How to decline a breech delivery? - Mothering Forums

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#1 of 15 Old 06-11-2012, 09:04 AM - Thread Starter
 
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Hello wise mamas,

So I have spoken a few times with my midwife and she has sort of jumped over the breech discussion. Obviously, she is not wanting me to focus on baby being breech (transverse really) and I understand the "we will cross that bridge when we get there" mentality. However, it has been mentioned that if baby is in a breech position at delivery that I could continue to have the homebirth. Perhaps she said this for my own benefit, not sure, but I have decided that I am not comfortable delivering a breech baby at home. 

How can I speak to her about this without insinuating that she is incompetent? It has nothing to do with her skills, it is my own fears I don't trust. Also, since she doesn't really want to discuss it, how can I speak with her about it when I am only in the beginning of third trimester. I don't want her thinking I am obsessed with baby being breech, I just want to discuss things frankly.

 

Thank you

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#2 of 15 Old 06-11-2012, 11:14 AM
 
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i would let her know at your next visit that you have decided if your baby is breech at the time of birth that you are most comfortable with a hospital birth, and emphasize that that is your comfort level and has nothing to do with your midwife. how many weeks are you now?


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#3 of 15 Old 06-11-2012, 11:38 AM
 
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And if she doesn't listen to your desires/comfort level, that's a red flag. Make sure she will support your decisions. It is your baby & body. A true professional will understand that it is not about her.

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#4 of 15 Old 06-11-2012, 02:29 PM - Thread Starter
 
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Thank you both. I am 31 weeks. I have it written down to speak with them, and it felt good just to write it down. I have a hard time "causing waves" so to speak.

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#5 of 15 Old 06-11-2012, 06:39 PM
 
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My guess is that she's trying to help you focus on other things.  I don't know the percentage of breech babies but I imagine it's pretty low and probably not something to worry all that much about. For the record, I wouldn't have a breach baby at home either...but I would have crossed that bridge when it came, like your MW said. 

 

If you're worried about breech, have you considered doing some optimal baby position work like on Spinning Babies? 


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#6 of 15 Old 06-12-2012, 03:17 AM
 
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"How can I speak to her about this without insinuating that she is incompetent? It has nothing to do with her skills, it is my own fears I don't trust."

 

You shouldn't have to feel apologetic about not wanting to engage in high risk obstetrics (breech) in a limited resource environment (the home). 

 

The fact that she is offering you a breech delivery may indicate that her willingness to accept risk and your willingness to accept risk are not aligned. 

 

I would use this issue as a jumping off point to have a serious discussion about what your risk tolerance profile really is and to make sure that both of you are on the same page.

 

Also -- you should never have to worry about hurting your health care provider's feelings!  You are advocating for your well-being and the health and welfare of your child!


I support homebirth that meets the qualifications set forth in the AAP's 2013 policy on homebirth.

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#7 of 15 Old 06-12-2012, 08:58 AM - Thread Starter
 
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Feeling more confident in bringing it up. Thank you for the advice.

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#8 of 15 Old 06-15-2012, 08:09 AM
 
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Originally Posted by poppylove View Post

Feeling more confident in bringing it up. Thank you for the advice.




I'm really glad you are feeling better about it. Like BuzzBuzz said above, you should not have to feel badly. Don't worry about hurting her feelings, your sense of peace is more important than worrying about being "polite".

If I were feeling nervous about bringing it up, here is how I would do it:

"You know, MW, I have been thinking a lot about my homebirth and about the baby's position. I've been trying to release my anxiety about it and I have come to realize that the reason I keep thinking about it is because I'm really not comfortable with birthing a baby breech at home. Realizing that I am okay with having to go to the hospital birth in the case of baby remaining breech has made me feel a great deal of relief and I think I'm ready to just let go of it and focus on just being happy and healthy for the rest of my pregnancy. I know the baby will turn, so it's not a big deal...but I wanted to let you know that I have decided for sure that if the baby were to remain in this position, I would like to go to the hospital. What are is your experience with OB shadow care and would you be able to assist me in a hospital setting? Etc Etc.

 

Don't ask her how she feels about you going to the hospital. Announce that you've decided that if the baby stays in a crappy position, you'll be going to the hospital and make her understand that it makes you feel much better to know that the option to have a hospital birth if you want to is what makes you feel most at peace.

I bet you anything she is just assuming that your preference would be to stay at home and that she will be perfectly okay with you deciding you want to be in the hospital...I bet she won't be hurt at all by that because, if she is a good birth worker, she wants you to be where you feel most peaceful and cared for/safe.

 

Good luck. You know that baby is going to turn into a super perfect position for you, right? 31 weeks is super, super waaaay before you need to be worried!! Baby will turn! Turn baby, turn!


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#9 of 15 Old 06-15-2012, 09:38 PM
 
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i totally get your hesitation, i'm not sure i would have felt comfortable birthing a breech baby at home. although i wouldn't have been comfortable getting sectioned either, so it's kind of a draw for me. Just to throw it out there, if you do some research, you'll see there is insufficient evidence to show that a c-section is actually safer than a vaginal delivery in breech presentation. Most hospitals don't do it simply because nurses and OBs aren't trained in it anymore - OBs are trained surgeons, and performing a c-section is just modus operandi for them. the ironic part is that it's major surgery with many possible complications - including long term. Experienced midwives typically have delivered breech babies vaginally. In any case because it's an abnormal presentation it brings up a lot of other issues. I agree with the posters who said your MW will probably be fine with it, she most likely just wants you to be comfortable with your birth. 


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#10 of 15 Old 06-16-2012, 09:23 AM - Thread Starter
 
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Thanks Begonia and Broody. 

I didn't end up speaking with her. I guess when I posted this I was going thru one of those hysterical pregnancy moments, that I try to avoid. Nonetheless, I have made peace with speaking to her about delivering in the hospital IF it comes to that. I definitely don't want a section either though, so I guess I still have some research to do on the topic. 

 

I know it is early, so I am not worried about baby being malpositioned yet, I was mostly worried with my ability to express myself. So thank you for all the great advice. Much appreciated. 

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#11 of 15 Old 06-16-2012, 11:23 AM
 
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first of all, you're at a point where baby is moving around a whole lot, before settling into a head-down position.  i imagine that your midwife was trying to assure you that you were not going to "lose" your homebirth. 

your baby is very likely to flip.  most do, i think you might begin to suppose otherwise at week 36-37.  even then, some babies flip at the very last minute.

 

are you using a doula?  i think that doing that, even with a midwife, might help you with your discomfort of self-advocacy.  some people really don't like to speak up, for whatever reason.  make your true wishes known to your doula.  think through every option. 

maybe even write down your ideal plan and contingencies or desires- whether you do employ a doula or not.  many people who have difficulty saying things out loud feel more comfortable writing things down.  include your what if's.  if the baby is breech at 39 weeks, then you're no longer willing to consider a homebirth but would like to use that midwife in hospital, or whatever you envision. 

 

as far as the midwife's receptiveness goes- it's her/his job to inform you of the risks associated with different things and to be flexible as far as what you want.  it should not hurt her/his feelings if you state that birthing a breech baby falls outside of the risk you're willing to take or your comfort zone. 


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#12 of 15 Old 06-16-2012, 12:38 PM
 
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Originally Posted by poppylove View Post

Thanks Begonia and Broody. 

I didn't end up speaking with her. I guess when I posted this I was going thru one of those hysterical pregnancy moments, that I try to avoid. Nonetheless, I have made peace with speaking to her about delivering in the hospital IF it comes to that. I definitely don't want a section either though, so I guess I still have some research to do on the topic. 

 

I know it is early, so I am not worried about baby being malpositioned yet, I was mostly worried with my ability to express myself. So thank you for all the great advice. Much appreciated. 




Hey I'm glad you are feeling better about this!

I TOTALLY know what you mean about weird pregnancy hysterics! Happens to the best of us. It'll all be okay. Don't worry about feeling slightly anxious when it comes to bringing things like this up with your MW, a lot of people feel that way. <3

You know what I find really busts down walls of insecurity and anxiety in social situations? Total and complete, radical honesty. Next time you are in front of her just throw yourself face down into a conversation about this feeling you have...just come out of nowhere with it, blurt it out!

 

"Oh man I just have to say this I totally don't know exactly how to tell you when I disagree with something you say cause I think you're so awesome and I don't want you to feel like I'm questioning your skill or thinking you're dumb and I don't want YOU to think I'M dumb but I was totally going around in my head when we were talking about the breech thing and I would really prefer being in a hospital if the baby stays breech but not because of you, just because of my comfort level and ohmygod it was making me so nuts but I didn't say anything because I didn't want you to take offense. There, I said it"

...and then just watch her sit back and laugh and be like "dude, you are so funny...so many ladies have said this to me...it's okay, you don't have to worry about hurting me. I'm glad you told me" - and you can both laugh together.

Opening yourself up, being completely honest and just letting the beans spill, is sometimes the best way. It gets everything out there and will INSTANTLY deflate the intense bubble of worry you built up about the issue in your mind. It breaks the ice and makes for very good, very honest communication. It will bring you closer to this woman and most likely will make for a better birthing experience. My midwife is someone I am always intensely honest with...and we have built the most wonderful friendship around that honest, genuine way of being. I just delivered my third baby with her....I love this woman...really and truly..and that love and trust and friendship is totally built on honesty and the ability for our relationship to withstand emotional situations and testing. She will be a friend to our family for a long time. That's really nice for us, for my kids and for her family too.


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#13 of 15 Old 06-18-2012, 11:54 AM
 
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1. If you show up to the hospital breech, unless its like some amazing rare place AND you already have been there for two ultrasounds and an MRI, the only thing they will do is slice into your abdomen and c-section you.

2. about 1 in 30 babies will be in some sort of breech position when labor starts

3. yo can try to turn the baby but that doesnt always work

4. I figred I lwould "bring that up" later with my OB for DD.  When I showed up at the hospital, a c-section was the only option they would "let me choose."  Recovery was awful.

5. The risks of serious problems with breech birth are about 0.9% and if your midwife is skilled in that area, that's incredible.  Because its hard to find people who know how to do it, its a rare skill.

 

Just my two cents, but please please please 

 

RESEARCH THIS NOW and decide while you aren't in labor.  You seem to have choices still, and eventually, might not have that luxury.  I didn't.

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#14 of 15 Old 06-19-2012, 10:42 AM
 
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I second doing the research on hospital policies on breech babies before you make your final decision.  Most likely baby will turn in the next few weeks, but if not, you can make an informed decision.  The hospital here is automatic C-section for breech, but homebirth midwives are not legally allowed to deliver breech babies at home (here).  Thankfully my 3rd (and easiest birth) was a surprise breech (he was smart enough to turn head-down just for midwife visits apparently!) so I was able to have my low-stress homebirth and not have to worry about refusing to go to the hospital for an unnecessary C-section.
 

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#15 of 15 Old 06-19-2012, 10:47 AM - Thread Starter
 
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Caedmyn, that's really cool you were able to deliver him at home. Was it more challenging then "optimal" position actually pushing? Did you know he was breech in labor?

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