Would you attempt HB with a footling breech?

[msmiranda]

Why or why not?  How about a frank breech?

[4midablemama]

If it were me, I would be very comfortable attempting to deliver a frank breech baby naturally; I would not feel safe attempting to deliver a footling breech baby naturally, because I have researched this particular presentation, and to me, personally, there's just too much risk involved. Along the same line, I would not attempt to deliver a breech baby at home, period. I have a friend who did it, and I think that she is a warrior woman, but for me, it is too far out of my comfort zone, I would spend the entire labor terrified that I was risking potential injury to my child. I would do everything I could to avoid medical interventions, but when it comes down to it, my instincts are meant to protect my baby and my instincts tell me no, absolutely not.

[kythe]

I'd be a bit hesitant because in my state, I may have issues finding a provider.  DEM's are not allowed to attend breech births where I live.  Unless I could find a CNM that I was comfortable with who did home births, I might find myself looking at an unassisted birth.

That said, I would have no qualms about a vaginal breech birth.  I was born breech in a hospital during the 1970's when most breech births were vaginal, but women were forced to lie flat on their backs during labor.  My mother was told that it was dangerous to move once her water had broken because the cord could get tangled, so she laid flat on her back - not even at an angle - from her admission to the hospital until my birth.  I was born with no complications or use of forceps (even though that was common then), though my mother had back pain for several years after my birth.

When you consider how many breech babies were born under similar circumstances at that time and still had good outcomes, I would think that giving birth at home without the bad medical advice would be a cinch in comparison.  At home you can move and change position at will, working with your body for a best possible outcome.  This is more than you could ever hope for even in a hospital today. 

Hospitals now push for c-sections with breech babies, though some doctors will give a mother a "trial" labor but require her to have an epidural "just in case" of an emergency c-sec.  Very few are open minded enough to truly let labor run its course once they have deemed you high risk.  Yet I look at my mother and think if she could labor for 8 hours flat on her back and still push me out breech, I could do the same at home where I have better resources and support.

[Engineering_Mama]

I would definitely HB a frank breech. I was born vaginally, frank breech, in the hospital. My mom's 1st birth. Like Kythe said, if she could do that I'm sure I could manage it at home. I'd have to do some more research and talk to my midwife before committing to a footling breech at home. But given that my only alternative around here would be a scheduled c-section I would lean towards homebirth even with a footling.

[nononose]

I would definitely birth my baby at home if it happens to be breech - footling, frank or complete.  BUT, my midwife has much experience and comfort with breech birth, she has far more experience, knowledge and understanding than any OB at any of the 5 local hospitals, and all the hospitals require a transfer of care for breech in labour.  My daughter was breech, and they forced me to have a c-section.  They did let me have a "trial" of labour, and everything went really well, but they still wheeled me into the OR after I got fully dilated and it was a horrible experience that I still have not gotten over.  I have confidence in my midwife, and that is a big part of the puzzle. I would not have this same confidence with a different provider - too much can go wrong and be caused by the care provider intervening too much.   I'm still figuring out how to get away with this though, as breech requires a hospital transfer.  The additional concern with a footling breech is cord prolapse, and that dilation may not be complete before pushing starts (easy enough to check if you are worried).

[raelize]

i would birth frank or full at home, but not footling.  there are to many possible complications.  adn i would need an experienced breech midwife

[Naturallove]

I would attempt to deliver a frank breech at home, but definitely not a footling. I have had 2 midwives this pregnancy and neither of them will deliver footling breeches at home births because of all the risk involved. If I were in that situation I would be looking to some natural remedies to turn the baby.

[Bird Girl]

I would be too concerned about a chord accident with a footling breech--that's not something that can be resolved with positioning, and it needs immediate treatment.

[greenmama66]

Yes, Ii would but that's because I attended a friend's full fottling breech home twinbirth- both babies came out that way and were fine. Depends upon how comfortable the mom is with it all- she was fine.

[GoBecGo]

I do know someone who had an accidental UC with a footling breech baby (she was apparently on her local news, with the EMT phonecall recording of her going "I see feet!  I see blue feet!" (she was sitting on the toilet).  They told her to lie on her back and hold her knees (go figure, luckily the baby gushed out knees to head in the next push anyway).  Initially the ob in the hospital didn't believe her but the neighbour's cleaning lady (who had come in to investigate her husband's urgent cries for help) had taken a photo of her on her phone with the baby, head at vulva, lying kicking and crying facedown between her thighs.

I know it would probably be fine, BUT i personally wouldn't attempt it deliberately at home.  A frank or full breech, yes, probably if my MW (who is naturally-,minded but very sensible and has both excellent low intervention figures AND an excellent safety record) was agreeable in supporting me.  I do also know a woman who lost her baby at a home breech birth (also unexpected).  I know anecdotes aren't worth as much as real data, but the faces of those children will be where my mind goes first when i'm in the emotional journey of labour, so i do need to consider such things anyway.  My main worry would be cord accident, BUT my #2 was a true knot baby born at home and had no problems, so i know that isn't necessarily a major risk, it just *might* be.

[lovinmy3]

I haven't had a homebirth yet, but am highly considering it with my next pregnancy. I've had 2 drug free vbacs in the hospital with a midwife. My first baby was actually born via c-section because she was frank breech. At that time I didn't even know having a vaginal birth with a breech baby was an option so I just went along with the OB and had a c-section. I would consider having a frank breech baby at home. In fact, both the midwives I had with my last 2 pregnancies said I would have had no problem giving birth to my breech baby. I'm not sure about footling breech though. I'd have to reserach it more and have a highly experience midwife. A few days ago someone on a due date club had posted this link of pictures from a footling breech birth. Even if I'm not sure I would do it I thought the pictures were really neat  www.homebirth.net.au/2001/03/mechanism-of-breech.html

[lovinmy3]

http://www.homebirth.net.au/2011/03/mechanism-of-breech.html sorry try this link the other one had an error

[rajahkat]

I would if I could get a specific midwife and if she was comfortable with it.  

[loveneverfails]

Under no circumstances would I give birth to a footling breech child vaginally in home or at hospital, because there is a 1 in 20 chance of death.  Not 1 in 100.  Not 1 in 1000.  1 in 20, and that does not count babies with hypoxic brain injury.  I would consider planned home birth of a footling breech baby to be reckless, negligent parenting and no midwife should be taking on that client profile. 

Vaginal birth of a frank or complete breech at home, I would not attempt unless baby flipped at 9cm and I had no shot of making a hospital.  

[koalove]

footling~ no way.  ive seen a very traumatic birth that ended in death with a footling breech with a very experienced midwife.  before that, i probably would have.  not sure i would home birth a baby what was not the standard in every way.  lucky for me, both my boys were average, easy, healthy babies to birth.

[msmiranda]

Thanks for the replies, all!  This is not something I am considering myself -- my personal comfort level would preclude attempting any vaginal breech delivery at home -- but I had heard about a situation involving someone else and was curious to see what people thought here at MDC.  It turns out that the situation I heard about didn't actually involve a footling breech, but another type of breech (probably frank).  Both my LOs have been safely head down by 32-34 weeks and my fingers are crossed that this one will be the same, but I've been interested academically in the issue of vaginal breech birth for a while.  In doing some research I was interested to learn that the switch to delivering almost all breeches abdominally actually hasn't done that much to improve outcomes, and that head entrapment can occur during a c-section as well.  It seems that breech babies are at higher risk of adverse outcomes than vertex babies no matter how or where they are born.

This article had a lot of relevant information and citations to the medical literature, and seemed balanced even though it was written by doctors and is published on a mainstream site, so I thought I would link to it here in case anyone is interested in reading more.  This article goes into more detail about the flaws in the 2000 study that sounded the death knell for vaginal breech birth in hospitals.

[AlexisT]

The Hannah TBT only dealt with frank/complete breech, not footling, so even if you dismiss it you're left where you began. When you're discussing this you need to check sources carefully, because many are restricted to frank/complete--the most favorable breech positions for vaginal delivery, the majority of breech, and the safest non-vertex position to deliver. You need to find sources specifically on footling, and last time I looked (some time ago) most of the data on footling breech was old. It seems, from what I've read, that delivering a footling vaginally has been out of fashion for longer than frank breech, and that therefore, even if it were theoretically safe, you'd be hard pressed to find an OB or MW who had any extensive experience in delivering them. They won't encounter a footling that often to begin with, much less one where everyone wants to attempt vaginal birth.

Say the odds are 1 in 20 (I can't verify this) - that means that 95% will be fine. So most of the anecdotes, then (and we've all seen the videos), will also be fine. But 5% is still a pretty high risk. It's the limitations of anecdotal stories.

[~~Sarah~~]

Originally Posted by loveneverfails 

Under no circumstances would I give birth to a footling breech child vaginally in home or at hospital, because there is a 1 in 20 chance of death.  Not 1 in 100.  Not 1 in 1000.  1 in 20, and that does not count babies with hypoxic brain injury.  I would consider planned home birth of a footling breech baby to be reckless, negligent parenting and no midwife should be taking on that client profile. 

Vaginal birth of a frank or complete breech at home, I would not attempt unless baby flipped at 9cm and I had no shot of making a hospital.  

I'm not sure how you've come up with this statistic, but it is obviously in error. Also - please let professionals decide where their own skills lie.

Originally Posted by AlexisT 

The Hannah TBT only dealt with frank/complete breech, not footling, so even if you dismiss it you're left where you began. When you're discussing this you need to check sources carefully, because many are restricted to frank/complete--the most favorable breech positions for vaginal delivery, the majority of breech, and the safest non-vertex position to deliver. You need to find sources specifically on footling, and last time I looked (some time ago) most of the data on footling breech was old. It seems, from what I've read, that delivering a footling vaginally has been out of fashion for longer than frank breech, and that therefore, even if it were theoretically safe, you'd be hard pressed to find an OB or MW who had any extensive experience in delivering them. They won't encounter a footling that often to begin with, much less one where everyone wants to attempt vaginal birth.

Say the odds are 1 in 20 (I can't verify this) - that means that 95% will be fine. So most of the anecdotes, then (and we've all seen the videos), will also be fine. But 5% is still a pretty high risk. It's the limitations of anecdotal stories.

The Hannah TBT has been properly torn apart enough times that it is not even worth discussing anymore. They included pre-term babies, they included twins, and many (if not most) of the care providers involved were not skilled. All of these things create much higher risks, and went against the nature of the study, thus rendering the conclusions invalid.

I was at the Breech conference in Ottawa about 18 months ago. The physician from Germany who came to speak about Breech birth was from a large hospital where they sent all of the moms with breech babies from the surrounding areas. When asked about the difference between the different types of breech presentations he nearly shrugged, and responded by saying that it's all the same once they are out to the navel. He never risked anyone out due to placement of the feet. They do however, use MRI pelvimetry for first-time moms and VBACs.

Would I attempt a Homebirth of a footling breech? If I could find a skilled provider, I would.

[AlexisT]

I think you may have misread my comment slightly. I didn't mean that the Hannah TBT was a good study; I meant only that it was irrelevant to the question, because no footling breeches were included at all. It doesn't matter whether its results were bad or favorable, or whether it was well done or not; it doesn't tell us anything about footlings.

[Neuromancer]

On March 24th I had a surprise footling breech birth at home. The homebirth part was planned, but we had no idea he was breech. My midwife had only done 2 breech births, but that week she and the doula had watched videos of 3 successful vaginal breech births, so it was fresh in their minds that it was possible (also, my midwife was herself a vaginal breech birth back in the late 50s or early 60s).

I felt very comfortable being at home, but the labor was quite fast and I was in a lot of pain that I was mentally unprepared for. I have no idea if the pain I was in was "typical" of breech births or not. Nevertheless, my body took over and my 8 lb. 9 oz son was born with just the slightest help (the midwife reached in, hooked 2 fingers in his mouth, and tucked his chin at the very end), he came out crying, had a 9/10 APGAR, and did not need to be suctioned, One factor that I appreciate is that we were not far from the nearest hospital. Though transferring would have been very traumatic for me, I knew it was an option.

I hope to never have to plan a breech HB if I get pregnant again (I'd try to turn the baby, for sure, which I didn't get to do in this pregnancy because we had no idea), but I know it's possible!  I hope that if I get pregnant again it's not another footling breech -- just because of my pain!  ;) That said, hearing the risks of footling, I might consider planning a vaginal hospital birth with a breech-friendly practitioner (IF I could find one) if I had advance warning next time.  There's really a 1 in 20 chance of fetal death? If that is true, I'm glad I didn't know that while in labor!

Edited to add: I am 5' 10" and my midwife thinks that my height and "good pelvis" were a major factor in my positive outcome.