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vaginal breech delivery after 3rd degree tear?

(16 Posts)
golemmings Mon 26-Sep-11 21:03:36

Advisable? Anybody done it?

Between DD coming out with her hand on her ear and me going for a sprint finish, and my being impatient and not waiting for contractions we made a bit of a mess of my perineum last time but the 3rd degree tear healed absolutely fine with no complications.

I'm currently 40+4 and today the midwife is concerned that baby might be breech. I had a scan at 36 weeks which showed it head down but its such a wriggly thing that it might have turned itself around. If its not breech, then its so deeply engaged that the squidgy bit you can feel just above my pelvis is shoulders rather than feet. If that is the case then it must be bloody enormous because it doesn't seem to have dropped at all and it's still living on my lungs (as well as using my bladder as a trampoline!)

I'm sitting here contingency planning atm. If it is breech, assuming that it can't be turned, what are the risks of a vaginal birth or do I jump straight for a CS?

Has anybody got any experience of this? Also - what is the likely time delay between diagnosis of breech and confirmation of CS date? I assume if a CS is necessary it should be as early as possible to avoiding labour starting naturally?

lollystix Mon 26-Sep-11 21:37:36

Has she arrAnged another scan for you to confirm if breech? I'd push for that immediately. Would you want to do breech vaginal or would you rather an ELCS?

golemmings Mon 26-Sep-11 21:58:24

Scan booked for tomorrow - and sweep for Friday to cover all eventualities. Not sure on choice between vaginal breech or ELCS. We're in Shrewsbury which has a low section rate anyway and staff are experienced with vaginal breech births but I'm not sure to what extent the previous tear would impact on it.

Tomorrow I get to ask lots of questions but the more info I can go armed with, the happier I'll be!

lollystix Mon 26-Sep-11 22:00:51

If they have experience of breech deliveries that's good. It would be the year bit that would worry me but they will advise on that I suppose. Bit of a dilemma - good luck xxx

lollystix Mon 26-Sep-11 22:01:17

Sorry tear not year - bloody iPhone

golemmings Mon 26-Sep-11 22:04:28

hmm... putting the concept of delivery and year in the same sentence worries me too!!

lollystix Mon 26-Sep-11 22:05:30

Lol grin a year would worry me too

smokeybacon Mon 26-Sep-11 22:10:49

Left with third degree tear after DS and nineteen months later had twins and delivered vaginally. Twin two was breach so it can be done although twin one had probably eased number twos passage a little bit iykwim blush I did have stitches but nowhere near as bad as the third degree one. Good luck!

Holdmyhand Mon 26-Sep-11 22:21:42

I had a vaginal breech delivery with Ds2 - undiagnosed breech til too late for cs. Birth was fine, very similar to head first delivery - just had a bit of gas & air. Midwives & consultant said they had little experience of vaginal breech - had room full of medical staff wanting to watch as they said vaginal breech so rare these days. In your position I would certainly want to know about experience of midwives / consultant.

Tangle Mon 26-Sep-11 22:57:08

Have you googled Mary Cronk? I had a (planned) vaginal breech birth at home with IMs for DD1 after doing a LOT of reading and thinking. IIRC the biggest conclusions we came to were that:

- Not all vaginal breech's are the same, and the language is used differently by different HCP's (This article by Mary Cronk summarises the two extremes quite nicely)
- The Term Breech Trial, published in 2000 and the basis for the recommendation for CS for breech, has been widely discredited - even its own authors now take the recommendations with a pinch of salt. Sadly the guidance hasn't changed...
- Vaginal breech is not intrinsically dangerous or foolhardy as long as you have HCP's competent and confident in vaginal breech.
- More recent and more robust research (IIRC it was called something like the PREMODA study and was undertaken in Paris in 2008?) found vaginal breech to be at least as safe as CS as long as stringent criteria were met.
- There is no research I've been able to find comparing outcomes for the birth approach advocated by Mary Cronk with a more medicalised vaginal breech or with a CS.

When we were facing the dilemma, we felt quite strongly that a CS was unnecessary. I'm not sure there was any particular reason for that other than instinct. One of the things that did feature strongly in our decision was that we could contract IMs with substantial breech experience who we felt we could put our trust in.

I don't recall coming across anything that said you're more likely to tear with a breech than with a cephalic baby - unless they start mucking around with forceps, etc. One of the reasons we wound up at home was that the vaginal breech experience on offer at our local hospital would have been very managed - and I wasn't up for that at all!

All I can suggest is that you read up on the different types of vaginal breech, ask as many questions as you need to of the MWs to be sure that you know what to expect if you choose to try a vaginal birth and then make the most right (or least wrong) decision you can for you and your family given the options available to you.

Good luck smile

Tangle Mon 26-Sep-11 22:58:33

Incidentally, I found giving birth to all 9lb 12 DD1 a much more comfortable experience than birthing her 6lb but cephalic sister. Bottoms are just much squidgier...

BeautifulBirths Mon 26-Sep-11 23:27:17

If your baby is breech and your labour starts and continues spontaneously then vaginal breesch would be a very real option for you. Google mary cronk and jane evans who are independent midwives very experienced in breech. I'd go for it but talk to your care givers and ensure they are confident. It is more natural and causes less problems if you birth a breech on all fours too. If you are needing induction for any reason or augmentation in labour (a drip to brng labour on) then even the most experienced midwives advise against vaginal breech. Good luck and enjoy your birth!

golemmings Tue 27-Sep-11 15:00:15

Thank you all. That's really helpful.

[edited]

I'm just back from the hospital. The baby is cephalic and is very deeply engaged which makes life much more straight forward but it was fabulously helpful to have been able to spend this morning reading your comments and following them up and I went in to the Panda unit with some views but a good handle on the questions I wanted to ask! It made me feel much more confident so thank you al!

Tangle Tue 27-Sep-11 22:13:26

grin

Glad you went in feeling prepared - but even more glad its now all irrelevant!

Fingers crossed everything goes smoothly for you smile

BeautifulBirths Tue 27-Sep-11 23:26:31

good luck. Have a fab birth!

golemmings Wed 28-Sep-11 09:54:27

Thank you!!

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