him if he delivered vaginal breech and his (predictable) answer was "not on purpose!"

He then went on to say, however, that if my baby were breech and I didn't want a c-section that he was pretty confident that he could find and refer me to a perinatologist within a 4-5 hour drive who would deliver a breech baby vaginally. He said that the perinatologist would probably do CT scans to get accurate measurements of both the baby and my pelvis (rather than rely on ultrasound) to make sure that nothing was freakishly disproportionate.

My doctor also claimed that when he worked in a different state this scenario played out several times with patients of his and resulted in vaginal deliveries of breech in a hospital.

Has anyone else ever heard of this? Prior to today's appointment I had always assumed that only midwives would attend a vaginal breech birth. I'm not sure how I'd feel about all of the "required" imaging and delivering in a large university hospital, but it was kind of refreshing to hear an answer that wasn't a knee-jerk "breech=c-section."

[mambera]

CT??? I would under no circumstances CT a healthy baby. That's like 500 X-rays at once. You can't find a good midwife who does vaginal breech births?

[rparker]

I'm not breech... this was a totally hypothetical conversation. (knock on wood) Yeah, the CT scan part freaked me out too. I just thought it was interesting because I'd never heard of this even as an option before.

If I do end up breech, I'd actually probably have to travel as far/farther to find a midwife, although that would definitely be preferable. The home birth midwife situation locally is kind of screwed up, which is why I'm going with a hospital birth in the first place... but our town really is in the middle of nowhere.

[JessicaS]

Huh?!?!? That is weird.

[nia82]

Ugh, I wouldn't do a CT! Try to find an obgyn who does do vaginal breech births in case you have to stick with a hospital birth. I did a lot of research and calling around and I'm not even pregnant yet.... I just want to know what happens if.... kwim?
I found an obgyn who does breeches 2 hours South. I'm sure you can find someone too!

[mwherbs]

it is the perinatologists here that have done the vaginal breeches and twins in the hospitals - haven't heard that they do CT scans but they do several ultrasounds. catch the baby(ies) in the OR . I think if the issue comes up you will know what to be asking about- over all I am sort of liking your current doc because he is thinking about avoiding c-sections if possible.

[AlexisT]

That is odd. I do know of OBs who do breech deliveries (often they're older and trained when vaginal breech was the norm) but an MFM for what was a standard obstetrical practice not that long ago? unusual.

Does he know a specific MFM who does this? That would make more sense than automatically thinking MFM for breech.

[RedOakMomma]

I had a CT scan before my twin birth...the amount of radiation in CT machines varies widely...not all of them are so extreme.

In my case, my ds2 WAS breech and I was at 40 weeks. They also had huge head measurements (via ultrasound) and it was my first birth. I felt confident, but in order to avoid induction and all the other stuff the dr.s were worried about, I agreed to the CT to measure their heads and my pelvic opening.

Ds1 was born fine. Three hours of intense pushing, but fine. Ds2 was another story. Since he was breech, his head didn't have a chance to form to my pelvic opening at all. In the breech extraction (OB reached up into my uterus, found his feet and tried to guide him out) his head DID get stuck. It was a very tense few seconds as the OB had me breathe, try a slightly different position, and as he worked VERY hard to get ds2 out. My OB is cool as can be, and even in the haze of labor I was very aware that he was worried when the baby got stuck.

So yes...there are OBs and peris that will do breech births, but it sounds like they often require a few tests beforehand. This could be a insurance thing, maybe? They feel like they need some proof that they did what they could to assure a breech delivery would be safe? I don't know. I just know that I was very thankful to have found an OB that would support a natural, breech twin B birth.

[Wittyone]

Three of the five OBs in my practice will catch breeches, even in primips - the docs (or the hospital, I'm not sure) require an MRI of the pelvis prior to labor to r/o a disproportionate fit, labor must be spontaneous and progress reasonably normally, they will not induce or augment, and the delivery is in the OR. We recently had a primip at 41 weeks come in with her water broken, not in labor, diagnosed breech for the first time at that visit. She opted for the MRI and awaiting her labor to start, and had her baby vaginally the next day

[sanguine_speed]

Here, it is illegal for a midwife to knowingly attend a breech delivery.

So, the ONLY option is UC or an obstetrician.

My third baby was breech (and slightly premature) so I went to the hospital and told the doc to catch (or move over and let my midwife catch as she was the most experienced in the room from international and pre-regulation experience).

The protocol here is to do an MRI but not if you have a 'proven pelvis'. I had delivered a 'macrosomic' baby previously. I am now facing a potentially full-term breech and feel well-proven enough to refuse an MRI. And it's also normal to be asked to deliver in an OR with an IV--neither of which I will do.

I'm not sure how it is everywhere, but here, a doctor cannot refuse care. So, they cannot say "you must deliver in the OR with an IV or I won't catch your baby." Or, they can say it, but if they do it, they'd lose their license. This sounds luxurious as I keep hearing that so many women don't have any choices and have to have c-sections.

[jeminijad]

Sounds odd, but it also sounds better than automatic section for breech! A homebirth midwife might be ideal, but at least you have another option to avoid major abdominal surgery.

[MegBoz]

Originally Posted by sanguine_speed

I'm not sure how it is everywhere, but here, a doctor cannot refuse care. So, they cannot say "you must deliver in the OR with an IV or I won't catch your baby." Or, they can say it, but if they do it, they'd lose their license. This sounds luxurious as I keep hearing that so many women don't have any choices and have to have c-sections.

Hm... we'll I've read on MDC before that many mamas don't advise having a HCP attend a breech who is opposed to it. Mostly because they have no training in it AND, they think it's dangerous & should never be done AND... therefore... they will be nervous! & therefore might mess it all up!! By yanking & such.

I don't know lots about it, but I've read often that breech birth requires patience & "hands off" so nervous yanking can really be detrimental - and therefore I can see the logic behind a recommendation to not unwillingly force an HCP to attend a breech. (Not that that means a mama should unwilling consent to CS either! Just sayin' I see it.)