vaginal breech delivery at home - any positive stories?

[teamB2011]

i have hired IM who is experienced in vaginal delivery so going to give it a go. would love to hear others' positive stories.

I would base you decision more on your personal situation and potential risks. Your Im should discuss these fully with you.

I know you want positive stories but I think it's a crazy irresponsible thing to do. Sorry!
I'm all for home births as I've had 2 but breech births can quickly turn into a serious emergency and no way would I risk it. I do hope it's not your first otherwise you really are deluded. (IMO , of course!)

The major London hospital I had DD at (who was breech) did not have one member of staff who had ever delivered a breech baby vaginally. C section has been the main choice for so long that very few seem to have any experience.

I'd question your IM very very carefully.

It's very risky. I'm not sure this is something you should do with the attitude of "giving it a go".

Tricky. I am deeply and passionately pro natural birth, but this is a difficult one.

DC2 (home birth) was breech for a while and DH and I agreed that a home breech delivery was a step too far for us.

In your shoes, I'd agree with Shedding about speaking to a supervisor of midwives about having a breech delivery in hospital. SoMs exist to help women get the births they want and it's worth talking to one - if nothing else, so your birth preferences are known if you end up transferring in.

Ignore anyone that says "A healthy baby is all that matters". YOUR health matters too - physical and mental health, that is. I've suffered birth trauma and would take a gentle ELCS with a sympathetic consultant over an emergency situation any day. Your IM and a SoM can help persuade/bully consultants to respect your wishes so you can still have delayed cord clamping, skin to skin in theatre etc. Good CS births are definitely possible.

Hope all goes well for you.

My second baby was breech, and delivered vaginally. It was a successful birth, but I was strongly advised to have an epidural (which I did) and to be prepared for emergency intervention. Luckily none was needed, but I was aware of the consultant with his scissors poised to cut if she didn't come out with the next push.

I so wanted a vaginal birth I think I was in denial about the risk. In fact, this was 16 years ago and I don't think I realised until recently when I saw a breech delivery on Call The Midwife what a big deal it was! I'd say persisting in getting support for a VB is one thing, but doing it at home is another. It really can go very wrong very quickly.

All birth caries risk, we just need to assess which risk we feel more comfortable with. There is nothing intrinsically more risky with vaginal breech birth as long as the caregiver has experience of them, which many IMs do. It is no more a 'big deal' than the birth of any other child! You are far safer at home with a good midwife than in hospital with inexperienced and twitchy doctors who will create problems where none existed before. Mary Cronk is a good place to start for info on vaginal birth at home. The Term breech trial is where the scaremongering started but has been roundly criticised since publication, and almost entirely discredited. Unfortunately, it has led to the de-skilling of midwives an obstetricians in vaginal breech birth which is a national scandal.

And how many vaginal breech births has the IM delivered?

I do have a true story. However it's not positive in the slightest.

I've had a vaginal breech delivery in hospital. Undiagnosed and she was on her way out so no other option but I was fortunate that the consultant on was very experienced in breech delivery and totally calm about the whole thing. She was wonderful. Midwives were not calm although I do accept that they'd probably had less opportunity to experience breech delivery. However, consultant said afterwards that it went well because it was my second baby and she was on the small side (5 12).

It was the most frightened I've ever been until DD was safely in my arms. This is because DH is a paediatrician who has seen several vaginal breech deliveries go badly wrong and he's told me the stories. He was very calm at the time but I knew he was worried. It's not just obstetric care you have to consider but neonatal care. The IM will probably tell you that she's trained in neonatal resus, which she will be, but the reality is that she's highly unlikely to have dealt with enough serious resus situations to be able to manage if your baby was really struggling. Every second counts in that situation, and a hospital transfer may be a life changing number of minutes away.

I don't mean to scare you, but this is what DH would say. You obviously need to weigh all the information carefully.

Breech is far more risky, but a midwife experienced in breech can facilitate a vaginal delivery.

Mary Cronk has completely retired now.

I wasn't suggesting Mary Cronk deliver the baby! Just as a resource for information. Please supply the evidence for the statement that 'breech is far more risky'. Paediatricians by definition become involved when things go wrong, and I have seen many cephalic deliveries 'go badly wrong' usually as a result of medical intervention, but that does not mean I would advocate an end to childbirth!

reikizen I think you have to be more careful before making such sweeping, and false generalisations about risk. There is plenty of evidence that breech VB carries more risks, two seconds on Google Scholar reveals quite a few studies:

www.sciencedirect.com/science/article/pii/S0140673600028403

www.ncbi.nlm.nih.gov/pmc/articles/PMC1120869/

onlinelibrary.wiley.com/doi/10.1002/14651858.CD000166/abstract

The OP will of course make her own decision and it is her right to do so, but it is important that she is properly informed.

Boo, those articles are based on the widely discredited Hannah term breech trial therefore I stand by my earlier statements. Beverley Beech and Mary Cronk are far better sources of information.

Well, I suppose I have a positive story in that dd3 was born in a vaginal breech delivery at home and we both survived to tell the tale. I wouldn't recommend it, though! It was rather different in my case, as the breech position was undiagnosed until it was far too late to do anything about it. I was lucky to have midwives who had experience of hands off breech deliveries: as previous posters have said, many midwives nowadays have never even witnessed one, let alone delivered a baby themselves that way. If your IM has enough experience to put your mind at rest then that's obviously a positive thing.

In my case, DD3 was born not breathing and with an Apgar of 2: dh said she looked like a corpse. Fortunately she recovered very quickly and while she was put in special care as soon as she arrived in hospital (we were transferred almost immediately after birth), they were unable to find anything wrong with her. Thank heavens. There's no way in a million years I'd have had her at home if I'd known in advance she was breech: I chose a home birth because my first two births were very straightforward.

Not exactly the positive spin on the experience you were hoping for, I'm afraid! I'm happy to answer any questions, though, if you've got any.

Sorry, I wouldn't consider it for a second. Far too risky.

I agree the Hannah term breech trial was flawed however its almost become a self fulfilling prophecy now due to people becoming deskilled.

I would seriously question how much experience the IM has and I'd also want some references to back it up to be honest. There aren't that many women choosing home breech births so where is she getting her experience from?

I guess if she's in her 50s then yes she could have quite a bit of experience. But I'd want to know how much recent experience? I'd want to know as an IM what emergency skills training shed attended recently? What neonatal resus training she'd had recently?

I have been a midwife for 18 yrs and have only personally delivered 2 vaginal breeches in hospital and one of those was second twin. I have seen approximately 6 other vaginal breech deliveries in hospital and there was one with a poor outcome, even at the hands of an experienced team. Risk can only be really assessed retrospectively and birth is unpredictable. I really don't think the risks can be completely appreciated until you have experienced them.

Have you considered an ECV to turn your baby?

And an experienced practitioner does not lessen the risk.

reikizen I am struggling to find a bibliography of Mary Cronk's published RCTs. All I can find is personal observation articles, and while I do not doubt her extensive personal experience, it is not a substitute for proper research. Also the latest article I can find by her is 1998, while the research I linked to is 2000, 2001 and 2003, so I don't quite understand your claim about the outdated premises of the RCTs i linked to.

Mary Cronk/Beverley Breech and beech birth have no hits on google scholar - where have you found their published academic work on outcomes of MW led breech births?

On the anecdotal side of things, even those who are supportive of the idea of home deliveries for breech births question the lack of skills in the MW population, e.g. www.ingentaconnect.com/content/mesl/tpm/2012/00000015/00000003/art00006

I wonder whether we are being led up the garden path by the nose as the OP has not appeared again on this thread . Regardless, I am fully aware of the lack of skills in the NHS midwife population, but IMs are different. They have a different skill set. I am not convinced that RCTs are the gold standard of evidence, or that unless a midwife has a quantitative piece of research to her name she has nothing to offer women or their babies. It is well known that midwifery skills differ from obstetrics but obstetrics is not guided by evidence in general unfortunately.
I have no interest as to whether the OP has a vaginal breech birth at home or a section, but what I do care about is the flinging our hands up in horror about the terrible risks that women are taking if they choose to birth in a way that is not the mainstream choice. Birth is in general pretty safe wherever and however we do it, but it is more often than not the interventions that cause the problems that women have to be 'saved from'.

If anyone is interested Benna Waites book 'breech birth', and Mary Cronk 'keep your hands off the breech' are very interesting. Beverley beech is the chair of AIMS and fellow of the royal society of medicine. She has written a couple of interesting articles 'breech birth - a midwifery approach' and 'birthing a baby by the breech at home.' One of the big teaching hospitals in Sheffield offer vaginal breech births in their birth centre, and are holding a conference in September on breech birth. In maternity care it is good to live by the motto 'never say never, never say always'.