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Old 12-31-2006, 05:34 PM - Thread Starter
 
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I had a C-section with my 21 month old dd. It was scheduled because she was breech and the cord was wrapped around her neck. I wanted so badly to have a natural birth, but I had no choice, so I thought. Looking back it seems that way but did I have any other options? Breech with a cord wrapped around her neck? On top of that, after the surgery, my incision split open and I had a much longer recovery where I had to pack/ re-pack and clean the huge wound daily for weeks after the result of which is a huge deep thick scar. My previous doctor would not do a VBAC and said that they would cut out the old scar out and give me a new "pretty" one. I just changed doctors and the new one said the same thing, especially because I had so many complications and there's so much scar tissue. So, basically I am going to have a C with the new baby (due in August). My question though is, did I HAVE to have a C with my dd? I read so much on here about people who get C-sections and they are so vilified- especially when they're scheduled, but it seems there really was no other option for me. What would you have done?

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Old 12-31-2006, 06:19 PM
 
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I would have done the same as you. It's unfortunate--people used to be able to vaginally birth babies like your dd (I was breach with the cord wrapped multiple times around my neck and born vaginally--but that was in Colombia in the early 70s.) However, these days in the US almost no one does these kinds of deliveries, and it is very important to have an experienced, knowledgeable provider, since it obviously is a more dangerous situation. So, unfortunately, you really have no choice. I really hope you don't feel vilified here by what happened. Natural birth is a nice goal but it is not the best choice in all situations and I would hope that everyone here can recognize that.
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Old 12-31-2006, 08:49 PM
 
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I agree with PP -- I would have agreed to the C the first time too

YES, that birth could have been natural -- but i fear that you would have been in MORE danger trying to do it that way as provider now-days just don't have the knowledge, training, or expereince to do so ---- so that lack of skill would have put you in more danger with a vaginal birth than a bad C..........sorry it sucks, but i think it is turth.

If I was you -- I would be agreeing to the 2nd C to "clean up the old one" and also not to risk a VBAC when there doesnt' sound like any providers would be willing to try ti --- again, teh VBAC is most likly maybe safer than another C -- butttttt, again, if you don't have an expereince provider to deal with all the scar tissue and so on -- then the narual becomes more dangerous for lack of a good support..............again it sucks, but i fear it is true.

so -- yes i think you HAD to have the first C

and FWIW -- I support and agree with teh 2nd C.

Aimee

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Old 12-31-2006, 09:20 PM
 
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Yes, you needed your c-section. For all the reasons mentioned above. I am sorry you are being railroaded into another one, but there was just nothing you could have done differently the first time around. In all things, you make the best decision you can with the information you have available to you at the time, and so I tell even the women who were scared/pressured into a truly unnecessary surgery not to beat themselves up over it.

But a breech baby...almost no one does them vaginally anymore, and frankly even with a very skilled, experienced provider I would not have wanted to risk a cord-around-the-neck scenario. Nuchal cord isn't a terribly unusual complication, and usually not dangerous in & of itself, but paired with a breech (was she footling, perchance?), it's jus too much of a risk for me.

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Old 12-31-2006, 11:25 PM - Thread Starter
 
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Thanks for your responses! I had been really thinking about it lately and it's good to know for sure that I really had no other choice- not that that in itself is a good thing but good to know!


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Old 12-31-2006, 11:26 PM
 
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i think we all do well to remember that c-sections are not in and of themselves evil (no intevention IS) -- they can and do save lives......

teh miduse and abuse of any intervention is the problem.

OP -- be confidnet

A

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Old 01-01-2007, 03:40 AM
 
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Did you attempt the Webster technique before agreeing to the c-section? If you did not then I would not be able to say that the c-section was necessary. I hope you don't mind my honest opinion. Cord around the neck are not a contraindiction for Webster and Webster is highly successful. My breech baby flipped twice with Webster and ended up with a double nuchal and I had him vaginally. I believe he probably got the nuchal cords each time he flipped. So if there was one nuchal cord and she flipped head down and remained she would either unloop the current nuchal cord or end up with a double which usually causes no complications (or of course she could have also just kept the one nuchal cord and not gained another).

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Old 01-01-2007, 05:56 AM
 
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Originally Posted by Aimee21972 View Post
so -- yes i think you HAD to have the first C

and FWIW -- I support and agree with teh 2nd C.
:
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Old 01-01-2007, 01:01 PM
 
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Did you do everything you could to try and move her? The Webster (like erin-brycesmom suggested), chiro, accupuncture, spinningbabies, cold packs, swimming, a version? If you did and she didn't move, then yes it probably was necessary. Also, I believe first time moms get railroaded more frequently than others, so try not to stress about that. We are led to believe that docs know EVERYTHING and we know NOTHING, it's just ingrained in us, especially women.

As far as the second section, I'd find a midwife and have a HBAC. Or I'd keep looking for providers until you can find someone willing to support a VBAC.

If you x-post this in Birth Professionals, you can get some midwives opinions about whether you are a good candidate for a HBAC.

I had a feet-first breech vaginally.

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Old 01-01-2007, 02:24 PM
 
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My question though is, did I HAVE to have a C with my dd? I read so much on here about people who get C-sections and they are so vilified- especially when they're scheduled, but it seems there really was no other option for me. What would you have done?
Did you HAVE to? It's impossible for me to say. I would have made the same choice. I consider myself a strong advocate for normal birth. I'm planning my second homebirth in June...but there are scenarios for which I would schedule a c-section.

What I don't understand is why having complications from your cesarean birth indicate that you should have another one.

That sounds like fuzzy logic to me.

Typically, moms who had cesarean births b/c their babies were breech are excellent candidates for vbac. Since you cared for your wound yourself, I am assuming your belly skin incision is what didn't heal properly? Your uterus wasn't the issue?

Are you familiar with ICAN?

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Old 01-01-2007, 06:26 PM
 
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Well, one option would have been to wait and see if the baby would turn naturally (babies sometimes turn even in labor.) A scheduled section means not allowing that possibility. As others have said, another choice would be to try to turn the baby prenatally, although sometimes babies are breech for good reason and manually turning them increases risk, especially if the cord is around the neck.

Babies can be and are born breech with the cord around the neck, but I don't know the degree of increased risk solely because of that. I've looked and looked and can't find anything about it. Can somebody explain to me why a cord around the neck is inherently more risky in a breech than vertex birth? (I'm not saying it's not, it's just not obvious to me.)

As other have said, there is no way I'd attempt a breech birth with most practitioners. Few have been trained to attend breech, and many who have been trained have a particular hands-on approach that I think can cause more harm than it's meant to prevent.
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Old 01-01-2007, 07:42 PM
 
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I wanted to note that most practioners will not do ECV(versions) if there is a clear indication that the cord is wrapped around the baby's neck or appears to be short. Most babies are breech for a reason. I truly believe this and so to answer your question I think your first csection was necessary. I wish I would have made the choice to have a csection than try a version that endangerd me and my baby and landed us in the OR with an emergency situation.
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Old 01-01-2007, 10:10 PM
 
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My last baby was breech up until a few hours before labor began, and she was born with a nuchal cord. She had been breech for most of my pregnancy, and then about a week before she was due my water broke. I thought she turned head down at that point, because things felt so different in there, but I couldn't be sure.

Sure enough, she was born head first, with the cord around her neck....at home, as a UC. She was 13 pounds.

You do not say in your post when you knew she was breech, but as in my case, babies can and do turn before and during labor. I am glad she turned, but I was prepared to birth her breech at home, UC. So, for me I would not have considered a c section for a breech with a nuchal cord.

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Old 01-02-2007, 12:22 AM
 
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As a pp mentioned, I've not read anything about increased risk with cord around neck in breech. If it was a frank breech I would have attempted a vaginal delivery with a hands-off provider at home.

-Angela
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Old 01-02-2007, 12:25 AM
 
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Just speaking for myself, I would have driven to Summertown, TN., gone to the Farm, and consulted with Ina Mae first. My homebirth midwife did do breeches.

I was thankfully never in that position, however, that was my plan should things have been different.

"The great enemy of the truth is very often not the lie, deliberate, contrived and dishonest, but the myth, persistent, persuasive and unrealistic."
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Old 01-02-2007, 01:17 AM
 
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Babies can be and are born breech with the cord around the neck, but I don't know the degree of increased risk solely because of that. I've looked and looked and can't find anything about it. Can somebody explain to me why a cord around the neck is inherently more risky in a breech than vertex birth? (I'm not saying it's not, it's just not obvious to me.)
.
This is just my guess but if the baby comes head first and there's a cord around the neck it seems from what I've read it's fairly easy for them to reach up there and move the cord. By them I mean midwives, it seems OB's are more likely to rush into a c-section with a cord wrapped around the neck no matter how the baby is positioned. With a breech baby it might be more difficult to reach that far? And don't breech babies take longer to push out and have a higher chance of getting stuck once the shoulders come out? All of that could mean the cord is left around the neck longer than it would be if the baby was head down, at least that's what I would assume.

I really don't know either way if a c-section could have been avoided in this case or not. If it were me I would have to do A LOT of research before making a decision, What's done is done though. What I'm wondering now is, is a c-section really neccesary for your current pg? I'm not saying it isn't, I just figure that if I was in your shoes I would try to focus on the present. I had an induction with my first and regret being bullied into it by my dr, but what's done is done, all I can do is think about what I would do differently this time and be thankful I have a chance to do it again
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Old 01-02-2007, 01:56 AM
 
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I think there are always other options. Obviously there were in my case since I chose not to have surgery even though my babe was breech up until the final hours before labor.

Every woman must do what she feels is right.

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Old 01-02-2007, 03:01 AM
 
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Most babies are breech for a reason.
Just your opinion, not really factual. But, I happen to agree with you on that part of your opinion. IMO most breech babies are breech because of things like mother's poor positioning (sitting in recliners, laying back on the couch, poor posture, etc). I do not think that most breech babies are breech because they somehow needed to be. Thankfully we have a wonderful non invasive risk free solution - Webster .

~Erin
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Old 01-02-2007, 03:01 AM
 
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Originally Posted by fourlittlebirds View Post
Babies can be and are born breech with the cord around the neck, but I don't know the degree of increased risk solely because of that. I've looked and looked and can't find anything about it. Can somebody explain to me why a cord around the neck is inherently more risky in a breech than vertex birth? (I'm not saying it's not, it's just not obvious to me.)
If you picture the baby descending breech, and see the cord around the neck....

The cord is attached to the placenta, which means the cord would be going UP to the placenta, PAST the head....

The cord can get pinched between the head and the pubic bone as the head is passing through the pelvis.



FWIW....I do NOT agree there are always other options. I do agree that most babies are breech for a reason, but that attempting to turn them with non-forceful means is safe. I do agree that most breech babies can be born vaginally. I do agree that I would look for a midwife experienced with HBACs instead of the repeat c/s. (Asking a surgeon what they think you should do about surgery and you're going to get a surgery answer....to have it or not.)


Interestingly there is a correlation b/w nuchal cords of 3+times and genetic problems in the baby.
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Old 01-02-2007, 03:03 AM
 
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Just your opinion, not really factual.
Erin, why do you feel that is not factual?
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Old 01-02-2007, 03:56 AM
 
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Probably you did need to go with a C-section for your first baby, but in the existing medical climate, "is this Cesarean necessary?" isn't a straightforward question. I see the question in layers:
  1. A small number of C-secs are actually necessary to the baby's or mother's health.
  2. Some are necessary at the time, but only because bad management or excessive intervention made it necessary.
  3. Some are necessary, but could have been avoided with better prenatal care or management.
  4. Some are not physically necessary, but must be done because nobody is available who can safely attend the birth, as in the case of many breech births.

So "necessary" or "not necessary" are relative. I think a lot of the hostility against Cesarean mothers is just misdirected anger against the situation they find themselves in. It can be difficult to make an informed decision with the skewed information typically provided to pregnant women. When a doctor says surgery is needed to keep your baby safe, sometimes all you can do is accept his advice and hope for the best. Even if the doctor was wrong, that doesn't mean the woman's decision was wrong, if you see what I mean.
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Old 01-02-2007, 04:38 AM
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i think that 'necessary' and 'not necessary' are very relative. i also agree that there are always "options," and that all of those options carry risks, and that often those risks are varient, but of no greater or lesser risk per se. (that is, c-sections carry "these" risks, while breech natural births carry "those" risks).

i also agree that there are times when c-sections are absolutely necessary for medical reasons--whether emergency or scheduled. it is an important technology that any woman who feels/thinks/believes that she needs one should have access to. thus, i wouldn't 'forceably' (via laws, etc) keep women from them if she chooses one. i simply hope that it is an informed and freely-chosen course of action.

i do not know your medical history, your special needs, your baby's needs, the situation's specifics, etc. thus, i cannot answer whether or not *your* c-section was "necessary." with this, it would therefore be *highly inappropriate* for me to "villify" your c-section. so, i won't do that.

but, i suppose i can talk about myself and my thinking on this. i do know a bit about nuchal cord because one of my clients brought it up when i spoke to her about UCing (this is my prefered 'method' of birth. )

knowing myself and taking the assumption that the situation was only frank breech and a cord wrapped around the neck, in a first birth, and assuming that spinning babies, webster, and natural course of labor didn't change the situation, i would have continued with a UC (this is my plan--i'm neither pregnant nor do i have any children).

why? gentlebirth.org has an article about somersaulting the baby as it comes out breech with a wrapped cord to avoid pressure on the cord during delivery, to avoid it 'pulling' on the placenta, etc.

it seems like it often happens 'on it's own' (seemingly the baby 'twists as it comes out unwrapping the cord as she comes down) so a UCer could handle it, learn it, or figure it out--or simply bring in an experienced midwife to help. I trust myself enough to figure it out, yes, even in the heat of the moment. but, i won't know if there's a wrap until the birth begins, as i won't get an U/S either. but that's neither here nor there.

in the end, i would not have scheduled a c-section, but i would not have ruled out calling a midwife or transfering to a hospital for an emergency c-section if i felt strongly that it was appropriate.

for myself, i think that the risks of a scheduled c-section far outweigh the risks of a breech birth with nuchal cord at home UC or midwife assisted.

as for this second scenario, it is entirely up to you. it seems 'unusual' or 'strange' to me to consider a potentially dangerous surgery to a safe vaginal birth (i assume that you are healthy enough for one) simply to reduce the appearance of a scar. why not have a safe natural birth and save up for the simple, and far less dangerous to the baby and yourself, and likely far less expensive, plastic surgery?
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Old 01-02-2007, 05:38 AM
 
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Erin, why do you feel that is not factual?
Because there is no evidence to suggest a reason for most breech presentations. I mean, I guess everything is everything for a reason, but I'm assuming you were implying something there. Maybe most babies are breech just because they felt like it, which is a reason I guess but I know that isn't what you meant. Otherwise the comment was completely pointless.

~Erin
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Old 01-02-2007, 12:49 PM
 
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Just your opinion, not really factual. But, I happen to agree with you on that part of your opinion. IMO most breech babies are breech because of things like mother's poor positioning (sitting in recliners, laying back on the couch, poor posture, etc). I do not think that most breech babies are breech because they somehow needed to be. Thankfully we have a wonderful non invasive risk free solution - Webster .

~Erin
More and more women are discovered to have uterine anomalies, thus there babies are breech for a reason. Most of these babies get malpositioned because of the confines of the uterus -- and this is usually not discovered until time of delivery. Some babies are breech due to cord issues, placental issues, fluid issues, birth defects -- the list can go on.
I think its real easy for several posters in this thread to blame mothers for their breech mothers or to say the csection was unnecessary because they could have UCed at home. (which is dangerous with a breech birth, great for you if it was successful but it carries its own risks) Its easy to sit on a pedestal and look down at women for not having a natural vaginal birth on this forum and blame them because they didn't do XYZ. Not everyone wants to travel hundreds to thousands of miles to see Ina May or go it alone just for the sake of having a vaginal birth.
Also Websters doesn't always work nor is always available.
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Old 01-02-2007, 01:47 PM
 
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or to say the csection was unnecessary because they could have UCed at home. (which is dangerous with a breech birth, great for you if it was successful but it carries its own risks) Its easy to sit on a pedestal and look down at women for not having a natural vaginal birth on this forum and blame them because they didn't do XYZ. Not everyone wants to travel hundreds to thousands of miles to see Ina May or go it alone just for the sake of having a vaginal birth.
I'd like to further clarify my response to be sure no other mamas feel this way about me.

I do not mean to begin a debate on the merits of UC, but it is important to note that for a growing body of women, UC is a natural, safe alternative to more common ways of birthing these days. And, UC is not birthing 'alone'. Some UC mamas do birth completely alone, but often they are with a partner or family members. For me, breech birth was not an indicator that I needed a surgical birth. I also would not have considered hiring a midwife or physician since most these days do not attend breech vaginal births, and to be with someone without education on breech birth would be unsafe to me.

I try not to 'sit on a pedestal' about these issues, and nor do I look down on anyone for choosing whatever type of birth they feel is safest and best for their babe. The original poster asked the question: was my c section necessary, and that would be the only time I would volunteer a response. I don't think we can answer what is necessary or not necessary for her. We can only share our own experiences and provide her with examples of what we did or would do in that instance.

As I said in my last posting, every woman must do what she feels most comfortable with.

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Old 01-02-2007, 02:15 PM
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i've re-read my own post and those by other pro-UCers and i do not see pedastals, judgements, or any statements that mothers "must" or "should" do something other than what they did do.

to emphasize this point, i will reflect my statements with OnTheFence's statements--

OTF: they could have UCed at home. *snip* it carries its own risks

Me: i also agree that there are always "options," and that all of those options carry risks, and that often those risks are varient, but of no greater or lesser risk per se. (that is, c-sections carry "these" risks, while breech natural births carry "those" risks).

OTF: Its easy to sit on a pedestal and look down at women for not having a natural vaginal birth on this forum and blame them because they didn't do XYZ.

Me: i do not know your medical history, your special needs, your baby's needs, the situation's specifics, etc. thus, i cannot answer whether or not *your* c-section was "necessary." with this, it would therefore be *highly inappropriate* for me to "villify" your c-section. so, i won't do that.

I pulled this one out because i'm specificly not judging this woman or any woman who chooses to have a section or "non vaginal, non natural" birth because i do not know which factors that she is weighing or why.

similarly: in the end, i would not have scheduled a c-section, but i would not have ruled out calling a midwife or transfering to a hospital for an emergency c-section if i felt strongly that it was appropriate. and i also agree that there are times when c-sections are absolutely necessary for medical reasons--whether emergency or scheduled. obviously, i'm not against c-sections when freely chosen and necessary. so, i'm not judging any woman who would seek one (emergency or scheduled), and nor am i judging myself or considering myself some kind of "failure" should i choose to have one.

thus, i'm not judging anyone, and it's certainly not a 'pedestal' to assert what i would do for myself given the information of only two issues (breech position--unknown cause--and nuchal cord) based on the information that i do have. and, if that didn't work, then i would get whatever medical attention i felt was necessary.
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Old 01-02-2007, 02:56 PM
 
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More and more women are discovered to have uterine anomalies, thus there babies are breech for a reason. Most of these babies get malpositioned because of the confines of the uterus -- and this is usually not discovered until time of delivery. Some babies are breech due to cord issues, placental issues, fluid issues, birth defects -- the list can go on.
"more and more" certainly does NOT mean "most". Yes, there are sometimes reasons for breech presentation but I do not believe that "most" babies are breech for those reasons nor can you (or anyone) provide evidence that most babies are breech for these reasons which is why I say that is mere opinion not fact. Webster has an extremely high success rate without negative effect, which to me is a kind of proof that there were no medical reasons for those breech presentations. I drove almost an hour (sometimes 2+ hours depending on traffic) to get to a webster certified chiro, but it was worth it to me because I had a wonderful vaginal NCB instead of an ECV followed by induction or c-section. Webster is available to the majority of us and if there was more awareness and advocacy for it, it would be even more widely available.

~Erin
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Old 01-02-2007, 03:22 PM
 
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Originally Posted by OnTheFence View Post
I think its real easy for several posters in this thread to blame mothers for their breech mothers or to say the csection was unnecessary because they could have UCed at home. (which is dangerous with a breech birth, great for you if it was successful but it carries its own risks) Its easy to sit on a pedestal and look down at women for not having a natural vaginal birth on this forum and blame them because they didn't do XYZ.
The OP asked for input. She asked if her c-section was unavoidable, and since no one can say anything for sure about a specific situation, I think most of us were taking her question to really mean: can breech with cord around the neck be done vaginally? Is it ever done vaginally? What is the real risk involved? A lot of people responded with opinions that it is extremely dangerous and therefore she did the right thing, no question. Which is fine. But she wasn't just asking for support for her decision, she was asking for thoughts on whether there were other options, and ended with the question, "What would you have done?" I read nothing in the OP about responses to that question being welcome only if they don't involve talk about UC. Further, NO one said that her c-section was unnecessary. NO one is saying she made the wrong decision for her. To accuse someone of "sitting on a pedestal and looking down on women for not having a natural vaginal birth" just because they would make a different decision than you is nothing more than a bullying tactic. If you have information about why a breech with a cord around the neck is especially dangerous, great, I'm sure we'd all love to hear it. But the attacks are really out of line.
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Old 01-02-2007, 03:41 PM
 
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Originally Posted by mamaverdi View Post
The cord can get pinched between the head and the pubic bone as the head is passing through the pelvis.
Okay. But that's true for breech birth in general. How does the cord being around the neck complicate that?
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Old 01-02-2007, 09:41 PM
 
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Most of those perceptions of hostility towards women are completely misdirected anyway. Any hostility is towards a system which puts women in the position of feeling there is no choice but to submit to unnecessary surgery (and then call it "electing" as if there was a choice) with it's considerable and welldocumented attendant risks. The only hostility I'm seeing is the usual mainstream desire to promote some kind of division between women instead of looking to the sentiments expressed which are patently clear in their meaning. If it makes us uncomfortable perhaps we need to look to ourselves first.

As others have said, caesarean is far more risky than vaginal birth except in some very rare cases. Breech has become pathologised in recent years for complex reasons but inescapably the nexus of commerce and misogyny that drives obstetrics cannot be ignored. Bearing in mind that we have survived and thrived for millions of years even with a small percentage of babies choosing breech positions, it seems odd that this one position is now regarded as scary beyond belief and surgery that kills healthy mothers and babies is the norm. We are seeing this creep into obstetric perceptions of posterior presentations now so let's not pretend that obstetric control of women's bodies doesn't exist and that women are choosing freely to have surgery.

The OP is in a growing band of women who are questioning, and rightly so, whether or not surgery was their best option. Sadly, of course, we can't predict who will genuinely need surgery in the course of a labour but we can be sure that without the poorly evidence practice which obstetrics has recently become, far fewer of us would be scarred. It's painful stuff, Avocado, and I wish you much peace when you complete your healing journey. It's interesting to me how a c-sec is apparently no big deal when it's recommended but the next time you want to have a baby it's suddenly a huge deal that you had surgery last time - unless you're choosing evidence based care this time and avoiding surgeons and hospitals.
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