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Please talk to me about natural breech births

(39 Posts)
Backgammon Tue 29-Jul-08 20:24:04

What are the advantages of a natural breech birth over a planned c-section please?

Am looking for advantages for the baby only (obv know about recovery for mothers from c-section).

Thanks!

NotQuiteCockney Tue 29-Jul-08 20:46:24

The baby's lungs get emptied of fluid more thorougly?

What sort of breech is your baby?

The big problem, these days, is finding MWs who are experienced at breech delivery.

daisydora Tue 29-Jul-08 20:54:45

Agree with cockney - if you can find mw's confident with breech delivery then it should be no different to a normal delivery iyswim. At least thats what I was told. The mw's at my local mw-led unit, were more than happy to come and deliver my breech baby at home! Unfortunately it never happened as she was doing the splits - one leg up and the other down.

Backgammon Wed 30-Jul-08 08:40:41

Bump.

milknosugar Wed 30-Jul-08 08:45:16

i had a section with my breech baby, we didnt really have time to go through the options so didnt make a choice. but while i was on the maternity ward a mw asked why i chosea section over natural birth, she didnt go into details but she said she would have been happy with a natural delivery, so there are some mw out there! try calling your hospital and ask them if there are any mw who would be able to talk to you. you will get loads of advice on here but you need a mw in your area for the actual event! good luck

Backgammon Wed 30-Jul-08 09:25:48

Thanks MNS I've got an appt with the consultant tomorrow to discuss whether I want a natural breech or a section - my hospital allows you to choose either.

I'm not desperate for a natural birth at all, but as it's an option I just want to know what the benefits to the baby would be should I choose that, as I have a feeling the consultant will probably just focus on the risks of each approach.

I won't feel cheated or disappointed if I don't have a natural birth, but if there's a reason it would be much better for the baby to do that then obv I will try to push for that.

reethi96 Wed 30-Jul-08 09:28:11

From what I have read a natural breech birth would be safer for you but is much riskier for the baby.

Backgammon Wed 30-Jul-08 09:47:09

Thanks reethi, that's what I thought, but a lot of people on here seem to have gone with natural breeches over a section so I wondered if there was something they knew that I didn't.

My feelings at the moment are that I want to do whatever is the safest thing for the baby, and if that's a section then great, no problem with that.

MarsLady Wed 30-Jul-08 09:50:49

AIMs Mary Cronk

More Mary Cronk

Hope these help. Wish I could say more but need to take DS1 shopping.

Tangle Wed 30-Jul-08 10:47:24

Looking at it from a different angle, what are the additional risks between a vaginal breech birth and a vaginal cephalic birth, and are they, to you, sufficient to justify a section?

IIRC, the main additional risk in a breech birth (assuming competent midwives, etc) is cord prolapse and the additional risk varies with presentation. For a frank breech (legs straight, feet by head) that starts labour well engaged there is little additional risk. As you go through full breech to footling breech the risk increases - although I've never managed to find any stats on how much it increases by...

"Breech Birth" by Benna Waites and "Breech Birth: What are my options" by Jane Evans are both well worth a look if you can get hold of them (both available from AIMS, but that may be too long for you)

milknosugar Wed 30-Jul-08 10:50:45

just remember a lot of consultants will advise you to go for a section where a mw would not necessarily, consultants see all the bad cases, mw see a mix. i was warned (by a very pro natural birth mw) that if i wanted a home birth it might be wise to stear clear of consultants. i would talk to mw aswell

Tangle Wed 30-Jul-08 10:52:12

Sorry - got dragged away half way through.

If you're talking to a consultant, make sure you're very clear on the distinction between natural breech birth and vaginal breech delivery/extraction. The risks to the baby (and you) of a vaginal breech delivery are higher than of a natural birth or a CS.

Additional "risks" that may be brought up are entrapment of the head (which just doesn't happen for full term, normally developed babies where labour is left to itself), and physiological things like hip dysplacia (which seems to be more linked to position in the womb than mode of delivery).

If I think of anything else I'll post again ;)

giddly Wed 30-Jul-08 10:54:15

As I understnd it it's not that there are more likely to be problems, but if problems occur then they are more difficult to manage. If the head (largest bit) gets stuck on the way out, the body is already out: the cord may get compressed, you can't use a ventouse / forceps or easily do a caesarian. It makes the whole thing much more of an emergency.
Have you already had a normal delivery?

SqueakyPop Wed 30-Jul-08 10:56:25

I've had a natural breech - no problems at all with it. I didn't need pain relief or stitches. Baby was well apart from a dislocated hip (from the pregnancy, not from the birth).

SqueakyPop Wed 30-Jul-08 10:59:13

Mary Cronk's website is excellent - it was what gave me the confidence to go ahead.

I was of the opinion that I would see how labour went. If it progressed smoothly, then great; if it stopped, then I would go straight to C-section. I would not have allowed any kind of acceleration or forceps. That is where the bad statistics come from.

Backgammon Wed 30-Jul-08 11:21:25

Thanks, I'm still favouring the section at the moment. It is my first and I'm pretty risk averse when it comes to the baby's safety. Plus, as I say I don't have any kind of emotional attachment to the idea of a natural birth.

BUT - if I can be convinced that a natural birth will be the best thing for the baby then I will obviously entertain it. TBH, I'm not totally confident that the staff at the hospital will be skilled/experienced in breech deliver but I guess that's something I need to discuss with them tomorrow.

Tangle Wed 30-Jul-08 12:32:50

giddly - one of the reasons why MWs that support natural breech birth say the baby should be normally developed and full term is because, under those circumstances, the baby's bum is pretty close in size to the baby's head. If you talk to MWs that have experience, they do not know of a single case (in the UK or other countries) in the last 40 years where a baby has got its head stuck.

SqueakyPop - another breech birth mum

The guidelines I was given were basically that you don't muck around with a breech - labour should start spontaneously (they wouldn't even give me a sweep) and progress totally naturally. If it doesn't start or doesn't progress thats telling you somethings not right and you go straight for a section. The breech's that have problems tend to be the ones where the HCPs have felt an urge to "help"

Backgammon Wed 30-Jul-08 12:47:31

Tangle, from what you say it sounds like you need to really trust whoever is caring for you to go for a natural breech. Did you have a homebirth or hospital birth? I'm booked for a hospital birth and haven't met any of the m/w's there so I'm not too sure how I feel about trusting them.

giddly Wed 30-Jul-08 15:55:22

Tangle: there was one recently (HB) in our trust sad. The College of Obs and Gynae also did a study that found aspyxia was the commonest cause of death in breech normal deliveries although is still *very very rare*. I'm not at all anti ND for breech with skilled midwife, but do think there are some different dimensions.

kazbeth Wed 30-Jul-08 19:05:27

Someone posted not long ago a link to some birth videos. One of them was a home footling breech birth. I was quite amazed at how calm it all was - the midwives were very hands off and the baby wasn't pulled or manipulated out at all. I always thought breech was very risky but it just goes to show what you learn on here. If you're interested in looking at it hopefully someone can provide the link again for you.

Tangle Wed 30-Jul-08 21:31:28

giddly - without knowing all the details I don't want to comment on your recent case, other than to say that whatever happened it must have been very sad for all involved . Do you have details of the study you mentioned? I'd be interested to see what their criteria were. My guess would be we're talking the same risk, and the asphyxia is caused by cord prolapse - I'd like to know though.

Backgammon - from talking to the MWs, the skill in breech birth is having the confidence to do nothing while things are moving forward and the experience to recognise when things have stopped progressing. I had a homebirth with IMs, although we were pretty well decided on both of those before DD was confirmed as breech. As others have said, it was a very calm and peaceful afair. DD was my first. I don't know that you actually need to have more trust for a breech birth than for any vaginal birth (one reason we were looking at IMs to start with was our CMW had dented our confidence in her and, by proxy, the CMW team), other than its so much easier to go into a vaginal breech birth with low confidence in your body's ability to do this due to all the scare stories around.

Its not an easy decision to make and it will inevitably be very personal to you and your circumstances. All that matters is that you are comfortable with the decision you make. You do not have to make a decision during the meeting tomorrow if you need time to think.

If you do want to follow up on the vaginal birth at the hospital after your consultant's appointment, call the supervisor of midwifery - in theory the consultants should know the score, but its always worth making sure the midwifery team are working off teh same hymn sheet. If they do have a small number of midwives with experience, it may be possible (and would be in their best interests) to make sure at least one will be available when you labour.

(Oh, and just in case the consultant is less enlightened than we currently have reason to believe, if they start quoting "research shows vaginal birth is less safe than CS", check what research they are referring to - its almost certain to be the Term Breech Trial published by Hannah et al in The Lancet {full text available for free if you're really interested} in 2000, and generally considered to be so flawed in conception, execution and analysis its not worth the paper its printed on.)

gothicmama Wed 30-Jul-08 21:43:33

I had natural breech with dc1 just been told by MW dc3 is breech so will have to check with consultant if I can have a naturla birth again hope so

Tangle Wed 30-Jul-08 21:54:42

gothicmama - why is it up to the consultant?

madmouse Wed 30-Jul-08 21:55:28

You will need a midwife with the confidence to be hands off. A breech needs to deliver itself, except for some guiding out of the head after the body is born. Some say that too much touching of the body can start the breathing reflex whilst the head is inside, but I have also seen that discredited.

When weighing up the risks you also have to ask at what point a csection would be done,as there is increasing evidence that early c-sections (38 weeks) give rise to breathing difficulties in newborns.

Rolf Thu 31-Jul-08 09:13:28

I had a natural breech birth - not by choice - the baby turned sometime between term + 5 and term + 8 so we didn't know she was breech until she started coming out. It was an unplanned homebirth, and was a lovely delivery.

My midwives hadn't done one for many years but they do have emergency obstetrics training every year, so they knew the theory and had practicsed on a dummy!

I hadn't done any research about breech deliveries so didn't know the issues between birth v extraction. One risk, as I understand it, with an extraction is that if you yank at the baby it will fling its arms up over its head and get stuck. I had an extraction but done very slowly and calmly and the baby came out easily (no distress, apgar of 8 at 1 minute). Although my midwives didn't have breech experience, they are very experiences, confident and competent midwives and were able to take things gently. IMO that's what kept me and the baby safe.

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