vaginal breech or elcs?

[NameOfTheNick]

So, baby hasn't turned and is still breech.
I need to make the decision on whether I want an elcs or attempt at a vaginal breech birth just incase The ecv doesn't work that I am booked in for on friday.

Anybody had a vaginal breech birth?

I have no idea what to do, as much as I really really do not want a epidural or c section I am thinking this may be the safest for baby.

Hi,
I'm 36 weeks and babys been breech for the last 7 weeks, it is first pregnancy.

I think they would ultimately support me if I chose vaginal birth, but I have been advised that with it being dc1 that they would prefer elcs, as I don't have a" proven pelvis" . And that recovery is a lot quicker and better with elcs than going through labour and then having an emcs.

ELCS would be safer NameoftheNIck There was an enormous research study on this where they compared vaginal breech and elcs and the results were so much better for ELCS that they stopped the trial.

Would definitely urge you not to consider a homebirth with an independent midwife because she will be uninsured so if there is a horrible disaster there will be no comeback.

What is the particular reason you are considering vaginal breech?

Such a shame that midwives have lost experience. My MIL was a midwife for 50 years and delivered scores of breech babies at home. They had no choice!

ELCS for breech seems to be the default route these days and I would imagine the research Ushy is talking about had the results it did because of the increasing lack of experience modern midwives have, due to lack of exposure. I am pro-CS, having had one emergency and heading for an elective, but I think you need to feel happy with your decision, so if you're keen on a vaginal birth, I would just do as much research as you can. I'm sure some hospitals will have more experience of breech deliveries than others.

There are lots of things to consider:

Have you had a scan to see how your baby is presenting and if there are any other issues of importance? E.g. Bum first is much much safer for a VB than feet first.
Do you have any fibroids or an odd shaped uterus which may influence both the presentation of the baby and potentially the success of a VB?
What skills do the hospital have for breech VB and who is likely to be there on the day who is skilled in this type of delivery?
Do they favour a lithotomy and forceps approach or a "hands off the breech" approach a la Mary Cronk? Google Mary Cronk and read her views on vaginal breech birth - she has lectured at my local hospital and they now do breech VBs with no interventions and the woman kneeling for delivery. But they still do only 1-2 breech VBs a month in a hospital with 300 odd deliveries a month.
How many babies do you want and how much would you be bothered by making a VBAC/ELCS decision in your next pregnancy?

To be honest, even though I've had one straight forward VB, with my current pregnancy if the baby ended up breech (currently head down at 29 weeks, good boy), I think I would accept an ELCS. But that's completely for personal reasons - I have a slight prolapse from the last birth and am keen for damage limitation this time round.

Mary Cronk suggests a trial of labour for select cases (bum presentation, and no other unusual circumstances) with an early switch to a CS if the labour doesn't progress smoothly and fast. You could do that. On your maternity notes it should tell you how to contact a supervisor of midwives and she would be able to talk through your options with you more clearly.

Ushy, I believe that study has been well and truly discredited by all and sundry.

Nameofthenick, you could speak to the head of midwifery to find out if there is a midwife with experience in breech births who would be willing to talk to you or even be on call for your labour.

Or would they be willing to bring somone in as a learning exercise (an independent or another NHS midwife)?
Could you speak to any of the local independent midwives to find out if they know anyone really confident in breeches to talk to you? Or at least talk to them about the risks or not of a breech birth. They may also know of mums who have delivered breech babies the would talk to you.

If you knew you were able to get someone who was really confident with vaginal breech deliveries at least you would be making a real choice - even if you still opted for ELCS.

As I said on your other thread, my midwife said she could deliver a breech 'with her eyes closed' - that attitude would be massively reassuring to me.

My second twin was breech, but I think that is a different situation as twin one has already paved the way.

Whatatip "Ushy, I believe that study has been well and truly discredited by all and sundry."

It's in the latest caesarean NICE guideline, whatatip, this is actually what it says on page 73:

"A systematic review identified 3 RCTs (n = 2396) that evaluated the effect of mode of birth for term breech pregnancies.

The risk of perinatal/neonatal mortality or serious morbidity was 1.6% in the planned CS group and 5.0% in the planned vaginal birth group. The absolute risk reduction in perinatal/neonatal mortality or serious neonatal morbidity was 3.4%, therefore for every 29 CS for term breech pregnancy one baby will avoid death or serious morbidity. These findings are consistent with findings from cohort studies "

Nameofthenick re my last post, I reread your OP and don't want to talk you out of your choice at all.

May be I misread what you meant, but I read your OP as meaning your big worry was safety for the baby which is why I posted the above. Is it more that you really want to experience vaginal birth? I do think you should follow your instincts in that case. On the other hand, if you want vaginal birth because you think recovery would be quicker - I am not so sure.

If you were a personal friend though, and you asked me whether I thought a vaginal birth for a first and breech baby was a good idea, I would say I would not go for it in a million years because the birth has a high chance of ending up being traumatic and the baby is more at risk. I am not you though.

But two things - the ECV may work ..whoopee AND unless you are planning no more children, you could consider VBAC for a second child.

Good luck either way

Well the ecv didn't work, and I have decided c section is going to be the safest for baby so in 3 weeks time, c section it is!

Now to start a thread on what to include in my hospital bag now I have to re pack it for a. Section!

Thank you very much to every body that has replied, especially ushy.