Breech birth vs C-section

[gingerlou84]

My baby is currently breech at 36+4 weeks. I had an unsuccessful ECV yesterday, which was quite painful, but baby is also back to back which apparently makes it harder to turn. I'm scheduled for another scan tomorrow and will have another go at the ECV if baby has moved to back to front. If that's unsuccessful, the hospital offer the choice of vaginal breech birth or ELCS. I am really uncertain which to go for. This is my first baby and DH and I have hopes of a large family (4+), however we want to look out for the wellbeing of this baby rather than future children who don't yet exist. Has anyone got experience either of a vaginal breech birth, or of a C-section who then went on to have several children? Thank you very much in advance.

Personally I wouldn't dream of having a breach vaginal birth. Because most people have c section for breach there isn't a lot of expertise for breach vaginal delivery at many hospitals. Though if they're offering you that maybe there is at yours. It's perfectly possible to have 4 caesarians though the risk increases slightly after the 2nd but the risks are still tiny.

Have had c section for breach by the way and it was a good experience/fast recovery.

I was a breech birth (leg presenting and the heaviest baby my mum had) and my mum was ok! (went onto have my baby brother a few years later who decided not to be awkward and was head presenting).

I know its not much help but is just to assure you both mother and baby survived a breech birth!

I would listen to the hospital. If they feel it is safe for you and the baby and you want a vaginal birth then you could try it.

I would choose section if I were you. Breech is a non-recurring cause and so further sections won't necessarily be advised of future babies are vertex. Also, I believe that breech delivery is riskier in a first-time vaginal birth than if you had previous vaginal deliveries. While I can understand your desire for a larger family, I would not choose to prioritise theoretical risks to hypothetical future children , over the very real risk of breech delivery for your actual baby here and now. Sure, plenty of breech babies are delivered just fine but there is a very real risk attached with really serious consequences. I just wouldn't.

Can you book an appointment to discuss all these issues with your consultant?
Best wishes

I recently had planned home breech birth, I thought very carefully about the decision and it was absolutely the right one for me, my circumstances where probably quite usual though in that I had an independent midwife. To help make the decision I read the Royal College of Obstetricians and gynaecologists 2016 guidance on breech presentation and work by midwives specialising in breech including Janet Evans, Mary Kronk and Ina May Gaskin amongst other things.

Things that influenced my decision:
I had had a successful home birth with my first (cephalic presentation) baby.
I was already booked in with an independent midwife as my area didn't have a home birth service at the time. As soon as she knew I was considering breech vaginal birth she organised some one to one training for herself with Shawn Walker (probably the UKs currently practising leading expert in breech birth) to ensure her skills were up to date.
My baby was in a frank breech position every time I was scanned.
My midwife arranged for the second midwife attending the birth to be one experienced in breech.
We had a meeting with the Supervisor of midwives at the hospital and had a robust back up plan for transfer in for section if necessary.
My midwife contacted ambulance control and had them place a marker on their system so if a call came from my house it would be prioritised appropriately.
With a 4 year old to look after I was keen to avoid a section if possible, also I live in a fairly rural area so being unable to drive for weeks would have made life difficult.
The most recent research (good quality large cohort study published 2016) concluded that the risk of full term upright breech vaginal birth is comparable to cephalic presentation.
The expert consensus from my reading is that in full term breech birth in the absence of congenital abnormalities the main risks are from practitioners not being experienced and skilled. Breech is a variation of normal rather than an abnormal presentation.
Finally, I felt absolutely confident that if I was left alone in a place at felt safe I would be able to give birth.

If my options had been vaginal breech at the hospital or section I would have chosen a section due to the issue of practitioner skill. When I saw the obstetrician to discuss my options he did not even mention vaginal birth until I brought it up and was then completely unable to discuss the risks. I don't think it had occurred to him as a possibility so he just didn't know!

Obviously I am very glad that it all went smoothly but I felt we had a robust plan B.

I would recommend joining the Breech Birth UK Facebook group. There are women on there who've had sections, ECV and vaginal birth in and out of hospital so there is no judgement just support and information to help you make the decision that's right for you.

Good luck with whatever you decide!

For a first baby I'd choose ELCS, no doubt about it. There just isn't the expertise around in most hospitals in vaginal breech deliveries. I had a section (not for breech) and can highly recommend it, the birth was incredible and recovery quicker than many of my friends who had VB.

I would go for the section. However I do think it's disappointing that the rise in c sections has meant skills have been lost. I was born 31 years ago bum first with my feet up by my head. C section was never even discussed.

The lack of skis effectively removes the choice from the mother.

My first was undiagnosed breech so I had an emcs after arriving at the hospital in labour. Recovery was fine but obviously took a few weeks to be completely back to normal.

The second time around I requested a late scan to check position (wanted to avoid section if possible but didn't want repeat of a breech being missed) then ended up with a fairly quick labour and ventouse delivery for fetal distress.

Obviously I didn't have chance to weigh up options with my first, but with a head down baby second time around there was no need for another section, and the same would most likely apply to you so I think in your shoes i would Base the decision purely on what you would feel most comfortable with for this baby... good luck!

I had a breech baby and it was no different from the births of my other children.

I'd choose ELCS. Like other posters have said it won't stop you from having further vaginal deliveries. Do what is best for your baby. First births can be difficult never mind a breach one and midwifes are not very experienced in them. I had a back to back baby first time and even that was difficult and resulted in bad 3rd degree tear. Due to ongoing issues and I am booked in for a section this time. Good luck with whatever you decide and I hope it all goes well.

Thank you all very much - that is really helpful and has given us much to think about. At the moment I'm leaning towards ELCS, mainly because I would be less frightened going into it, and I think to have a successful vaginal breech birth I'd have to be relaxed. Still undecided though and I don't want to be making the decision based on what feels "easier" for me.

I had ELCS for breech baby who turned out to be 10lb - I don't like to think what would have happened if they'd tried to deliver him naturally.

Good luck with whatever you decide...
I had a c section with my first (breech but also tiny, which was only picked up after my waters broke, so they were more worried about weight and didn't really give me a choice.) I was worried about having to have a second section with my second child, but my midwives were very supportive and I ended up having a fairly quick vaginal birth...
I think, as you said yourself, you need to think about this baby and yourself and do whatever you think will be best for you both.

I had a vaginally breech birth with dc3. It was fast but it was painful, more so than my head first dc.
If dc4 is breech I will push for a c section because I know from experience that in my hospital breech equals on your back in stirrups with drs trying and failing to insert catheters and them pulling and twisting the legs to get them out. If they'd left me to follow my instincts I'm sure it would have been much less painful.

Oh and she was 9lb so not a small breech baby at that.

I would skip another ECV (I'd never have had one at all) and go for the ELCS. Just refuse another ECV and that you want to book a CS.

Hopefully this won't be relevant to you, but it is possible to have multiple sections. Some of the risks increase but if you heal well they can be very uneventful. I have had three and have the thumbs up to have a fourth soon...

My 3rd DC was a footling breech, delivered vaginally. If he had been my first he would have been my last.
I also had an audience because a lot of staff had never seen a breech birth and wanted the experience. On the plus side I had an obstetrician to do the delivery, and a paediatrician present in case the baby had problems, plus a variety of accompanying nurses, anaesthetists etc.

For a first baby, where you have no idea how your body is going to react to labour, or how easy the delivery is going to be, I wouldn't risk a vaginal delivery. Different if you had already delivered a few whoppers vaginally and could be confident that you had room, but for a first timer, no way. Having a section first time round won't necessarily affect future deliveries, and the baby may yet decide to turn anyway...

First, you have to know what kind of breech - frank breech is almost the same as cephalic.

Secondly, you have to be completely natural with a breech. You cannot have any kind of acceleration.

If labour doesn't progress, go straight to C-section. Don't panic.

I had an emergency section for a breech baby (spontaneous labour), and a vaginal delivery on my next baby.

I wouldn't personally be happy to deliver a breech baby vaginally, I'd feel safer having a section.

I have a friend who had a breech baby by c section and then went on to have two more by vbac. In fact, unless you have other risk factors with subsequent pregnancies that is what appears to be recommended (although I think once you have had one section you are allowed to request another one so you get a choice). I also have a friend who delivered her first baby (breech) in hospital but they didn't know about the breech until she was pushing.
I have just had a breech baby by c section. I would have been a perfect candidate for a vaginal delivery. I had an uncomplicated pregnancy, frank breech, not a big baby and 3 natural deliveries. What I did is book my section for as late as possible, 39 plus 6 to see if I go into labour naturally. That did then happen at just 38 weeks when my waters went - all my other babies went to due date or over. However, contractions didn't start immediately and once I got to hospital I was too scared to wait and see what happens. They wouldn't augment my labour as that is too risky with breech. I realised then and there that I just wanted my baby out safely. So I had a section which I didn't particularly enjoy. If I was in full blown labour my decision would have been different as I think my body would have just taken over. The recovery for the mum with a c section is much tougher than with a natural uncomplicated delivery. But the doctor did tell me that with a breech vaginal delivery I might have ended up with forceps and significant tearing so that would have been tough too. So in summary, I think the decision is very personal and quite hard to make. I had convinced myself that my baby would turn last minute so my way of deciding was to wait and see what happens and how I feel on the day. For others, that might not work at all. So I think you should speak to different professionals and work out what is best for you.

OP I'm interested to know what you mean by "Still undecided though and I don't want to be making the decision based on what feels "easier" for me". To my mind, that would be a perfectly valid consideration amongst others. Why shouldn't it be included in your decision-making?

However in this scenario, I think it is a question of who bears the risk. With vaginal breech, the bulk of the risk falls on the baby. With a section, it is on the mother. So to my mind, a section is a brave and loving choice to make in these circumstances, not just the "easier" choice.

I attempted a vaginal birth with a breech baby (against my better judgement, but that's another issue). It resulted in a cord prolapse, which is obviously rare but was my experience. In hindsight, I wish I'd pushed for the ELCS.

Thanks so much for starting this thread OP, I've been in the same position! 37+4 with a frank breech. We've decided to go for the ELCS but also because he's 7lbs already and I have gestational diabetes. And they're worried about his heartbeat now too. But I still know what you mean about feeling like an ELCS is the easier option.

I feel especially guilty about the fact I've chosen his birthday rather than letting him come in his own good time! However, MY ECV midwife convinced me it was the right thing for me when she said 'imagine you attempt a breech VB, you get the legs out then discover the head's too big for your pelvis [I'm quite small]. How do you get the forceps around his head if he's the wrong way round?'

Decision made swiftly afterwards :)

good luck with whatever you choose!