I found out my baby was breech at 38 weeks.
Those last two weeks, I was completely undone.
Here is what I wish I had known.
I've spent the last 5 years studying and talking to professionals about breech. This is everything I have learned, put together to help you make decisions about your breech baby.
Do you need someone to walk you through what to do now that you know your baby is breech? Are you a birth worker who would like to be able to share well-rounded information with your clients?
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Can you have a natural birth with a breech baby?
Recent studies show that vaginal breech birth is just as safe or safer than cesarean breech birth; there are risks with both. Some researchers say that if you have an appropriately sized pelvis, there is no increased risk for mom or child. Some breech positions (extended or frank breech) are more suited to vaginal birth than others. Without regard to position, most obstetricians order an automatic c-section for a breech baby. Very few will agree to a trial of labor and even fewer will feel good and confident about doing it. Though there are some. Among midwives and in general, a CNM is less likely to feel good about an out-of-hospital breech birth than a CPM. Many breech babies are born safely and without incident at home. Some are born unassisted (UC). The foremost vaginal breech birth practitioners (doctors and midwives) tend to agree that it is a higher-risk birth and that having an experienced, confident caregiver is the best way to assure success. Your chances of finding this kind of care are largely a geographic lottery.
ACOG says that if elective cesarean is an option, in spite of its inherent dangers, so must elective vaginal delivery be an option.
Is vaginal delivery safe?
It seems that the evidence-based professionals who are reviewing studies and writing mostly say: Yes, though it depends.
1. Can you find a confident, skilled, experienced provider (doctor or midwife) to attend you? and
2. How many of the risk factors do you have?
If you have a provider or can get one and don’t have a risky position or additional complications, the short answer is that it has every likelihood of being safe.
In a recent study, researchers compared outcomes for planned cesarean and planned vaginal birth for breech babies among 8,105 women in France and Belgium. In the planned vaginal birth group, 71% were successful. No significant differences were noted in outcomes between the vaginal and cesarean groups.
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Cesarean is also more risky for breech babies.
A little known fact is that a cesarean does not remove all the danger of breech birth. It is safer to come out head-first, no matter whether it is an abdominal or vaginal delivery. Your baby still has to be squeezed and maneuvered out of a small hole, it is just quicker and more managed with a cesarean. Baby is still at an increased risk for injury by virtue of being breech. For example, a vertex cesarean has a 1.9% chance of being cut during the operation, a breech baby has a 6% chance of this laceration.
Babies born by cesarean are at risk for fetal hemorrhage, lacerations, fractures, nerve injuries, head entrapment, and always have a greater risk than vaginally-born babies for infection and respiratory distress.
The problem is that so few people have the skills.
Even thought the "skills" needed most often for safe breech birth are to keep your hands off the baby, it's important for the attending caregiver to feel confident and have some maneuvers in her back pocket. In many parts of the world, and to some birth professionals here in the US, a breech birth is just a variation of normal, a reason to pay closer attention but not a reason to fear. But in a lot of the western world, vaginal breech birth is under serious scrutiny. Because there is an increased risk, and most obstetricians are cesarean-happy and over controlled by the medico-techno-legal system, breech delivery skills have all but disappeared from the training. Here is what Ina May Gaskin, the nation’s foremost midwife has to say about it in her book Birth Matters:
I find it sad that obstetrics has been so dumbed down in the US that few doctors are taught anymore how to deal with a vaginal breech birth. They especially fear the case in which the baby’s feet present before its head. The very prospect frightens many because they have never witnessed a breech birth. ...What astounded me was the speed of the change in the very content of the obstetrics curriculum. When I learned that the reason for such a change was insurance companies that began threatening teaching hospitals during the seventies and eighties that they would deny them malpractice coverage if they provided opportunities for residents to witness a breech birth attended by an experienced practitioner, I had to wonder if doctors of the future would ever regain such skills. …. I know of at least two maternal deaths that happened in recent years in the US because of fear and ignorance surrounding vaginal breech birth. In both cases, the physician chose a C-section because of presentation. In one case, the mother died from hemorrhage during the emergency C-section performed for her second twin, whose feet presented, along with the umbilical cord, after her first baby had been vaginally born. This is the one case of umbilical cord prolapse that it NOT dangerous, because it doesn’t pinch the cord between the baby’s body and that of the mother, and a footling breech born with “the door already open” should be easily accomplished if the doctor or midwife is not petrified with fear. In effect, a mother of eight died because of ignorance that was imposed on her doctor by the insurance company. I find this intolerable. p.114-115