Vaginal birth for breech baby?

[frogs]

With all the hoohah in the news and on these boards about Caesareans, I wondered what other Mners would feel about having a vaginal delivery with a breech baby?

I faced this with dd2 who was discovered to be breech at 36 weeks. I had a very balanced and sane discussion with a consultant who said that I was potentially a good candidate for vaginal breech birth, since I'm 6 ft tall and previously delivered two big (9lb+) babies without any problems. BUT he warned me, with commendable honesty, that vaginal breech births were becoming so rare that midwives and doctors were losing the skills to carry them out successfully and that other consultants would be much more likely to push me towards a CS.

In the event, I had a successful ECV (turning the baby). Interestingly, the doctor who carried this out was Dutch and said that in Holland the protocol for breech births is to go for normal labour in the first instance, going straight to CS only if things don't progress straightforwardly. Presumably Dutch women and babies aren't so different to British ones, and their Drs read the same medical journals as ours, so the diffference must be primarily cultural.

For people who'd be happy with a Caesarian, this must be a total no-brainer, but there must be others like me who feel strongly that they'd prefer to avoid a CS if at all sensible. What would you have done?

[lazyeye]

My friend has just had her 3rd boy by cs after discovering it was breech. She had 2 previous vag deliveries. Not only was the baby breech, but it was in a sort of pike position, with its bum coming first and the legs underneath if you get me. She was told the 2 pple who perform the EVC - turning thing were on holiday so it wasn't an option for her. She had also heard so horror stories re the turning proceedure......I think the position it was in entirely ruled out a vag birth......

I'm currently 32 wks pg and was told at the 28 wk check that currently the baby is obique. Of course it has time to turn......I think you were brave to go for the the EVC. I think if this baby doesn't move, I'll be going for a CS. I don't fancy the turning somehow, and can't they turn back anyway??

[wilbur]

Very interesting to hear about the Dutch way of doing thing, frogs, sounds very sensible. In that situation, I would go for a normal labour but be very much prepared for a c-section at the first hint of anything being amiss. I do know an ind m/w who has delivered breeches at home and they have been absolutely fine, but I would probably not be that brave. It's a very great shame that m/ws are losing the skills to deliver breech babies - it must have been quite common in the past. My feelings about this are compounded as both my sister and I were breech babies (sis was footling and me bum first) and my mother got us both out using pethidine and a clued up obstetrician.

[bundle]

my sister had her daughter by c/s because she was breach, she was delivered at 38 wks and weighed less than 6lbs, so I think she could have done with staying inside for a bit longer. she wasn't given much option really, she lives in Yorkshire and I'm not sure what the maternity services are like. it's refreshing frogs that at least some doctors admit that part of the problem lies in a loss of skills because of fear of things going wrong. I've had 2 c/s now for different (medical) reasons but went for a vaginal birth both times.

[frogs]

The ECV was absolutely fine, I would have no hesitation in recommending it. The most unpleasant part was being on a drip that makes you feel a bit shaky and hot, but the actual turning took a couple of minutes at most and was uncomfortable, but definitely not agony. After that they turn the drip off and monitor you for half an hour, and you go home.

I'd heard all the stories about babies turning back too, but they told me that less than 1% of babies turn back once the ECV has been successful. I had the distinct feeling that dd was more comfortable too once she was the proper way up, there was much less rolling and fidgeting.

[frogs]

hi dino -- I do hope yours isn't breech, it's v. uncomfortable having a hard little head wedged up against your ribs...

The independent midwife was part of my plan B I was hoping to find someone who would go into hospital with me and prevent it all turning into techno birth nightmare. I don't know how the politics of it would have played out at the hospital mercifully I never had to get as far as exploring that. A home breech birth like wilbur mentioned would be WAY beyond my personal risk tolerance zone.

[boingyzebra]

Frogs: The protocal that you say the Dutch doctor who did your ECV described -- that is exactly the advice that I have heard on the homebirth list. Take it as a trial vaginal, no interventions, and straight to C-section if there's failure to progress.

So, I guess that's what I would do. ECV carries a 1-2% of placenta abrupture (no thanks!), and breech babies can turn as late as when you're already in established labour (this happened to a friend's 2nd twin).

[Zerub]

My midwife said that dd might possibly be breech at the 38 week check, and booked a scan - mostly to confirm that she wasn't breech. I was all set to come home again after the scan; if dd was breech I was going to wait till I went into labour. If she was still breech at that point I'd have given up the idea of a homebirth and tried to deliver vaginally in hospital, being prepared for a cs as Wilbur said. The NHS midwives weren't confident that they could cope with a breech homebirth.

And then when they did the scan, they said, oops, she is breech and she is feet first. She might push the cord out. You've got to stay in hospital and have a cs tomorrow! So that scuppered that. I'd love to know whether they were right or just scare-mongering - does anyone know? ie what are the risks of cord prolapse with a footling breech - would I have been ok to give dd a few more weeks inside and a chance to turn?

They didn't want to let me try vaginal birth in case dd's feet started to come out before I'd fully dilated. And they wouldn't do ECV cos I didn't have enough fluid (they could have prepared me for a cs and then tried the ECV though couldn't they?).

[Freddiecat]

I also have a breech baby now (30+ weeks) and although everyone says plenty of time to turn I am still worried as I know DS turned at 18 weeks.

I think my plan is if the baby is still breech in the last few weeks to try moxa sticks and then go for a vaginal delivery if possible. Like the dutch doctor said though, I want to go straight to C-section if there are any problems. REALLY don't want a C-section but even more do not want to risk myself and baby with it getting stuck.

Thing is DS was ove 9lbs and 10 days overdue. I am being scanned to check this one is not going to be too much bigger as I think they'll induce me early if it is. I also have a minor cardiac condition (which caused no problems last time) so might have all choice taken away anyway.

Good luck with your baby's turning lazyeye and dinosaur - perhaps we need to scrub more floors!

[Heathcliffscathy]

frogs, in holland i think the stat for homebirths is 66% (i.e. this is the norm and you only go to hospital if there is a problem or you want to). they also have same midwife through whole process...sigh.

[miserlyzebra]

Zerub: Far as I understand footling breech is considered one of the worst types of breech, the one where CS is most advisable, but I'm not that sussed up on it.

[frogs]

Zebra -- I asked about the abruption, being aware that they do the ECV on labour ward so they can go straight to section if a problem arises.

They said they do a couple of ECVs a week, and the last time they had to do an emergency Caesarean was 4 years ago. This was a major London teaching hospital which obviously has a very established protocol for ECV -- I would imagine that the likely success rate would vary according to the experience of the people doing it.

I've become quite evangelical about ECV, as lots of people who'd never had one were queueing up to tell me horror stories beforehand (thanks, guys!) The reality wasn't anything like that, and enabled me to have a completely straightforward delivery with never a stitch in sight. Can't be bad...

[SpringChicken]

Glad i found this thread. I am currently 29+4 and was told at my last 2 anti natal visits that the baby is breech.

Midwife did assure me that there is still plenty of time for the baby to move but if the baby is still breech at 36 weeks then it is time to look into the options available.

Isn't it strange how you pressume everything is going to go as it should - i always skipped past the bits in the books about c/sections and breech births as i never thought it would happen to me.

[Zerub]

SpringChicken, here are some stats you might find encouraging!

at 28 weeks - 25% of babies are breech
30 weeks - 17% are breech
32 - 11%
34 to 36 - 5%
37 to 40 - 3.7%
from Holistic Midwifery by Anne Frye

So its not unusual that your baby is breech at the moment, and your chances of baby turning by itself are very good.

[frogs]

SpringChicken, you might also want to know that if you go the alternative medicine route for turning a breech baby (acupuncture, chiropractic, reflexology) they are most effective before 35 weeks, and are don't work instantly, ie. you want to start well before 35 weeks.

Most reports on the effectiveness of these techniques are pretty positive, although none of it worked for me. Was 36 weeks by then, though.

[AlanP]

Two of ours were breech, dw was advised to lie on the floor with her hips on the sofa thereby keeping baby higher and allowing them to turn. Success both times, may have turned anyway but who knows?

[lazyeye]

Oh can you expand? I can't quite visualise "lie on the floor with hips on sofa" - sounds hard, but will try anything.....

[miserlyzebra]

I think anything that gets your hips higher than your knees is supposed to work -- handstands in the swimming pool, kneeling with your elbows in the floor and your bum on a settee or the stairs, etc.

[SueW]

There are two midwives who are trying to re-introduce the skills and confidence necessary to deal with breech babies - Mary Cronk and Jane Evans.

They are running workshops around the UK for professionals involved in maternity care.

[tamum]

I don't really want to be a scaremonger, but I guess how painful ECV is depends on how badly stuck the baby is. I had it with dd (my second), and it was honestly as painful as the worst contractions I'd had when I was in labour with my first baby. I was totally unprepared, and would at least have thought twice about it had I known. I would probably still have given it a try, but at least I would have been prepared. It didn't work, BTW.

[gothicmama]

I had a natural delivery of my breach baby - she was undiscovered breach until week 38 and by the tim eI got to go for them to try and turn there was not enough room / water to turn in, I was adament that I didn ot want a general or a c section and luckily the consultant and trainee dr managed the delivery It was daunting afterwards as she had to go be warmed up ( allthat hanging around whilst the head came out last but it was fine

[midden]

I had a ECV with my second baby (dd) and the turning lasted about 20 minutes and was successful. So glad as I was booked for a home birth and wanted to avoid CS at all costs. I am horrified to hear that women are not being offered ECV or told the doctors who perform them are on holiday - I went on to have a very enjoyable (very quick 2 hours) birth and it makes me angry that other women are denied that chance. Staff were supportive about a breech vaginal delivery in hospital too though, if I had taken that option.

[midden]

I had a ECV with my second baby (dd) and the turning lasted about 20 minutes and was successful. So glad as I was booked for a home birth and wanted to avoid CS at all costs. I am horrified to hear that women are not being offered ECV or told the doctors who perform them are on holiday - I went on to have a very enjoyable (very quick 2 hours) birth and it makes me angry that other women are denied that chance. Staff were supportive about a breech vaginal delivery in hospital too though, if I had taken that option.

[AlanP]

Expanded version - apologies for delay.

Lie on your back on the floor.
Put your legs on the sofa and thry to move your hips as far as possible onto the sofa.
20 mins recommended.

[Gumdrop]

My midwife had me shuffling up and down on all fours with my head close to the floor like I had dropped a contact lens for ten mins a day - worked, but a really odd feeling when dd seemd to give huge heave and rotated!

Good luck