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It's Possibly Going to be a Breech Homebirth - Page 3

post #41 of 61
Quote:
Originally Posted by sahmof2girls View Post

OP:

Here is a great Birth story for you to read

http://birthwithoutfearblog.com/2011/12/21/home-birth-of-twins-born-past-41-weeks-one-footling-breech/



I was just coming here to add that!  I think that makes 3 very successful home birthed twins w/ a footling breech that I've heard just this week!

 

YES, it would be awesome if the baby turned.  But the world isn't going to stop turning if not.  There are still options. 

post #42 of 61
Quote:
Originally Posted by BroodyWoodsgal View Post


I just want to point out, that for many women who are in the same position as the OP, it IS a choice between HOME and a C/S. If I found out my current baking baby was breech....a vaginal birth in the hospital would simply NOT be an option. It does. NOT. happen. in. my. state. Period. So...I'd be forced to go UC, go to the next state over with MW, or go with a skilled MW who is in my state and is angry about the laws and so, has been known to handle some breech HBs for women she knows. But I don't think that last option would work for me, because I don't know what added layer of emotional "stuff" comes with skirting the law like that, you know? That could add a whole different level of "stuff" in that MWs mind, to do with liability (criminal and otherwise) and any other number of factors. Should something go wrong in a situation like that, say even something so bad as a baby dying...it goes from being a tragedy or potential malpractice lawsuit, to being a straight up criminal issue...manslaughter charges, whatever else. I don't need that swimming in my MWs mind. You know? Going the next state over with a competent, skilled midwife seems like a good idea...until you consider that with my first birth I went from "ohhh, I think that was an ACTUAL contraction!" to "look at her little chin!! She's beautiful!" - in exactly 1 hour and 57 minutes. With my second...it was 1 hour and 37 minutes from painful contraction #1, to holding a baby. The drive to the state line is a solid hour....once I cross the state line, I still have another 45 minutes AT LEAST to go, to get to the MW who would be assisting me. That sounds like a recipe for a UC breech birth... "automobile style" - I'm all set.

 

So, if this baby were breech...my ACTUAL options would be a c-section...or a shaky MW situation....or a UC car birth. Or....a UC. I won't get a section for a breech baby. Period. So, I guess that would be a UC baby. How comfortable with that am I?? More comfortable than being wheeled into the OR.

 

Some of us live in states where it is easy to find someone who will come to your home and deliver a baby that others would not. Some of us live in states where you can go to a birth center attached to a hospital and they will let you attempt a breech delivery (VERY uncommon these days, but it still happens sometimes). Most of us live in states where Breech homebirth is restricted, as far as who can legally attend...and almost ALL of us, live in states where there is simply not an OB who can deliver you in a hospital, vaginally, for a breech baby. Period.

 

Them's some crummy choices.
 

 


While it sucks that choices can be limited, that does NOT change the fact that a footling breech poses more risk than a frank breech. The decision between a home birth and hospital birth must weight the factors differently when there is a higher level of risk associated with a given situation. Call it a "variation of normal" or whatever you want, but it changes the equation. Homebirth/UC is not a one-size-fits-all answer (and neither is a hospital birth FWIW). Promoting homebirth/UC at all costs is just as wrong as promoting hospital births for all situations. 

 

And, for the record, a c-section is not a death sentence. And there are very few situations where mother and baby have opposing risks (it is my death or the death of the baby). Yes, c-sections can suck and be harder to recover from, but the complications/risks are over-stated as well, and I find it difficult to swallow the claim that it is NEVER the right option.

 

post #43 of 61

with the state of most hospitals- I don't think the risks are overstated. a woman in NY died recently after her C/S as a direct result of her C/S and now, two much wanted twins are without a mother and her husband without a wife. I just mean, when it comes to breech, Id rather take my chances with a vaginal breech than a C/S. 

post #44 of 61
Thread Starter 
Quote:
Originally Posted by BroodyWoodsgal View Post


I just want to point out, that for many women who are in the same position as the OP, it IS a choice between HOME and a C/S. If I found out my current baking baby was breech....a vaginal birth in the hospital would simply NOT be an option. It does. NOT. happen. in. my. state. Period. So...I'd be forced to go UC, go to the next state over with MW, or go with a skilled MW who is in my state and is angry about the laws and so, has been known to handle some breech HBs for women she knows. But I don't think that last option would work for me, because I don't know what added layer of emotional "stuff" comes with skirting the law like that, you know? That could add a whole different level of "stuff" in that MWs mind, to do with liability (criminal and otherwise) and any other number of factors. Should something go wrong in a situation like that, say even something so bad as a baby dying...it goes from being a tragedy or potential malpractice lawsuit, to being a straight up criminal issue...manslaughter charges, whatever else. I don't need that swimming in my MWs mind. You know? Going the next state over with a competent, skilled midwife seems like a good idea...until you consider that with my first birth I went from "ohhh, I think that was an ACTUAL contraction!" to "look at her little chin!! She's beautiful!" - in exactly 1 hour and 57 minutes. With my second...it was 1 hour and 37 minutes from painful contraction #1, to holding a baby. The drive to the state line is a solid hour....once I cross the state line, I still have another 45 minutes AT LEAST to go, to get to the MW who would be assisting me. That sounds like a recipe for a UC breech birth... "automobile style" - I'm all set.

 

So, if this baby were breech...my ACTUAL options would be a c-section...or a shaky MW situation....or a UC car birth. Or....a UC. I won't get a section for a breech baby. Period. So, I guess that would be a UC baby. How comfortable with that am I?? More comfortable than being wheeled into the OR.

 

Some of us live in states where it is easy to find someone who will come to your home and deliver a baby that others would not. Some of us live in states where you can go to a birth center attached to a hospital and they will let you attempt a breech delivery (VERY uncommon these days, but it still happens sometimes). Most of us live in states where Breech homebirth is restricted, as far as who can legally attend...and almost ALL of us, live in states where there is simply not an OB who can deliver you in a hospital, vaginally, for a breech baby. Period.

 

Them's some crummy choices.
 

 

This pretty well articulates WHY I posted in the first place.  Yes, I have ONE OB that I know consults and potentially delivers vaginal breech birth....but only in very specific situations.  Otherwise, if I go to the hospital, I will automatically have a C-section.  I am working with a midwife who is confident in her ability to deliver a breech vaginally as safely as possible, and who is also willing to suggest the decision to transfer if conditions require it.  I trust her quite a bit.  I was looking for information from parents who have been in this situation, what did they do or suggest I plan for, how did it turn out for them, and I guess I didn't articulate that well.  I am aware of the higher risk breech birth, and aware that not all breeches are the same.  I do appreciate the different perspectives...but with only three-ish weeks before I'm 'due' and being 37 weeks this weekend, reviewing this thread and others and then thinkinga bout what it is I'm willing to risk and what risks I'm comfortable with....I'm at the point where I've made peace with a possible home breech birth if this child does not turn.   

 

post #45 of 61

On the subject of risking out...

 

Ultimately it is not a choice between "risk and no risk" but between one set of risks and another.

 

I have several "contraindications" to homebirth. I'm fat, old, have a clotting disorder (FVL het), sleep apnea, and hypothyroidism.

 

HOWEVER...

 

I also have a ridiculously simple obstetric history, live 5 minutes from a hospital with perinatologists on call and a level III NICU, and NOT ONE of my risk factors particuarly impacts labor and birth. In fact, I hit my highest risk, most difficult time right about the time they would send me home.

 

I have a midwife who trusts my judgement (and I trust hers) and who works well with the perinatologist we consult with. And I have history of good instincts about when I do and don't need help and I'm VERY willing to ask for help when I need it. 

 

What I'm not willing to do is put up with the BS routine mandatory crap they want to pull at the hospital. The perinatologist says that with my risk factors, they want to do continuous fetal monitoring and have an IV running. I could theoretically get confrontational and refuse them, but the L&D staff is used to having a heplock or IV established and they are not fast at getting them started in emergencies, so laboring there, refusing those interventions, we'd be looking at 10 minutes to start an IV if I start out in the hospital.

 

I have never needed IV meds in labor, not once. And I HAVE gotten clots and infections from badly done heplocks, and react badly to tape, so an IV is not a "harmless" intervention for me. I have fibromyalgia, and because of my size, it is hard for them to get the belts tight enough to keep the heart rate monitored without me being completely immobile, AND in excruciating pain because the points the belts go over are pain points for me. 

 

So for me, in my circumstances, I'm better off laboring at home, where in an emergency an ambulance would be here in 3-4 minutes and have the IV in before we got to the hospital 4-5 minutes later, where I have a MUCH better chance of never needing any interventions at all, than I am starting out in the hospital "just in case" because of my risk factors. 

 

That said, my risk factors + breech would probably be out of my comfort level for homebirth. 

post #46 of 61


 

Quote:
Originally Posted by jenrose View Post

On the subject of risking out...

 

Ultimately it is not a choice between "risk and no risk" but between one set of risks and another.

 

I have several "contraindications" to homebirth. I'm fat, old, have a clotting disorder (FVL het), sleep apnea, and hypothyroidism.

 

HOWEVER...

 

I also have a ridiculously simple obstetric history, live 5 minutes from a hospital with perinatologists on call and a level III NICU, and NOT ONE of my risk factors particuarly impacts labor and birth. In fact, I hit my highest risk, most difficult time right about the time they would send me home.

 

I have a midwife who trusts my judgement (and I trust hers) and who works well with the perinatologist we consult with. And I have history of good instincts about when I do and don't need help and I'm VERY willing to ask for help when I need it. 

 

What I'm not willing to do is put up with the BS routine mandatory crap they want to pull at the hospital. The perinatologist says that with my risk factors, they want to do continuous fetal monitoring and have an IV running. I could theoretically get confrontational and refuse them, but the L&D staff is used to having a heplock or IV established and they are not fast at getting them started in emergencies, so laboring there, refusing those interventions, we'd be looking at 10 minutes to start an IV if I start out in the hospital.

 

I have never needed IV meds in labor, not once. And I HAVE gotten clots and infections from badly done heplocks, and react badly to tape, so an IV is not a "harmless" intervention for me. I have fibromyalgia, and because of my size, it is hard for them to get the belts tight enough to keep the heart rate monitored without me being completely immobile, AND in excruciating pain because the points the belts go over are pain points for me. 

 

So for me, in my circumstances, I'm better off laboring at home, where in an emergency an ambulance would be here in 3-4 minutes and have the IV in before we got to the hospital 4-5 minutes later, where I have a MUCH better chance of never needing any interventions at all, than I am starting out in the hospital "just in case" because of my risk factors. 

 

That said, my risk factors + breech would probably be out of my comfort level for homebirth. 


Agreed, it is weighing two sets of risk factors. And having a well thought out plan if risk turns into reality. That is not the case with some other posters here on MDC. 

 

A footling UC without a viable plan if things are not going well is not, I believe, the best option. I guess we all have different risk thresholds that we are comfortable with.  I happen to be a risk averse person and would choose the risks of a hospital birth over a UC for a footling. The OP seems to have a plan in place and has not completely excluded treatment options, so that is good to hear.

 

 

 

 

 

 

 

post #47 of 61

There are three types of breech births : spontaneous, assisted, and extracted for stuck arms and head. The risk of the head being stuck is why care providers go to c-section. However you have the fact that you birthed other children so that is Great!  A Frank breech is the best presentation to have and a footling more risk of cord coming first. i have attend numerous breech mothers, in fact a frank breech less then two weeks ago at 9lbs.12oz. It is a different labor and birth then a vertex baby. If you want to ask questions or need support feel free to contact me as I would be happy to help you.

Charlotte Sanchez

 

post #48 of 61

Both of mine were breech.  The first I had a ECV done in the hospital with a great doctor.  Baby flipped right away and stayed in for another 4 weeks before being born at home.

 

With the second, we tried a very gentle ECV with the MW since we moved from the great doctor.  She wouldn't budge.  I thought i was ready for a breech home delivery.  Researched, read, talked, focused, etc.  But it did bring great anxiety to the birth - as I was always aware of the possibility of cord entrapment.  The L&D was long but she was born fine.  Looking back I would not do another breech at home,  too stressful.  My Mw had done many breech and felt very comfortable doing it but there was a level of anxiety that wasn't there the first time. 

 

If this next one decides to be breech, I will labor at home as long as possible and then go to the hospital and hope for a vaginal delivery. 

 

Good luck.  It is a tough decision to make and so frustrating that there isn't the option to deliver in the hospital!

post #49 of 61

Interesting thread to follow.  

Thank you for all the info & wide variety of opinions.

 

I have not been in that situation (of a breech) so I can not say what I would do.  

Both of my births have been at lovely at home, one with a midwife & one on my own.  

 

Thanks for the links & lively chat.

post #50 of 61

Listipton,

I am also a CNM who catches breech positions early and recommends various tilt/inversion exercises early on around 32-33 weeks & I have the mom return weekly, and if the baby is not turned by 35 weeks, I do external versions. My supervising OB and a nearby OB who takes my transfers, will also consider vaginal breeches, selectively, for some ladies due to various reasons, conditions, etc. Why has no one given you educatino on these various exercises and/or performed versions before or at 34-35 weeks?

Karen Benfield, CNM & Owner of BirthTender Midwifery


Edited by BirthTender - 6/4/12 at 3:50pm
post #51 of 61

I'm also a CNM that does home births and I asked that very question 2 weeks ago and got no answer.  It's possible the baby's already here since the due date was January.  It'll be interesting to hear how this all worked out.  I think it is less risky to do an external cephalic version that it is to plan a breech birth. 

post #52 of 61
Quote:
Originally Posted by mamablitz View Post

with the state of most hospitals- I don't think the risks are overstated. a woman in NY died recently after her C/S as a direct result of her C/S and now, two much wanted twins are without a mother and her husband without a wife. I just mean, when it comes to breech, Id rather take my chances with a vaginal breech than a C/S. 

I absolutely agree that low-risk women with frank breech babies should be able to birth vaginally with a skilled attendant - and I'm happy that's now a possibility in my city.
But I think we need to be realistic and not alarmist about the risks in the instances where C-sections are truly necessary. The chance of a woman dying from a C-section is 1 in 2,777. The lifetime risk of dying in a car accident is 1 in 84.
post #53 of 61

Hi honey, I've been in your shoes!  PM me if you'd like.

 

This is such a tough spot to be in.  It's really hard to know what to do, and because so few women find themselves here there isn't a clear path to follow.

 

Homebirth is a good choice if you are confident in your midwife's experience. The downside is there's no pediatric team there to help the baby right away if needed. Then again, this is true for any vertex birth too.  There are many upsides to Homebirth in that you will not have to fight during labor.

 

Hospital vaginal breech is hard, but not impossible. You might be fighting all the way, which is a terrible thing to have to do in labor! Is your hubby up for this? Do you have a sweet, polite, but tough as nails doula?  Are you good at filtering out negativity and saying "no thank you" over and over?  If you don't luck out and get the doc you're hoping will be on call, you can still refuse a csection.  As soon as you arrive tell them youre going to to refuse the csection  for reason of frank breech position in the absence of any fetal distress, and tell them youre ready to sign an AMA form (against medical advice)  No one is going to drag you into the OR against your will.  plus once they know how serious you are they might be more motivated to call in the doctor with breech experience.  The upside of being in hospital is ultrasound to rule out transverse or footling presentation, forceps in case of head entrapment, and immediate nicu access.

 

You're 37 weeks now, are you doing an  ECV?  I would do everything in my power to get that baby to turn.  Yes, it will hurt, but much less than a c section recovery.  I did it but it didn't work unfortunately. 

 

I chose a c section rather than homebirth. I figured that the c section risks are pretty clear, and the risks of vaginal breech weren't (because the term breech trial is flawed).  However, from my view from the other side, I now know I'll never choose a csection for another breech baby, based on how traumatic mine was.  But, we can only make decisions based on the info we have at the time

post #54 of 61
Quote:
Originally Posted by mamablitz View Post

with the state of most hospitals- I don't think the risks are overstated. a woman in NY died recently after her C/S as a direct result of her C/S and now, two much wanted twins are without a mother and her husband without a wife. I just mean, when it comes to breech, Id rather take my chances with a vaginal breech than a C/S. 



i do not want to start trouble, but that poor woman died, and her poor twins are motherless, because of medical issues, not because she had a c/s.  she would have been what one would consider exceptionally high risk.  in a medical institution where 5000+ births take place a year,  she was the first mama to die in over 6 years.

 

surgery has its risks, but she did not die because of her c/s.   

post #55 of 61
Thread Starter 

Just checking in.  Baby has still not arrived, but is still sitting breech.  We have tried everything to flip this little person, however, it is still stubbornly sitting in a Frank position.  Our home birth is still a go and I will post once we've delivered.  Thank you all again for your responses :)

post #56 of 61

Have a wonderful labor and birth mama!!!!!

Here is a great video on a breech homebirth

http://birthwithoutfearblog.com/2011/10/14/breech-birth-video-faith-in-god-and-his-will/

post #57 of 61
Thread Starter 

Kellan Wilder is here!  The little stinker turned sometime during the last 5 days of pregnancy!!!  We had a home water birth, but it went so fast (one hour!) that the midwife didn't make it in person and was on speakerphone.  We didn't even have time to fill the pool all the way.  Just wanted to let you ladies know how it turned out :)

post #58 of 61

congrats!

post #59 of 61

HAhahaha WOW what a great update! I love sneaky last minute turners!

post #60 of 61

WOW that is so wonderful to hear!!!!!!!!!!!  Enjoy your babymoon!!

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