Vaginal breech birth?

[QueenofDreams]

I'm just curious about opinions on this. This is only triggered by having seen a breech birth video on youtube, and there are a lot of comments about medical professionals being too quick to suggest c-section for breech babies. What does the mn jury think?

My DD was breech- I wanted a cs, so I was fine with that. The risks were more 'known' IYSWIM, and I felt much happier with a cs than with the risks of a vb.

I never went into labour, and had a calm and straightforward planned cs at 39 weeks. This was the right choice for me.

I think its something that I'd only want to do if I had skilled, competent and above all confident one-to-one care throughout delivery.

I doubt thats possible on the NHS these days though. But when you read Ina May on the subject you can see that its perfectly possible to deliver breech babies vaginally at home. I don't care how much of a hippy people think she is, the results her practise has achieved over 30 years speak for themselves.

But as more and more breech babes are delivered by caesarean it becomes a situation that fewer midwives will ever have handled and so it becomes less safe.

apparently my local hospital is more supportive of breach birth than any other maternity unit in the UK. they will give you a CS if you ask for one, but equally have no difficulty with you having a VB if there are no complications other than the breech position. You get a red flag on your notes so that you are attended to by the senior midwife on duty and apparently their safety rating is just as good for breach as for cephalic presentations. If there are any problems they just whip you in for a section. On that basis, I will aim to go for vaginal birth if my baby doesn't flip (still 8.5 weeks in which to do so!), but only on the basis that they obviously know what they are doing. I wouldn't talk midwifes/doctors into doing it if they weren't keen and lacked experience of breach vaginal deliveries.

It depends on the breech imo.

My sister was born breech as in bum down and feet up by her head, that is not too complicated.
DD1 was footling breech, so she had one foot in my pelvis wedged under her bum, then her other foot was next to her head. After the scan showed this they refused to allow me to have her vaginally as she would not have been able to get out without damaging her hips. They couldn't turn her as she was comlpetely wedged, in factm the CS was difficult enough because of the position she was in.

I wanted to try for a breech but the consultant's exact words were 'This is why women used ot die in childbirth, because we couldn't see exactly what position the baby was in and they woudl get stuck. Please don't do it'

Vaginal breech birth is absolutely a safe option (the big study which is the reason why we section most breech births has been universally accepted as deeply flawed) but only with a practitioner who is experienced in breech birth. Most NHS doctors and midwives are not (although some from Africa and the Indian subcontinent do have considerable experience of this option). As midwives we have theoretical knowledge, but very little practical experience, however independent midwives do tend to have more. The basic rule of thumb is that the labour and delivery should be absolutely perfect, text book, and any deviations from this should change the plan from vaginal to operative delivery. It is certainly not the reason why women used to die in childbirth, what a loon!

starlight I agree - I'm only 20 weeks at the moment, but if baby was breech I'd want someone experienced to deliver

My biggest fear in labour is having a c-section. The very thought terrifies me! So maybe I'll start chatting to my mw about options if baby decides to be breech!

addie that's interesting about your local hospital.

Depends on the kind of breech.

If the baby is frank breech (folded in half), then there is little difference between this and a cephalic birth.

The key thing with a vaginal breech is to let nature take its course and be reassured when it progresses (even if slowly).

It is important not to induce labour (even with sweeps, pineapples and sex), or to accelerate with (with syntocinon/pitocin). Epidurals are a bad idea too. If you use synto, then there is a chance that the baby chin will get trapped under the pubic bone and basically get stuck.

You don't always know the kind of breech, and there are some that can't be delivered vaginally. Without a scan beforehand, it is hard to tell, but if labour stops progressing, then there is a strong liklihood that you have the wrong kind of breech.

Any breech labour that stops progressing should be delivered by c-section rather than pitocin and/or forceps. In the much maligned Term Breech Trial of the early 2000s, medically-managed vaginal breech births did not do as well as natural vaginal births or c-sections.

My DD was breech at the very last minute and my consultant told me quite emphatically that there was nobody on the staff competent to deliver a breech vaginally. Another doctor did contradict this later, but at 43 and with no burning desire to go through a fifth labour I went for the CS.

Queenofdreams I was petrified of having a CS and went for ECV to try to turn the baby. As it turned out the CS was a very positive experience and much less painful than the usual route.

reikizen, I know that now, but at 41+6 with an undiagnosed breech until then it shit me up enough! She was proper wedged in though and showing no inclination to move even after an ECV. I know what position she was in and she was not coming out vaginally like that, it woudl have been physically impossible imo.

I would find out how experienced the midwives are at delivering a vaginal breech birth first. Then I would decide. I wouldn't want to do this if they had little or no practical experience. (I had a cs due to breech presentation).

I was born to a vaginal breech delivery in the 1970s back when there was no US. My poor mum clearly remembers the midwife announcing when she arrived at hospital fully dilated and ready to push, 'this is not a head its a bum!'
Didn't seem to do me any harm but I realise one persons experience is not the same as statistical evidence. Nonetheless its always swayed me to feeling that I would like to try a vaginal birth in the circumstances if ECV failed.

My DC4 was a vaginal breech birth. It was unexpected, though. She was head down at 40+5 when I had a scan, and I was planning on a hospital delivery. When I went into labour 3 days later I had a very fast labour and didn't manage to get to the hospital. The community midwives got to my house 20 minutes before she was born, and the first we knew she was breech was when my waters broke and the mw thought she could see either a buttock or a foot, but definitely not a head .

It was a wonderful experience, and I had excellent midwives, who despite all their experience had never done a breech birth before. It was by far the easiest delivery I've had. It was a very odd feeling, having her body outside me and waiting for the next contraction so her head could be delivered. Whenever I can't sleep or am sad, I think about that day and it cheers me up.

If I'd known she was breech, I probably would have opted for a c-section rather than worry about experienced staff being available on the day.