Breech caesarean?

[meimango]

Anyone out there had the experience of being recommended a caesarean because bubs is breech?

Am 38+6 today. Went into the hospital a week ago as I hadn't been getting my 10 movements a day and the baby was monitored for heartbeats and all was fine thank goodness.

Went back 4 days later as routine check as bub decided to be active again and found out he was breech! So two days ago went in for a ecv only to be told by the consultant that it shouldn't have been offered to me as my placenta was anterior and he had never been able to turn a bub with that positioning. So no ecv. So i'm going in to sign the caesar consent forms in a couple of days as have been strongly advised by doctors and consultants at rfh that vaginal birth would be more risky. I know they have a high caesar rate there for whatever reason. Wish I'd done more research on c sections now as have spent 9 months researching natural birth!

I was so hoping to be a low risk, hypno water birth at birth centre giving bubs the chance of coming into the world naturally; but worried about trying alternative methods to get bubs to turn, such as moxibustion - as was told that its posssible in turning him the outcome could be worse eg.cord could wrap around etc... Just want to make sure he comes into the world safely whatever the method now.

Would love to know if anyone else out there has been in a similar situation.

Will have to go now as staying at mums in law tonight.

I'm no expert on moxibustion but I thought that there wasn't really the risk of baby getting entangled in cord, etc. Although the proceedure encourages the baby to turn, the baby actually does the turning rather than being pushed round with an ECV. So if there is some reason why the baby can't turn like the cord been tight then it just won't turn. Although maybe 38+6 might be a bit late

Good luck with whatever happens.

I was recommended a CS because DD was breech. So I had a home birth with Indpendent Midwives !

As a very brief synopsis of why, the research supporting CS as the safest method of delivery for breech presentations (Term Breech Trial, Hannah et al, 2000) is open to a LOT of interpretation. Having talked to and been attended by very experienced midwives, I don't believe that the vaginal breech birth (as distinct from a medicalised delivery or extraction) of a normally developed, term baby is intrinsically dangerous. Sadly, the results of the Trem Breech Trial were lept on by the medical profession and CS became standard practice. In consequence to that, midwives skilled in attending breech birth are now comparitively few and far between - and so we're facing the prospect that the skills to birth breech babies safely will be lost such that a CS will soon be the safest method of delivery. This situation may already exist in a lot of NHS hospitals - which is one reason why we used IMs where we could be confident they had the skills and experience and considered breech presentations to be unusal rather than abnormal.

If you want to explore the options of a vaginal birth try and get hold of Jane Evans - she's a very experienced IM based in London (I'm guessing that's where you are) that lectures around the UK on breech birth.

A couple of good books (if you're interested and can get hold of them in time) are "Breech birth: what are my options" by Jane Evans and "Breech Birth" by Benna Waites. I felt both of these gave me a far more balanced view of things than the NHS registrar I talked to.

As said previously, using things like moxi won't force your baby to turn if it doesn't want to, so you loose nothing by trying . You might also want to look for a chiropractor skilled in the Webster Technique - this doesn't try to turn the baby, but aims to make sure the mother's spine and pelvis are aligned such that the uterus isn't constrained, which can often allow a breech baby to turn itself.

I know that we were very fortunate on a number of counts - we'd suspected DD was breech for a while so had done some homework, we were within the range of a very experienced IM and we could afford them. I'm not trying to say that you should do the same thing, just that there may be options if you want them.

Fingers crossed for you. 2008 will be a wonderful year however your baby arrives

I could have written your post.
Anterior placenta, breech baby, lack of movements, and high blood pressure as well. I opted for the route I felt was safest - which for me and my baby which was a section.

The hospital I was in said they would support me if I had a section, but would advise against it. and I felt with all the other issues I had when pg, a section was safest.

But, breech births are doable - my mum was booked in for a section with me as I was breech but I ended up coming quickly so was born feet first, and I have been awkward every since

I was told DD was breech when I was 41+1 and 4cm dilated!
In my case it was safer to deliver by CS as she was not only footling (one foot down, one up) but the foot up was wrapped behind her head so they were concerned about her hips dislocating or her getting stuck.
I was most pissed off as my mum have 2 breech deliveries (out of 5), one feet first and one butt first so I was assuming I could deliver naturally as well.
So I would say find out exactly what position LO is in before making a firm decision, turns out that DD would never have turned anyway as her head was wedged under my ribs (it took 25 minutes for them to get her out, and I had bruised ribs for days) luckily for you you have a bit of time to think about your options, just be grateful you weren't admitted there and then, put on bed rest to stop labour pregressing and then given a CS, without even access to MN to discuss it

Good luck with whatever you decide!

My mother was a midwife and had seen enough babies with very battered heads following breach deliveries to gently persuade me not to try a vaginal delivery, as my pelvic outlet was not huge, according to my MRI scan.

A newspaper doctor (Tom Stuttaford or James Lefanu) recently wrote about adults who'd never reached their full genetic intellectual potential as a result of damage suffered during difficult labours.

I look at my bright and happy soneleven next weekand thank God I had a Caesearean. Too many things were stacked against us having a vaginal delivery. But every woman (and every woman's pelvic outlet) is different.

You'll do what's right for both of you. Good luck.

Just back from mums in law so have tomorrow to swot up and take action before talking with doctors.

What a wonderful range of responses from you all. Each of you have really made me think about different aspects of the prospective delivery and honed the questions that I need to ask myself and the doctors. Thank you. I'm really touched that each of you took the time to respond and share your own experience.

Regarding the moxy, I'm heading down to my local Chinese herbalists first thing in the morning, they'll want to do an assessment of my condition before they attempt anything I'm sure. Thanks for the clarification about it Stripey. As you say, Tangle it can't hurt!

Tangle, what a mine of knowledge! Thank you for sharing a summary of your findings. Its a 'heads up' to the political aspect of the situ also. I'll look up Jane Evans and her book and also see if i can get a chiro to find a last minute appointment for me.

Its comforting to know that others have made the choice of caesarean in this instance and known that that they have made the right decision for their situation Elf.

Chirpy, it must have been so distressing for you with so little time and resources to make decisions and such a relief to have your baby safe at the end of the procedure. I'm going to make sure of bubs position and will have to play some things by ear when it comes to decision time, based on facts.

And will also make sure of my own pelvic capability, Eliza. I will have to be sure the chiropractor and doctors will be able to tell me exactly how I have shaped up. I'm sure there is a reason beyond 'bad luck' that bubs is breech - so need to be sure that won't cause more harm than good. So glad that it worked out well for you and your son. My dh is particularly concerned about giving bubs a good intellectual start in life so def another aspect to consider given your mother's experience.

What a great place - this mumsnet! Wishing each of you and all those who read this a loving 2008!

Don't know if you will see this but just to add to what has already been said, I too had an elective for a footling breech. As several people have said, the problem is lack of skilled professionals. The doctor I saw said that he personally would be ok with delivering a breech, but couldn't recommend it as he knew many of his collegues had never seen one, and he couldn't (obviously) guarantee to be present if I went into labour. Something you might want to consider if you go down the elective route is going for a 'natural' c-section, or as close as you can get. Someone I met at my antenatal class had an emergency c-section and had trouble relating to her first child. She therefore opted to see what was happening when the second was delivered by elective. Something along the lines of the delivery described in this article.www.guardian.co.uk/family/story/0,,1656246,00.html Personally I could skip the music and the lavender, but I wish I had opted to see what was happening (I think they only take the screen down at the crucial moment!) but when I raised it with the midwife (probably too last minute) she tried to talk me out of it. To be honest by the time it came to it, I just wanted to get on with the job. What I ought to have done was talk it through with the doctor when I saw her a few hours before hand. Having not done so, it was therefore a matter of raising it again in the operating theatre, and by that time I was concentrating rather too hard on the fact that I was about to have a spinal put in! Worth thinking about anyway. I somehow feel as if I have been 'cheated' out of not having a normal birth (dh thinks I'm barmy!) although I realise that the decision we made was probably the right one under the circumstances. Being able to see what was happening may just have helped a little...

Hi Meimango,

Glad it was useful. If you're digging on the internet, Mary Cronk is another wealth of knowledge on breech birth.

If you do decide to investigate vaginal birth, make very VERY sure you know what kind of exerience your practitioners have and what kind of birth they would support. I had a very hands off birth, with midwives that were confident that they could just let me get on with it while observing and they'd know if/when they needed to intervene (hands off the breech!). I was on all fours, which allows gravity to work on the baby's body to help release the head safely. I was supported in labour - I wouldn't say I was particularly assisted.

If I'd gone into hospital for a vaginal breech, it would almost certainly have been consultant led, and would almost certainly have had me in theatre, in stirrups, with an episiotomy and having forceps waved around. Some doctors still use traction to help deliver breechs. In my mind, all of that adds up to a much greater risk of damage to the baby (not to mention the mother...). If that had been my only choice I'd have been in for a section like a flash.

I don't think they recommend pre-labour scans to estimate pelvice capacity anymore - most women release a hormone in late pregnancy that loosens the pelvis and gives extra space. If you're not on your back your coccyx should move as the baby decends, allowing something like an extra 4cm diameter! Similarly, scans to estimate the size of the baby are notoriously innacturate, especially as the baby's head is designed to squash a little...

The scare story you're most likely to hear is the "head stuck" one. This tends to derive from pre-term babies (which are more likely to be breech as they just haven't got round to turning rather than for any sinister reason), where there is a dispraportion between the size of the baby's head and hips. If you talk to midwives that have seen a lot of TERM breech births, they just don't find it happens as the bum and head are pretty well the same size.

Good luck for Thursday. At the end of the day there's no right or wrong answer. You just need to do what feels right for you. Just don't be afraid to ask questions and keep asking them until you get answers that make sense . You also don't HAVE to sign the consent form then and there if you don't want to - they may not like it, but it's a big decision and if you need more time to think then take it!

(Oh, and I've just found a brilliant website: www.breechbabies.com/. At least it should be - the java scripts are playing silly buggers for me, but from what I've seen it looks like there's masses of info there )

I am someone who discovered their baby was breech in the delivery suite when his bum appeared instead of his head!

It was too late for a c- section, so was able to deliver naturally, kneeling up, hanging on for dear life onto headboard and husband. (A small crowd had gathered at this point because its not something they see everyday)
He was my third.

But I wanted to add a positive, but unexpected, delivery story to give you more to think about!

Although I didn't believe it would work, I followed a recommendation and had a reflex session to try to turn my first baby.

And it worked.

google reflex/breach if you are interested in trying it.

BTW I had a CS for second baby and found the whole experience very positive.

Am 31 weeks and my scan on Friday revealed baby is breech.

Am also at Royal Free Hospital so v. interested to see what your experience is.

Have decided that if she is still breech at 36 weeks to go for c-section. ECV doesn't appeal to me: painful for mother, risk of foetal distress and placental separation and no guarantee that baby will not revert to breech afterwards. My sister was breech and turned day before delivery!

I am so pleased that you're focusing on getting LO into the world safely and not too hung up on a natural labour.

Hi - not sure if posting too late. But I too wanted natural labour, had done hypnobirthing etc. etc. Bub was resolutely breech from 28 weeks and didnt turn once. Then I started to get episodes of reduced fetal movement - had a few too many and obs and I both ruled out trying an ECV as we didnt want to put LO under any unnecessary stress. I didnt consider trying a natural delivery (midwife was experienced in delivering breech birth) and ma very glad I didnt. My DS came out very very skinny with a big boney head....his bottom would have slipped through before I was dilated enough to let his head through.

My CS was a fab experience and dont regret it for a second.....

That's the problem, though, isn't it; you can never say "this would have happened". You only know the results of the choices you made, not the choices you didn't.

My midwife was very frank. In her experience for a breech birth to be successful labour needed to start completely spontaneously (she wouldn't even do a membrane sweep) and progress completely naturally. Not all breech babies will birth vaginally succesfully, but in her experience if those two criteria were meet then the births were generally very straightforward. If my labour either hadn't started or hadn't progressed she'd have been the first to recommend we transfer for a section and we'd have taken her advice.

There is a school of thought that says how the mother feels about it is very important in how the birth will go - i.e. the mother subconsciously has a pretty good idea of whether she could birth the baby vaginaly or not. It looks like that may have been the case for you, dal21, and I'm really pleased your CS was such a good experience for you .

32 weeks and LO still breech - but is moving a lot so may get into position. I think i may be the exception to the rule cos i prefer the idea of a planned c-section. The idea of being in labour (pain!) for 24 hours doesn't appeal to me at all. I know that labour can be quick but i don't want an epidural (friend is a consultant obstetrician and he isn't in favour - slows down birth). I much prefer the idea of knowing when the big day is - but on the other hand the pain afterwards ....

Sorry to hijack but this thread is one very relevant to me.

Just an update. Thanks for all your replies, they helped me through a confusing time. We ended up trying the moxibustion - we had a course of three sessions, but given i was 38-39 weeks we weren't expecting too much. So baby wriggled around a great deal more than usual (which was comforting as i'd been going into hosp for lack of movement) but fraid in this instance, bubs didn't turn. Dh and i opted for the breech caesarean at 39+6 - keeping in mind the placement of my placenta, we were happier with the percentages of baby health with surgery; though we were disappointed to have such a medicalised experience. That said, the staff at Royal Free; midwives, doctors, anesthetists, consultants, were exceptional and put me at ease at every step pre and post labour. Very glad to hear that i can go for a VBAC next time.
For Lovemymum - No issues with bonding or pain post op. I've been on baby safe painkillers as I want to remember these early wonderful days fondly. Stayed in recovery for a few hours with husband and mums, then moved to post labour ward for 3 nights - where the midwives were truly brilliant - offering support and advice as needed. Though I would have much preferred to be at Edgware Birth centre with a natural birth for the recovery as post ward is stressful. The nights were intense, as all the other mums on the ward were in need of advice also - four sets of crying babies at 3 am is sure to set off anyone's stress levels! So was very glad to get home - but armed with good advice and a wonderful healthy baby. I hope you have the birth you want and a happy post delivery!

Congratulations Mei!
Welcome to the world LO. .

Thanks for thinking of me. Am now 34 weeks and LO is still breech.

meimango - Congrats on the safe arrival of your DC . I'm glad you found the experience positive, even if it wasn't what you originaly wanted. Enjoy your babymoon

Many congratulations meimango. I am in exactly the same position (sorry) - 37 + 3 weeks and baby is still breech despite ECV on Monday, acupuncture, reflexology, scrubbing floors etc. Am booked in for c-section 28 Jan (baby also has a very big head and is footling breach) and it is good to hear your story

Got similar problem, baby transverse (sideways) 36+1, at midwife on Wednesday, really don't want ecv as read too many bad things, have tried weird and wonderful methods but no luck yet, anyone got any stories of babies turning late?

Stacey - my younger sister was breech and turned the day before she was born by c-section. Mum had c-section anyway cos i was c-section (1972 and 1975).