[MyBabiesCome1st]

I'm sorry but I don't completely understand the dangers of a vaginal birth with a breech baby.

A friend of mine is 38 weeks and her baby is breech and her doc is talking about doing a C section next week. I don't understand this b/c the only person I ever knew to have a breech baby delivered him vaginally and he was ok. I'm blessed I guess b/c my baby is head down (although I guess being only 34 weeks that could change for me) but why can't women have vaginal deliveries with a breech baby? What's all the fuss?

I'm sorry if that comes across as ignorant, but I honestly don't know what the dangers are and I'd like to know so I can offer my friend some sound advice.

TIA

 

[julie128]

The danger is that the baby could suffocate before being fully born. It is uncommon, but it happens. The bigger danger is that the parents will sue the OB if anything goes wrong, whether related to the breech birth or not. OB's aren't even taught how to deliver breech babies anymore. If your friend wants to give birth vaginally, she should find the oldest doctor that she can, one who was properly trained in attending breech births.

 

[lorijds]

My understanding is that the danger lies in the fact that, really, the head is the biggest part of the baby. So if the head doesn't descend first, it can get caught up on the cervix (if it isn't fully dilated) or the pubic bones, resulting in cord compression, fetal distress, and possibly death.

From what I have read and discussed, the dangers of complications of a vaginal breech birth *with a skilled practitioner * (ie, one who is comfortable with and has experience with breech birth) and the danger of complications with a c-section are about equal. However, most doctors aren't learning how to do them, and perhaps even more ominously, malpractice insurance and hospital lawyers aren't allowing them to be performed by doctors who *do* know what they are doing. Our doctor used to attend breech births at the hospital; now the hospital won't let her. The only way it can happen is if the mom allows no vaginal exams, and it is a surprise.

 

[applejuice]

The reason allso breechs are considered dangerous is because of the reason for the breech:

narrow pelvis
prematuity
poorly shaped uterus
placenta previa
hydrocephalis
short cord
any other birth defect that may not already be diagnosed.

 

[lorijds]

Good point, applejuice. Sometimes it is not the fact that a vaginal birth bum first is dangerous, but what caused the baby to prefer the breech position that is dangerous.

Our doc used to attend lots of breech births at home, all successful, all resulting in healthy, happy moms and babies. Once she was gone, and a mom went into labor and was breech. The midwife wasn't comfortable attending the breech without the doc available, so we sent the mom to the hospital, where she had a c-section. Our midwife scrubbed in and assisted. She said she had never seen such a short cord, and it was wrapped 3 times around the neck. She thought that the baby would probably not have ever descended, but if he had, the cord would have either broken, or he would have suffucated; either way, she is convinced we would have lost the baby, had we attempted a vaginal birth. Sometimes c-sections are the best. Hard to know until afterwards, though.

I firmly believe that someone or something looks after babies and moms. All the many other breech moms our doc used to attend never had any problems. The one that would have ended all our careers, not to mention ended the life of a beautiful little boy, went into labor when our doc was on vacations? Too much of a coincidence to take lightly. So, take heart. Your friend has someone looking out for her.

 

[pamamidwife]

Henci Goer has a great chapter on breeches in her Thinking Woman's Guide.

For a frank breech, feet up by the head, the risks of the head becoming entraped are very rare. Unless, of course, the baby is a preterm baby - preterm babies have bodies that are smaller than the heads. For a full term baby, most often, the legs and the chest dilate the cervix more than what is needed for the head.

The biggest risk for a breech baby is mismanagement by the provider.

 

[gremlin44]

And each breech position holds a different "risk."

A double footling breech (coming out both feet first) is a risk due to all the space available for the cord to drop through the cervical opening and become compressed between the legs and the body or tangled in the legs. Also, with the legs extended downward, it is much harder for the cervix to dilate and stretch fully to accomodate the baby's head as the last object to be delivered--in frank breech the large diameter and surface area of the presenting rear end and thighs helps to stretch the cervix more throroughly.

 

[gossamer]

I am reading a book right now about a woman who gave birth in the Netherlands and her daughter was full term and died from being breech. Her daughter was delivered by a midwife and suffocated five minutes before delivery. So there are risks to having a breech baby.
Gossamer

 

[JesseMomme]

I agree with pamamidwife. It sounds like the netherlands story surely must have more to it. If the cord is still pulsing, the baby is not going to suffocate, and a momentary compression of the cord is not a worry so long as the baby is on it's way down and out.

 

[hotmamacita]

Both of my twins were breech. The first was a frank breech. And the second was a footling breech. My skilled and ever wonderful midwife was calm and cool and handled everything, including complications smoothly and with medical professionalism.

I think it is dangerous to make blanket judgements. Your friend will have to trust her instincts and comfort zone. There may be some reason that she needs to be in the hospital that may not be evident until later.

However, it is foolish to say that all breeches are dangerous, imho. The care provider must be trained in all situations, regardless. I would be very uncomfortable with a midwife or a doctor who didn't know how to catch a breech or who wasn't well-trained for an emergency.

Peace and hope for Blessings on her birth,

 

[applejuice]

My mom went to the hospital for her fifth baby. My mom's four other babies were born at home, but this one was breech. It was 1961. She had a hard time then finding a HCP who sould deliver vaginally.

My sister was delivered vaginally, a frank breech. My mom came home immediately four hours after the birth. It was Mother's Day.

My sister however had a badly bruised neck on the right side from the rough management by the OBGYN. She developed a hematoma on her little neck from the damge to her delicate baby skin. She had the area operated on when she was five years old to straighten out the muscles that did not grow during the time it healed during the first six weeks of life.

There was no apparent reason for the breech. My sister just liked it that way.

MY mom went on to have four more homebirths.