Breech: Vaginal or C/S

[Peppamint]

I'm planning a homebirth, but have noticed that a lot of moms posting here and at another board I lurk at keep mentioning an automatic c/s birth if their baby is breech (or if it's twins and #1 is breech).

I was under the impression with dd (hospital birth) that if you had delivered a baby vaginally that depending on your OB they would let you have a breech vaginally.

What is your OB/Midwife/Hospital's policy?

[Kerlowyn]

The midwifery practice I use in Cambridge MA will deliver breech babies in the hospital, even if it is your first. However, the OB on call for the hospital must be present.
I think the only exception is a footling breech.

[phoebekate]

I voted for can be vaginally even if you have not delivered vaginally before - however, i think that breech does need to be treated slightly differently to vertex presentation. the research i did lead me to feel that with breech babies not only is it prefferable to have no interventions it is an absolute necessity, if you go into labour on your own, if it progresses well, if baby decends and is born all under your own steam then what's to worry about? On the other hand if I didn't go into labour, I would not induce, if I didn't progress I would not augument, if baby didn't decend there would be no forceps, episiotomies, if I couldn't cope with the pain there would be no pain relief, etc, in any of these cases I would choose a ceaser over any other intervention as I don't think that being pushed or pulled out is safe for a breech baby... just my two cents. I don't think that it should matter too much what position the baby is in given the above, but I know it would be tough finding someone to attend a first time mum with a footling breech, especially if you weren't prepared to let them do anything but catch :-).

[Greaseball]

In 1970, only 11% of breech babies were delivered by c/s, vs. 88% today. I don't believe women and babies have changed that much in the past 30+ years.

Women have delivered breeches - including footling breches - at home, and some of them were even UC's and/or VBAC's.

I think if a baby works its way into a breech position it's because it has a good reason for wanting to lie that way and it would be disrespectful to interfere with that. It would be like if I decided to go to sleep sideways and then my dh came and pulled on my legs to move me into a vertical position.

I also read there is only one intervention required at any type of breech birth and it is that someone must support the mother in a standing squat position.

Remember, doctors have a $$$ interest in keeping you in the hospital and making you think birth will be dangerous for you.

And no, a huge episiotomy is not required and you don't have to be under 35!

[NaturalJoy]

I don't think it's always necessary either. But my OB told me that most just won't do it for liability reasons.

With twins, they deliver breech baby bs fairly often. It just kind of "happens" and no one says much about it. She said it's their dirty little secret, LOL. She did say she's more comfy doing it with baby bs because a baby a has already come down through that pelvis leaving it nice and open.

I have a vertex baby a and a breech baby b. My OB has told me that we'll have a vaginally in the OR and that she will then have u/sound transducer on my belly to see what b does when a comes out and she'll try to do an ECV to get b head down. If that doesn't work, she said there is the *possiblity* of having to section for b. She won't come right out and say it, but the other *possibility* is she just might be delivering b breech

I did see a maternity ward recently where they let a woman deliver a singleton breech. They said the justification in her case was it was her 8th baby and she had a very proven pelvis...

[Peppamint]

Hmm... sounds like it isn't as bad as I had originally though then! For some reason, I was thinking that it meant automatic c/s birth and that just kinda freaks me out!

My natural inclination is to birth naturally with no interventions (I'm having a homebirth) no matter what position the babe is in. My baby has been head down the last two times I saw the midwife and seems to be that way most of the time. : Sometimes it feels like he flips because it hurts when he does this weird moving thing, but generally I can feel his butt and feet at the top of my uterus.

I need to discuss this with my midwife more, but at the beginning of my pg she talked like breech was no biggie.

Thanks for satisfying my curiousity!

[coracle]

A friend of mine who is a nurse-midwife told me that medical professionals (in the U.S.) have largely lost the art of delivering breech babies, that it is something the care giver has a feel for or not based on both training and practice. Mostly, she said, nobody gets trained in it any more because the people doing the training have not done it enough themselves. If your midwife is not fazed by the possibility of a breech delivery, she probably has done it enough that she would be safer than a doctor who had hardly ever attempted it.

The OB/midwife practice I used for ds refused to attempt vaginal delivery of any breech baby. I'll look around at the other practices near me for this pg, but they are all run by OBs with midwives as employees rather than partners and that may be the standard policy in my area.

-Sue

[Kelly71]

Breech is NOT a complication, it is only a different presentation.

[lilyka]

It depends on the presentation and if things look good etc. As a general rule, so long as the baby is in a good position I don't see whyt anyone couldn't at least start with a plan of vaginal breech. There is only one Dr. in town (out of hundreds) and he makes you lie on your backs with your feet in stirrups. Honestly I feel this is a dangerous position to both mother and baby and would prefer a c-sec to this BUT even though my midwife isn't allowed to deliver breech babies I could totlaly see her "missing" that the baby was breech andnot noticing until it was too late to change plans/.

[Peppamint]

Originally posted by lilyka
There is only one Dr. in town (out of hundreds) and he makes you lie on your backs with your feet in stirrups.

Ugh! To me that seems like sexual assault, KWIM? So advantageous to the Dr., but not for the mother or baby!

Originally posted by coracle
A friend of mine who is a nurse-midwife told me that medical professionals (in the U.S.) have largely lost the art of delivering breech babies, that it is something the care giver has a feel for or not based on both training and practice.

That makes sense... Dr.s are so used to just giving a ceasar anytime that a birth doesn't follow the 'normal' procedures. :

[Peppamint]

Originally posted by hippymama2B
Breech is NOT a complication, it is only a different presentation.

Excellent Point!

[Chelly2003]

My DS was footling breech, my OB told me that if he had been anything other than that he would have let me go ahead and deliver him vaginally.

Chelly

[Viola]

With my first, my OB told me that a breech baby meant automatic c-section--no chance of a vaginal delivery.

There is only one midwife in Reno that I know of, and she only does homebirths. She delivered a footling breech of a woman in my playgroup.

[kpiperj]

My OB told me that a breech presentation means automatic c/s and I've found that this is the case for many OBs in SoCal. The liablility is just too high for them to attempt a vaginal delivery. They're even more adamant about a c/s if it's your first baby as your pelvis is unproven.

[MysticHealerMom]

my birth attendants seem to be uneasy about a breech. i'm not. but, i don't think we'll have to go there (positive thoughts...). i believe they indicated transport for breech. feh, i'd rather go unassisted. i've read some of the uc stories where they birthed alone w/a breech. they followed their intuition and stood/squat for the delivery. i believe it was footling, that's where the feet come out first, before the butt, right?

i read another story of a baby that wouldn't turn, and was born vaginally breech, and it turned out the cord was not only around the baby's neck, it was short, so it was close to the placenta at the top of the uterus, as the baby was coming out, the last thing was the head/cord and it was obvious at that point, the cord had to be cut before the baby was all the way out, there was resusitation involved, but not much. the baby couldn't have turned, and I can see how surgeons would be concerned about this - but, babies do stop breathing, and they have more than one mechanism for air - cord and lungs, so once the baby got out, it was a matter of stimulation and minor resusitation. the thing is, no one knew about this condition beforehand. it isn't likely that they would have been able to determine it. this is part of the inherent risk of childbirth - is it less risky to have a c/s? that's not minor surgery... I don't feel more confident in c/s than in the above scenario w/professionals who don't lose their head. or uc's who keep it together, too. birth is natural.

I hope I didn't scare anyone w/that story... I thought it was powerful, not scarey....



edit: keeping it together; um, do i need a disclaimer? i don't intend to come off insensitive, if it sounds that way... situations vary...

[shanetedissac]

HI!

My midwife will not deliver a breech baby. I'm planning a Home birth. There is a Dr. in the are who will deliver a breech vaginally but the way he requires you do it makes a c/s sound so much better. (operating room, flat on your back, epidural, huge episiotomy). I have seen vaginal births done naturally (on line) so I know that it can be done with a trained, experienced provider.

It is definetly something to look into. You always have choices!

Take care-

[Greaseball]

Why an epidural? And why not just allow tearing? I don't get it.

I still think I'd rather do that than a c/s, but I don't understand why it would have to be that way to begin with.

If the doctor is concerned about pain, like if he has to reach up and grab the legs, why not just a pudendal block?