Home breech birth - how late to leave it?

[Rat99]

I'm 41 weeks and my baby is breech. I'm still planning to have it at home, but how long should I wait before going for a c/s instead? As it's breeched, I don't want it to be induced as that seems to cause problems, so the only options are home birth or c/s. I was thinking of waiting 2 weeks and then see how it's going. Any thoughts?

Tough decision, I would say have your check ups, and if all is alright, and everyone is happy then stick with your plan of HB....but it does depend on so many factors...like size of the Baby, etc...well....and scans don't really tell ya much in that respect, and sadly a lot of midwifes seem to find it hard to estimate the size relatively correctly....!
I wish you the best of luck though and am sending you some labourvibes!

Ummmmm...

Probably not what you want to hear, but I did quite a lot of research into vaginal breech delivery when dd2 was breech in late pregnancy. I'd previously had two uncomplicated deliveries with large babies (9lb plus), so I was probably as good a candidate for vaginal breech delivery as any. And that's what I was planning to do, but there's no way on god's earth I'd have done it at home. I don't understand why you can't have it in the hospital -- my consultant (large London teaching hospital) was prepared for me to have a vaginal delivery, although he did warn that it wasn't common and staff were consequently 'de-skilled' at performing them.

As I understand it, you're right about induction being problematic for breech, but my understanding of the protocol (Mary Cronk etc) for vaginal breech delivery was no intervention for as long as possible, but if things don't progress, go straight to CS. Hard to see how that would work with a home birth. My plan was to take an independent midwife with experience in breech births into hospital with me. It never came to that in the end, as I had a successful ECV at 38 weeks. I'm a bit of a closet hippie in childbirth terms (would have loved homebirths but not allowed for medical reasons), but the combination of breech birth and post-term is not one I would take on lightly, and certainly not in combination with home birth.

Why not reconsider a hospital birth? It's got to be much safer for the baby. Breech labour can cause all sorts of complications like trapped umbilical cord which could lead to oxygen starvation. Probably not what you want to hear either, but no one tells you of the things that can go wrong. My advice also is to make you sure are monitored throughout.

I would act on the advise of your consultant.

A few more details - it's a first birth (just to complicate matters further) and is estimated to be about 7.5 to 8 pounds. I tried ECV but that failed. A few have suggested hospital delivery - that doesn't seem to be an option where I am, unless I go for continuous monitoring and lots of intervention (likely to cause problems itself). Frogs is right - it's vaginal birth and straight to CS if problems - the most likely problem, though, is failure to progress, so there would be time to travel to hospital. Obviously, that doesn't apply in the case of a trapped cord etc, but the risk of that seems to be reasonably low.

I'm happy with an HB to a point, but not sure how much more complicated it gets as it gets later. Does anyone know what the chances / types of problems are due to it being late?

(I haven't seen a consultant since the ECV 3 weeks ago. At that time he though HB was OK).

Have you got a midwife unit attached to a hospital, where they might agree to a lower-intervention birth? Otherwise you might like to look into the option of having an independent midwife accompany you into hospital to support you in the kind of birth you want. The UK expert in vaginal breech birth is a woman called Mary Cronk who is based on the south coast somewhere IIRC. You might consider calling her to see if she can point you in the right direction.

I don't think you can calculate an overall risk factor for being overdue. I'm on the Luddite side regarding inductions, and acknowledge that often the dates may not be correct and that other health systems calculate due dates more generously. BUT there are risks to going very overdue the placenta may start to function less efficiently and in combination with two other potential complicating factors (the fact that it's your first birth and that it's breech) I personally would not take an aversion to induction too far.

A friend of mine, who is in the premier league of lentil weavers, consistently goes to 42 weeks with each of her pregnancies (4 to date), but agreed to induction each time quoting a consultant who said to her: "All we know is that if we leave it too long, some of them will just fall off their perches". That really haunted me, and tamed my 'natural childbirth at all costs' instincts.

My dd was breech for a while, but thankfully turned at 37 weeks. I went on to deliver naturally at 41 weeks. However, I was never offered a vaginal birth, and was always told that if she didn't turn, then I would have a c-section booked in. I guess every mw is different, but imo I would have been much happier having the cs than trying to deliver vaginally, despite being so keen for a natural birth.

Agree with Frogs - it's a serious consideration to have a home birth with a breech baby - there is a higher chance of baby being deprived of oxygen, and while I can see you will be disappointed not to have your home birth, I would seriously re-consider a hospital birth, for the safety of both you and your baby.

Hope it all goes well for you.

its up to you to try for a normal delivery with a breech presentaion rather than a c-section, however, i would strongly advise that you have a hospital birth as there are many complications that can arise from breech birth, including cord prolapse, footling breech and the possibility that the babys head will need to be delivered by forceps.
in an ideal world, the babys head needs to travel out of the birth canal first as its the largest part of the body, therefore if the babys head doesnt descend down into the birth canal after the body descends this can lead to complications.
im not saying that you should have a cs, by all means try for vaginal delivery, im not trying to scare you but technically its not going to be a straightforward delivery so you would be better off being in hospital rather than being blue lighted there.

I agonised over this very same question then during my final ECV baby went transverse and so went CS - very weird for lots of reasons but not a total nightmare and in a way I was glad to get to the point of not having to mae a decision any more... so I'd chat to docs again...

I have to say I didn't even consider a home birth with my first as she was a breech. ECV failed and so decided safest birth would be a CS. IMO a home birth in this situation is so risky. Good luck

The other point to add to Space Cadet's post is that the later the baby is, the more the bones in the skull harden, meaning it would be more likely that you could have problems delivering the head. I completely understand you wanting your HB but I also think you need to decide at what cost you want your HB. Personally, the health and well being of my babies came before the type of birth I wanted. Perhaps ask for an appointment with your consultant again and have a really in depth chat with him about the risks of a HB.

I'm surprised that your consultant thought a home birth OK but not an non-continuously monitored hospital birth.

I had a sucessful v breech birth with dd at 40 weeks but I was in hospital , and she was in an ideallpostion to be delivered if memory serves me right there are 3 positions adn only one of these is suitable or advised for natural delivery she was 7lb 11 oz hope taht helps do what is best and right for you nad your baby and do not feel let down if you do not get your home birth be as open minded as possible

i could be wrong..so forgive me if i am, but i think a frank breech is easier to deliver vaginally.

Rat - Have you been on the UKMidwifery list ? Anyone can join and you could ask the independnt midwives (Mary Cronk) and all.
health.groups.yahoo.com/group/ukmidwifery/

I would not worry as it is 41 weeks and a 1st baby... from 42 weeks I would ask for a scan to check fluid levels. This would help you decide if it is still safe to be pregnant.
I believe that at this year's NCT conference they had a consultant OB (from Leeds?) who said that 80% of women who were not induced at 42 weeks gave birth between 42 and 43 weeks... I think FAR more women would give birth a bit after 42 weeks without being induced if they knew that they could carry on... most women do not really realise (and are quite understandably fed up by then) the genuine pros and cons of inductions and the real risks of post "term"!
If you were in france your due date would be at 41 weeks.

I don't think your issue is the gestational age until you reach 42 weeks... there is plenty of misconceptions about breech babies. Back in Janury this year the US "American Association of OBGYN" finally acknowledge that the study used in 2000 to justify far more automatic sections for breech was flawed!!!!!
Indeed a true vaginal birth (not a delivery = on your back legs in stirrups = dangerous!) is safe provided you know what to look out for. You have a far better chance of achieving this at home than in hospital. I met a little while ago a colleague (I am a doula) who had a vaginal delivery after fighting TOOTH and NAIL in the delivery room to let her carry on... her story was horrendous... she had to quote studies in labour and did demonstrate to them that she knew far more about this than they realsied... she too had done her homework. So I do not trust hospitals to let women carry on... I know in other circumstances where consultants to have agreed on a particular protocol only to have the midwife on duty say no on the night!
Good luck what ever you decide!

Just wanted to say, to whomever mentioned going to a Birthing Centre, that that might not be an option with a breech presented Baby that is overdue.
To go to a Birthingcentre everything has to be completely straightforward and normal!
With ds2 I wanted a hb but developed gestational diabetis in the last few weeks, and I was told I had to go to Hospital and that the Birth Unit (attached to the Hospital and right next to the Delivery Unit to boot) was not an option!
At a later date I found out, that indeed no one had given me the full info and that I could have indeed stuck to my original hb plans....something I deeply regret now!
Can I also say that, because you have a m/w with you at all times at home, they will be very much aware of any possible problem and would then advice for a transfer to Hospital anyway!
Also....if it comes to a cord prolapse in Hospital...is a Emergency C-section really gonna save anything...just wondering this. I would have thought it could not be done quick enough?
The problem with trying for a breech birht in Hospital, is all the Protocols that are in place, and as someone already mentioned the Consultants and M/w's sadly are often not trained/experienced in Breech Birth, which in itself is a problem!
That Uk midwifery group is brill....I used to be a member there and got so much good advice there!

I also did a lot of reading about this, another point is, with a breech baby there is no time for the head to change shape to got through the birt canal which can result in baby getting stuck, they then have to do a rather large epsiotomy to release the baby's head. For a first timer, you have no idea how your body will cope, for the safety of yourself and your baby I would get more proffesional advice rather than from other mums.

This is a link describing all your options if you are looking at more infoHomeBreech

How are you Rat 99?

Pupuce - OK thanks. Still not sure what to do, but I've got an appointment with an experienced midwife tomorrow, so will decide then.

(Midwife led units etc aren't available in my area - they've all been shut down recently)

Try asking the UK midwifery group... they are really good!
They are radical midwives and therefore very experienced!

Agree with everything pupuce says. Please give Mary Cronk a ring, she has loads of experience, I know it is a bit late in the day but she has delivered many breech babies at home. Her telephone number is on this link . She will be able to give you loads of useful advice and maybe know somebody in your area who can help.

You can give birth to your baby whichever way he/she decides to come out.

Heres to a peaceful birth (raises glass of wine to toast you and the baby)

Hi 3andnomore just wanted to say that you would be surprised how quickly they CAN get them out in hospital (which is one of the things that makes it so awful when they don't) from what a friend of mine was telling me the other day it can't have taken more than 5 minutes. Rat99 hope you get all the info you need and good luck with the birth, please just remember that at the end of the day it is a healthy Mother and Baby that matters not how you do it! Many people on her have not had the birth experience thay wished for but are glad that it all ended up OK.

daysoftheweek! that is good then
But then, a m/w at home might catch on to this one much earlier anyway...i.e. constantly there looking out for signs, etc....got to say though, I am very pleased that that was one decision I never had to make...as non of mine was breech...not a easy decision to make I think!

I would go for c/s, saver for baby and you imo. Maybe not the 'experience' you had in mind, but in the end it only matters that there is a good outcome for both of you. Why take any unneccessary risks?