Vaginal birth for breech baby?

[frogs]

With all the hoohah in the news and on these boards about Caesareans, I wondered what other Mners would feel about having a vaginal delivery with a breech baby?

I faced this with dd2 who was discovered to be breech at 36 weeks. I had a very balanced and sane discussion with a consultant who said that I was potentially a good candidate for vaginal breech birth, since I'm 6 ft tall and previously delivered two big (9lb+) babies without any problems. BUT he warned me, with commendable honesty, that vaginal breech births were becoming so rare that midwives and doctors were losing the skills to carry them out successfully and that other consultants would be much more likely to push me towards a CS.

In the event, I had a successful ECV (turning the baby). Interestingly, the doctor who carried this out was Dutch and said that in Holland the protocol for breech births is to go for normal labour in the first instance, going straight to CS only if things don't progress straightforwardly. Presumably Dutch women and babies aren't so different to British ones, and their Drs read the same medical journals as ours, so the diffference must be primarily cultural.

For people who'd be happy with a Caesarian, this must be a total no-brainer, but there must be others like me who feel strongly that they'd prefer to avoid a CS if at all sensible. What would you have done?

Also found this left lying around by dw and scanned it in - sorry illustrations don't copy:-

The position your baby is lying in becomes more important towards the end of your pregnancy. Your labour is more likely to go smoothly if your baby has entered your pelvis in the best possible position, that is with his/her back towards your left (or sometimes right) side. The smallest diameter of the baby's head then leads the way through the pelvis with baby's chin tucked onto its chest
However, If your baby lies with its back towards your back (the curve of your spine), then the baby has to' straighten its neck and the wider part of its head has to enter the pelvis. In this positon the soft bones of the head are pushed forward- "moulded" until the head Is narrow enough to pass through the pelvis.
When your baby is lying In the best possible position, it is thought that
your baby?s head Is more likely to "engage" (most of it entering your pelvis) before labour begins.
your contractions, will work hi the most effective way. you are less likely to have a long "backache" labour, the likelihood of medical intervention Is reduced.
your baby will be born in the most comfortable way with little stress to his/her head.
2

INDICATIONS OF FOETAL POSITION
Anterior (OA) positioned foetus

Foetal back towards front of abdomen (between umbilicus & hip)
Foetal bottom is felt as a heavy moving sensation when movement occurs
Foetal heart beat heard here
Foetal head well tucked In

Posterior (OP) positioned foetus

Foetal back towards spine (Limbs towards front of abdomen)
A !ot of movement fell down middle of abdomen
Foetal heart beat heard here
Foetal head upright (?military1 position)

To encourage your baby?s head to engage before you go Into labour, and hi the best possible position for labour, you need to Increase the space between your spine and pelvis and so make room for your baby to enter your pelvis easily.
TRY TO:
Sit upright or lean forward from about 34 weeks, e.g. when watching TV or relaxing, sit on a straight backed chair or kneel on the floor leaning over a bean bag or some cushions.
Sit on the sofa or armchair with a firm cushion under your bottom and lower back so that you are sitting more upright
TRY TO AVOID:
Sitting with your knees higher than your hips.
Sitting with your legs crossed.
Slouching back in an armchair.
Taking long journeys in cars with "bucket? type seats.

Recommended Postures and Exercises

If your baby does have its back towards your back, the following exercises may encourage your baby to change to the best possible position:
Crawling on all- fours or kneeling over a bean- bag or cushions for at least 20 minutes a day.
Walking up and down stairs sideways (like a crab) for at least 20 minutes a day.
Swimming, most beneficial with your abdomen forwards. See the back page for details of our midwife-led Aquanatal sessions held locally.
When resting or sleeping. He on your side with a pillow behind your back and your top leg resting forward so that your knee touches the mattress. (This ensures that you Abdomen is forwards, creating a "hammock" for your baby.)

SUGGESTED POSITIONS FOR LABOUR
If your baby Is still in a back to back position when you go into labour adopt the all fours position whenever possible, this will encourage your baby to change Its position aided by the force of the contractions.
Whatever position your baby is fn at the start of labour it is important to remain upright and mobile for as long as possible to aid the progress of labour in the first stage and the descent of the baby?s head In the second stage.
If you wish to squat in labour a supported squat is advised i.e. with your partner/companion supporting you under your arms so that you have both feet flat on the floor- in front of your hips. Try to keep your back straight and make sure your knees are not higher than your hips.
IDEAS AND ILLUSTRATIONS REPRODUCED WITH KIND PERMISSION OF JEAN SUTTON (MIDWIFE) -BIRTH CONCEPTS, 55 HOLL1STER LANE, RD3 TAURANGA, NEW ZEALAND.
Leaflet produced by: Caroline Baddiley & Jacqui Storrie, Midwives, Royal Bournemouth Maternity Unit RBGH, Castle Lane East Bournemouth, Dorset BH7 7DW