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Childbirth

Share experiences and get support around labour, birth and recovery.

Natural Breech Births

40 replies

Indith · 24/01/2008 15:44

I have a friend who is breech and has her heart set on a natural birth. She is due in March so has some time to turn but I'm hunting out a few facts she can arm herself with should she choose to argue for a natural birth rather than automatic section.

Looking at past threads on here I understand that there are cases where a section is pretty much manditory (footling is one I picked up on) but otherwise so long as you have a breech experienced MW you should be fine.

So

What are your experiences?

What is good reading material?

What should she ask regarding position of baby etc to be able to make an informed choice?

Would she get a late scan to check position?

Thanks in advance

OP posts:
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Lulumama · 24/01/2008 15:51

i think tangle is good on this subject.

and mary cronk has excellent advice if you google her about breech birth

cluckyagain · 24/01/2008 15:57

My friend was breech with her second (bottom down) and after being told by the local hospital that it was either 'be lucky' and have a mw who had even seen it before or go for an elective caesarean, she decided to go for a private Mary Cronk MW. As it was the baby was born v quickly, and the mw arrived as the baby was born - it was great though and she thoroughly recommends them - great preparation apparently (not touching the baby as it comes out as they curl up apparently and then get stuck!) They were £3000 though!!!

belgo · 24/01/2008 15:59

I've seen one on TV - and the doctor stood there and let the mother do all the work - he said that it's dangerous to interefere with the delivery.

There was a mumsnetter quite a while ago who had a home birth for her first baby, a breech delivery. I will do a search.

scorpio1 · 24/01/2008 16:00

My Mum had a natural breech delivery, baby fine at birth, over 8lbs and she is only 5ft 3.

Said it was a little more uncomfortable than her other births (2 other VB), but not nessecarily worse.

bundle · 24/01/2008 16:08

Mary Cronk is only delivering babies for women she's delivered before (iykwim) as she's getting on a bit. I've met a midwife who delivered an undiagnosed breech in a midwife-led centre and she said the whole world stopped as its legs popped out!

Indith · 24/01/2008 16:15

There you go you do the hoovering and the washing up and a wealth of information appears! Thank you all. Mary Cronk showed up a fair bit on the thread search I did before so shall def look for some of her stuff though I don't somehow think funds will be stetching to an IM!

Keep talking to me you wonderful folk though I shall not reply til later this evening as I'm off to pick up a snotty, teething monster from creche

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Maidamess · 24/01/2008 16:17

No one knew my 3rd was breech until I pushing and his bum popped out! But I managed to deliver safely and quickly (hid head took a little assistance to come out)

It didn't feel any different from the other two. (Apart from the audience of 20 who had come in to have a gawp)

ArrietyClock · 24/01/2008 16:18

Mine was breech. We too came to the conclusion, as you have done, that it's all down to whether you can find a MW who is experienced with breech deliveries. If you are going NHS then it's absolutely luck of the draw on the day. C-sections are now so common that not many MW's seem to have much, if any, experience. There was a study done some years ago called the Term Breech Trial that's worth looking at, though it seems you can interpret the results in a number of ways. I think Mary Cronk's stuff refers to that.

She can always try having the baby turn (External Cephalic Version). A fun experience (not!). I've never played rubgy but now know what it's like to be in the middle of a scrum. It is not without risks. It's more likely to be successful if it's not a first baby as the mothers muscles are somewhat slacker. There are also other ways of trying to turn the baby. Burning stuff near one of your toes, favourable positioning, that sort of thing. Variable success rates for all, I believe.

She should be offered a late scan for positioning. If she has an elective c-section they will do one before hand to check the baby hasn't turned on it's own. Mind didn't....We opted for c-section. The decision was easier as ours was a footling breech..

The only other thing I would add is that if she opts of an elective section she might want to think about how that is done. I almost asked for the screen to be removed at the last minute, then didn't (didn't discuss it far enough in advance) and wish I had. She could also go even further and as for a Nick Fisk natural section approach (try google). Personally I can skip the lavender, etc. and I'm not sure how many hospitals would view it, but if it's what you want, you don't get if you don't ask... (why of why didn't I ask?????)

Indith · 24/01/2008 17:49

Thank you

Have read a Mary Cronk article, sounds very reasonable. I like the way she is not all guns blazing vaginal birth but very accepting that sometimes a section is best.

The Nick Fisk stuff looks good too, I think that will be good to show her that if he has an elective she can still have some control.

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bundle · 24/01/2008 17:53

she calls intervention "help"

personally i wouldn't want to be more than 10 mins away from "help", pref in a co-sited birthing unit

sophiewd · 24/01/2008 17:55

My friend had a natural breech birth and everything was fine, she did some hypnotherapy in the weeks leading up to it and found that invaluable.

cluckyagain · 24/01/2008 17:55

Oh - just remembered - they wouldn't let the private MW on the hospital premises so my friend had to have a home birth....what lovely choice!

Pennies · 24/01/2008 18:00

I delivered a breech baby - they didn't know until they saw the bum though. I'm sure it can't be that uncommon and I'm not sure why they're so happy to do a CS on breech births.

No probs here - only had gas and air and a very fast labour (2.5 hours from start to finish). Head needed turning but apart from that all OK.

I think if I was in that situation again I would have the birth in hospital just in case further assistance was required but otherwise I would stand firm and see if they'll let her do it.

Indith · 24/01/2008 18:03

Great to hear of so many positive stories. She has a MW led centre as first choice at the moment but i'm sure if agreeing to hospital gets a natural birth it won't be a problem

OP posts:
frumpygrumpy · 24/01/2008 18:09

Haven't read the whole thread, just to say I had breech with my DT2, was all fine and dandy.

frumpygrumpy · 24/01/2008 18:10

does that mean i had a gaping tunnel for a vag?

Pennies · 24/01/2008 18:12

probably

Indith · 24/01/2008 18:12

Lol frumpy

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ScienceTeacher · 24/01/2008 18:28

My last baby was breech, and was born without incident.

I suspected she was breech myself, did lots of research (including Mary Cronk), and decided the best thing to do was to keep quiet about it and avoid examinations.

I knew that if labour progressed, then there should not be problems with the birth. If the labour stopped, then to go straight to C-section - absolutely no acceleration.

Indith · 24/01/2008 21:47

Thanks all for the stories. I've sent her links to some of the articles and to the thread. Just heard that at her appointment today the MW was not very positive but hopefully she will now be well armed and informed about her choices

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Piffle · 24/01/2008 21:57

my ex's wife recently gave birth to their baby breech. They did not know either!!!! Really fast labour under 1.5hrs no time to do section etc. She had small tear 4 stitches and used homeopathy and healed really fast.

Tangle · 24/01/2008 23:20

Didn't realise I was infamous

My personal experience was DD (DC1), who was born last April at home with IM's as a footling breech, 9lb 12oz in about 7 hours with no pain relief.

Background reading I was given that, IMO, gave a much more balanced view than the NHS was: "Breech Birth" by Benna Waites and "Breech Birth: What are my options?" by Jane Evans. I'd recommend both of them (the first is longer and discusses alternative therapies that are often suggested, incl accupuncture, moxibustion, chiropractor, positioning, and probably some more besides).

Position is a tricky one. I had to fight to get a scan before 37 weeks to confirm presentation, and in the end got in at 36. DD was frank/extended breech. Something changed around 40+5, and at 41+2 I had another scan (explicitely requested by MWs) to check what was going on - she'd got her legs down and was full breech. She was born about 12 hours later as a footling. So I guess two things to take away from that are that it is possible to birth a footling breech safely, and that positions can change! I'd assume that whether or not you get a late scan depends on your midwife and your PCT policy - but they should certainly scan before a CS.

If your friend stays within the NHS, is confirmed breech and wants a vaginal delivery then she may well have a fight on her hands. I was initialy given the "option" of successful ECV or CS. When pushed they said they wouldn't recommend it but if I really wanted then they'd "allow" me to attempt a vaginal delivery, but it would be in theatre, in lithotomy, with a pair of forceps and with a cast of thousands looking on. I would add that this was the registrar's view - while I was on the ante-natal ward I got the impression that some of the midwives would have been supportive of a "hands off" breech birth, but by then I had little confidence that they'd be allowed to help me without calling the Dr's to fulfil trust policy, or that once the Dr's were called they'd refrain from medicalising the whole caboodle.

I was very lucky in that I could afford IM's, and even luckier to live close enough to some that I trusted implicitly and could take me on at 36 weeks. If I'd stayed within the NHS I would have opted for a section - at that stage I didn't feel up to fighting that battle.

Ah yes, the infamous Term Breech Trial... The Term Breech Trial was a large study done by Hannah et al, was published in 2000 and compared planned method of delivery for breech babies (vaginal vs. CS). It found that CS was apparently safer for both mother and baby. However, there are a large number of issues that have been raised with the conception, execution and analysis of this study and papers have been published on both sides of the Atlantic recommending it's conclusions be ignored (there's the full text of a critique available here for free if you're interested that has some of them. The complete list of flaws is horrifyingly long ). Sadly, the results were lept on and, almost overnight, CS for breech became the norm across much of the developed world.

Everyone agrees that key to the safe vaginal birthing of a breech baby is the skill and experience of the attendants. I'm very afraid that CS for breech has become so common midwives are not developing those skills and so soon CS WILL be the safest way to deliver a breech baby. Which is fine till you're not diagnosed .

ScienceTeacher · 25/01/2008 06:18

I interpreted Term Breech Trial to say that if you are going to have a medical birth, then C-section is far safer than lithotomy/forceps/synto etc.

However, midwife led births were safer than medical ones.

My midwife hadn't attended a breech birth before, but she did everything right - ie sat on the other side of the room...

Mintpurple · 25/01/2008 08:41

I agree completely that the Term Breech trial is very flawed, unfortunately, as we all know it has been taken as gospel by virtually all western hospitals. So not only do we have many midwives who have never seen a breech birth, but there are very few experienced doctors, so it definately is a skill which is dying out.

As a midwife of (ahem) long standing I have seen many breech births and delivered a few, but I would not be happy to say I was confident as its not something we do regularly, not for the past 10-15 years anyway. If you are lucky to have an IM help out, they will probably have much more experience than almost all hospital midwives.

The consequence of most mums going for c/s is that the few that slip through the c/s net are treated in a very medicalised way and in any hospital that I have worked in (and thats quite a few, esp as having done a lot of agency work in London) the lead HCP is always a senior doctor. M/W will not get a look in, so when you are discussing finding an experienced m/w, dont look in the hospital system, as even if it was Mary Cronk herself, she would not get near you in a London labour ward!

There was a very interesting article written by Mia Davies in the newsletter of the Association of Radical Midwives recently (mid -late 2007) about her struggle to get a midwife led breech birth in a London hospital and how she was undermined at every turn by the establishment. Unfortunately I cant find the article online, but you may get it from your local library, or join the ARM - its a worthy cause! It was very interesting how support was withdrawn from all sources, both from medical and mid staff and in the end (I think) her consultant delivered her in the stirrups, flat on her back

So, to get to end of my ramblings, although the midwives in hospital may support your wishes in this, we will almost always be overruled or ostracised in the process. I believe that Mia has since left the UK.
Although you will probably get a breech birth at home with IMs, you wont have the backup of neonatal resusc facilities or theatre in the case of an emergency. So its not an easy choice.

For what its worth, the successful breech births I have seen have mostly just laboured naturally, no synto, no intervention, good progress and descent. The ones which have not gone well have generally had slow progress and slow descent. I have also seen a few footling breeches which have also been fine.

However, Indith, if your friend is not due for another 4-8 weeks, there is plenty of time for it to turn still.

Coco2008 · 25/01/2008 10:48

Thank you for all the information - I am the friend wanting natural birth but with a naughty little wrong way round baby! Have been doing more reading up and the more i read the more i think i'll probs end up with a caesarean VERY disappointing, but i have an appointment to see about it on monday with a consultant so I'll know more then. I'm not due until 1st March so there is still time for her to turn i appreciate all the advice and comments, its all so baffling and the midwives are all giving me conflicting advice!