Natural Breech Births

[Indith]

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

Hello dear

Getting very technical now (mint and tangle) but so interesting. Makes me so grateful for the birth I had and so and at the way things keep going within the NHS.

Having just had an emergency c-s with undiagnosed breech (4 days ago!) instead of the home birth i wanted i wish i had been forewarned.
would have wanted to go the IM route at home but if not that then at least been prepared for implications of cs (eg looking after ds1).
get all the info you can and make your choice best you can with resources available.
good luck

Scienceteacher - the TBT compared the outcomes of planned cesarian vs planned vaginal breech birth. They made no differentiation between midwife led, hands-off vaginal birth and Dr led, medicalised vaginal breech delivery/extraction. They also made no allowance for actual mode of delivery - so women that were assigned to the vaginal birth group but actually delivered by CS were still analysed as a "planned vaginal birth", and vice versa. Those are two of the flaws that might be considered fairly significant.

There was either a passing comment in the TBT itself or subsequent analysis of the data by other researchers indicated that in centres that had a very high vaginal breech birth rate anyway (such as in countries that don't have a high CS rate and so most likely have more experience of vaginal breech birth), the outcomes for the planned vaginal group were much better. However, the gross conclusion of the TBT was that a planned CS gives a better outcome than a planned vaginal birth (undefined). To my knowledge there hasn't been any published research comparing the outcomes for vaginal breech birth with that of vaginal breech delivery or CS - I'd love to know about it if there is!

Indith - sorry, trying not to get too bogged down in the detail, but I can get carried away at times. And I also become more and more grateful for the birth experience I had.

Coco2008 - if you do want to look at a natural birth, even if bubs stays breech, you have nothing to loose by contacting IMs local to you. They can be flexible regarding payment, especially if it's a case they sympathise with (such as a breech baby being considered abnormal rather than unusual, twins, etc), so you might be able to work something out even if first impressions are it's out of your reach. I've heard of them agreeing to payment plans, or payment in kind (I think one of mine was looking for a decorator) for example. Even if they can't take you on as a client for whatever reason, they may well be willing to talk things through with you and give you information in a different way to the NHS. Certainly I felt the information the NHS gave me was geared towards getting me into theatre - the information my IMs gave me was geared towards helping me make an informed choice. Might be worth a thought, and good luck whatever happens .

Tangle detail is good. I'm glad I started this it is way more interesting than what I'm supposed to be doing

Just posted this link on another breech thread but thought I'd post it again. Photos of a home footling breech birth Very impressive and you'll see that the mother is just left to do what she needs to.

Good luck

Benna Waites, Breech Birth...excellent book picks apart all the current research on the subject. Very good for both MWs and lay persons.

Well, i had my consultation and he said chances of her moving on her own small so im booked in for an ECV in 2 weeks time - cant wait seeing as the consultant referred to it as "barbaric"! but so long as my baby is ok and there is a chance i will be able to deliver naturally im gona go through with it. thanks again for all the advice, even though some of it is too complicated for my swamped brain!

By the way, does anyone have any experience of the ECV proceedure? they just told me that its not painful, just uncomfortable (cant be more uncomfortable than the skull pushing against my ribs!) apparently takes 1hr-1.5hr?

Hi Coco2008
I have just found out DC2 is breech (I am 36 weeks) and that the consultant who did my successful ECV with DC1 has moved on. Feeling v frustrated as ECV experience last time was very positive. I had to be prepped for CS as there are some risks (placenta being dislodged, cord getting wrapped round baby) but it didn't hurt, and took no more than about 15 mins. Felt a lot of pressure as dr pushed in the style of someone opening a big jar of pickles (with one hand on head and one on bottom)! Then a very satisfying gallomph as baby swizzled around. Had to stay on monitor for about an hour, to check she didn't ping the other way up straightaway. But she didn't and we went home and then she was late and I had to be induced! Now I'm being told my two breech presentations might indicate somehting about the shape of my pelvis. Hmph.

LOL jbsilvertongue, i got told my pelvis was probably to blame, but i think my little unborn baby is just a naughty little minx! Info about ECV very helpful thank you and makes me feel a lot more positive. Indith told me her friend also had a successful ECV so it's looking good. Prepped for CS though? In what way? i am TERRIFIED of CS which may sound odd, because I really want a really natural birth with as little pain relief as I can manage. Are you having another ECV then? I think success rates vary throughout the country cos where I'm having mine is 40% successful

Coco2008 I had ECV with my late-diagnosed breech last year. It was very very painful, even with gas and air. They don't push for long- I think my consultant said maximum 2 minutes at a time. My DD was very firmly wedged and wouldn't shift. After the procedure I was left with a massive yellow bruise all along the top of my bump

Do a search on ECV- there have been lots of threads. If they are going to turn it seems it doesn't hurt. Most say it doesn't but some had a similar experience to me.

Coco2008,

Arrietyclock's posting from Thursday is SO right - especially the hearbreaking "why oh why" at the end. Please, please be prepared so that if they DO end up with a CS, you know what to expect and how to make the experience more "yours". I put a LONG posting on
lilimama's birth story explaining how my undiagnosed breech saw me land up in theatre with resulting resentments and sorrows - Lilimama's tale of an unplanned emergency CS has prompted lots of sympathy.

It's great to see all this optimism about a natural breech delivery, never let go of that - but if I'd known in advance, as you do, I'd have prepared myself for that operation and not felt so bitterly disappointed, like Arrietyclock, about not pursuing options. I didn't even know there WERE any. It seems there's plenty of "time" for them to ask if you'll agree to being gowned/medicated/anaesthetised "in case you end up in theatre" while you're labouring away (I took the gown but nothing else), but not to ask how you feel about the screen, the cord-cutting and other aspects of your baby's first moments. I understand all sorts of requests can be made - music etc; silence at the moment of delivery so the baby hears your voice first. The "natural caesarean" sounds like the ultimate though. Before the op I probably wouldn't have considered it, but now, I'd go for that option any day over the numb, invisible "birth" I had.

Don't give in readily, but be informed so that if you do have no option in the end, it's still done on your terms! I think all women should be encouraged to write a "back-up birth plan" as you never know when you'll be whipped into theatre ...Good luck! Hope the ECV isn't too drastic and TAKE ARNICA to minimise the pain and bruising!!

I did have a second ECV - yesterday. Again no pain and it has worked, tho I am paranoid about DC2 deciding to revert to breech. Got told that second babies often don't engage until labour starts, unlike last time around where head engaged before we even left the hospital. Anyway, I realise I am lucky (in E Sussex) to have been offered to procudure twice and with a high success rate (the consultant who did my first ECV had a 90%+ success rate), and like you I wanted to avoid a CS if at all possible. Reading postive stuff on here about what you can ask for if it does come to a CS is all v helpful.

Last week I went to a study day called a day at the breech which is run by Jane Evans, Mary Cronk and Brenda Van der Kooy (all independant midwives). It was fab and inspiring and as a midwife I would love to be able to offer women these choices, but it does feel as though the system is again us. I would suggest to anyone seriously considering having a vaginal breech birth to try and go to one of their study days, they are aimed mainly for hcp's but do sometimes have pregnant women or people interested in childbirth who are not professionals. I'm not sure how often they do them, as they are all working independant midwives.

this is their website