Breeched baby at 38 weeks... don't want a CSec

[Dophus]

I am 38 weeks and had a presentation scan yesterday which showed that the baby is definitely breeched. The consultant said that the bay is too tightly packed to try an ECV. The estimated wieght is 6lb 9oz and this is my first pregnancy.

I had wanted a relatively natural birth useing the water pool and home form home facilities. The consultant has saif that he will support me if I decide to go for a vaginal delivery but doesn't really recommend it as there is an increased risk for the baby. If I attempt a vaginal delivery then there is a 50:50 chance I will end up with a C Sec. I hate hospitals and I am terrified by the thoguht of a C Sec.

I was feeling extremely positive, optimistic and excited about the birth. I now feel weepy, anxious and generally miserable.

I would like to try for a vaginal delivery but don't want to put the baby at any increased risk. Does anyone know how risky a vaginal delivery is?

ds was a footling breech. I had an (unsuccessful) ECV at 38 weeks. I then opted for a c-section - the consultant recommended it. I was told it was my right to labour if I wanted and that they would support me in that, but that ds' position was very unfavourable. I didn't want a long, hard labour with lots of intervention (who does?!), or to start labour knowing that it was going to be difficult. I was happy with my section and was up and about more quickly than most of the mums in my bay. I was very lucky. They didn't play my music though...

FWIW I know at least two women who gave birth to breech babies vaginally and with low pain relief etc.
These were second babies h/ever, I don't know if that makes a differnece?
Some hospitals do automatically say a C-sec with breech, but if you want to try a vaginal birth I think you should at least have the right to explore it further.
Agree with you re risk to baby tho, of course, ie you don't want it.

I should add (sorry, I wrote my first post earlier, before the excellent advice from Mears) that both the births i am thinking of were with an independent midwife, as Mears suggests.
H/ever I don't think either was diagnosed before birth.

Just another person who had a c-section with my first baby as I had placenta previa which can kill the baby without a c-section and also because of the pp he was transverse with his head tucked into my pelvis. The c-section was very easy and pleasant with great staff, my baby was with me the whole time (apart from drying and weighing), as was my dh. I breastfed my beautiful ds in the recovery room, about 40minutes after his birth, and the spinal block anaesthetic (which I recommend) wore off after about an hour. I was in hospital for five days, but I really didn't need to be. I was in more because my ds lost a bit of weight (though looking back I think his weight was just overstated to start with due to a mixup) rather than because I was ill or anything. I cam home on the Friday and my dh went back to work on the Monday and I looked after my baby by myself with no problems. I healed well and drove after a couple of weeks (took me that long to get organised enough to get me and babe out of the house ) and I healed with no complications. It was such a straightforward and painless way to have a baby that I am having my second (on 7 Feb!) the same way.

BTW, it was a very beautiful, moving experience too and dh and I were both in tears with happiness to see our son.

It's so hard to know what's best!

I've decided I need to go into labour when the senior consultant is on call as he would support a breech. Sadly I can't determine when labour will start!

I have also just learned that I have BUPA cover for an elective but not emergency (for reasons I don't really understand). I may book for a CS in one weeks time. If baby makes an early run for it then try for vaginal delivery.

I've had two sections, one elective (for footling breech, which nearly nobody will deliver) and one "emergency" for failure to progress-ish (failure to engage, really - independant midwife felt section inevitable, waters had broke, best to just get it done). The fact I was in labour (ish) the second time around seemed to help - I think the baby was properly ready to come out, the contractions had got some of the fluid out of his lungs, etc. I wouldn't hurry with the section.

Also, current NICE guidelines say you should be able to get out of hospital after 24 hours, if you are not feverish. If the hospital is unpleasant, and you have good support at home, this is an excellent idea.

I found recovery from sections hard. The more you take it easy, the better it goes, but I'm rubbish at lying still.

Yes, my section this time is only five days before my edd. I wanted to wait as long as poss. Last time it was 37+5, which I had to fight for and I still think he could have done with a week or two longer inside. No problems, he breathed beautifully, good Apgar etc, but he didn't half look surprised and cross

Dophus - you could wait right up till 40 weeks and if labour hasn't started by then have C/S on NHS. No need for BUPA I would have thought.

My breech cs was done at 40 weeks exactly See some do arrive on their EDD! In my case it was staff shortages over the New Year period. I was told that if I went into labour not to hang around at home but to come in asap for an emergency cs.

I had an ECV at 37 weeks with my 3rd, which was successful. But I researched my options pretty thoroughly beforehand, and FWIW, my conclusions were:

a) the scenario mears describes, flat on your back with continuous monitoring, forceps, etc etc would be a nightmare. Better a C-section any day.

b) breech delivery in an NHS unit without specially-trained midwives is likely to result in (a) above. The consultant said to me, very frankly I thought, that staff do so few vaginal breech births that they have become 'de-skilled' at performing them. The statistics showing increased risk arise in large part from poor management as much as inherent risk of vaginal breech birth.

c) My first preference would have been to go for a vaginal birth, but only if I could have organised for an experienced independent midwife to accompany me into hospital. But then again I'd previously delivered two large (9lb +) babies without problems, making me a good candidate for vaginal breech birth.

Do read Mary Cronk's website -- she's very evangelical about women's ability to birth a baby themselves if left to get on with it, which is inspiring.

Good luck!

My last baby was breech. Absolutely no problems giving birth to her. The key thing is to let nature take its course completely, and if things don't progress then make the decision to have a C.

Mary Cronks writings are fab and extremely encouraging and empowering.

Good luck in whatever you decide.

Oh, my breech CS was 39+5, so not actually early (we did push to get it later, largely so we could get our heads around the fact we were having a section). But my "emergency" CS was 40+5 after broken waters, and it did seem to help. Who knows, really, the breech CS was a total nightmare and the "emergency" one was a doddle - I remember saying my mouth was dry, and then saying that if that was my worst complaint, we were doing pretty well!

I had a c-section for my first baby at 38.5 weeks as she was footling breech. They wouldn't do an ECV - not enough fluid so not enough room. The things I have always wondered are:

• would she have turned if I'd given her an extra couple of weeks? I wish I'd waited until I'd gone into labour, had a scan to check she was still breech, and then had the cs if needed. With a first baby it was unlikely that I wouldn't have had enough warning that she was on her way.

• would she have been more ready to be born a few weeks later? We spent 8 days in hospital as she wouldn't feed - just wanted to sleep

• whats the deal with not trying an ECV? Can't they just try it and be prepared to do an instant cs if it goes wrong? I mean, if you're all ready with the spinal in and everything it only takes them 2 minutes to get the baby out. And if the ECV worked you could just wait for the spinal to wear off and go home... Some medical person can no doubt tell me why this is a dumb idea!

And the other thing that noone told me about having a cs - its not just this baby that is affected. It affects the next baby too...

Mears will correct me but a spinal is NOT good for baby (crosses the placenta) so you should deliver baby once you have a spinal.

Um, they don't generally do a spinal for an ECV. (You can get gas and air, though.) And if an ECV doesn't work, it's quite unpleasant and painful (as mine was). I don't know that spinals are bad for the baby, but they are hard on you, like any anaesthetic. And yes, if they go wrong, you can just have a section, but it would probably be a crash section, with general anesthetic and risk to the baby and you. Not a desirable outcome.

(I worry that ECVs, like breech births, are a skill that's being lost, at least in this country. Fewer mums opt for them, now, so fewer doctors know how to perform them. The rate of success does vary a lot from doctor to doctor.)

I think you can argue to go into labour first, with a frank or maybe even flexed breech, but not with a footling breech. The fear with a footling is, the foot gets out, the baby thinks it's out, tries to breathe ... well, you can see where this is going. You don't have to be very dilated for a foot to get out. This is what I gathered when I had my footling. We did wait until 39+5 though, as I had no early signs of labour.

I haven't read all of the posts on here, but can only give you my opinion from my own experience. My ds was a frank breech and I knew from about 32 weeks onwards. I was very upset when I found out at first as a CS was presented as my only real option and I absolutely didn't want that. I read all of the suggestions from the Mums on Babies book re adopting funny positions to encourage the baby to turn and acupuncture which I tried. Nothing worked.

I was booked in for ECV but due to problems with my blood platelet count this couldn't go ahead. I was having doubts about the whole procedure anyway as I had heard a horror story from a friend.

Also, I was breech and my mum gave birth to me naturally 30 odd years ago so I knew it could successfully be done. I had done my reading and everything pointed towards me being able to have a go as a frank presentation is the 'best' kind of breech I think. However, my neighbour is a retired midwife and she strongly advised me against trying for a natural delivery. 20/30 years ago breech deliveries were common place. That's now not the case and midwifes (generally) don't have the skills to deal with such deliveries. All the risk of such a delivery lies with the baby (she said). To cut a long story short, I opted for an elective section.

I'm sure other people have posted lots of medical back-up etc to allow you to make a proper decision but I can only tell you how I went about it. At the end of the day, all you want is a healthy baby and if a CS helps you achieve that.......that's what swung it for me. It's not most people's first choice but it doesn't have to be a bad experience.

My breech was the first on my midwife attended and she did brilliantly (I mean, how easy is it to grasp the concept of "hands off"). It helped that I wouldn't let her examine me, so she didn't know that the baby was breech ). But once she realised, she did everything "right", according to the Gospel of Mary Cronk.

We discussed it afterwards, and she said that if she had known, it wouldn't have been the lovely birth that it was, because of my OB's and the hospital's policies (this was in the USA).

My first was a c-section. He was feet first. As he came out the discovered he had the cord round his neck three times - something none of the many scans I had picked up. If i had gone for V birth would have ended up as emergency c-section anyway so am treally glad I took the view he was that way up for a reason and if he could turn he would. Am now 23weeks with #2 and am hoping for vaginal this time.

fruitful, an ECV isn't done with a spinal in. I did have a drip set up to relax the uterine muscle, but that was the worst part of it, frankly. I too had heard horror stories (all from people with no personal experience, needless to say) and the ECV was fine uncomfortable, yes, but by no means agony. And very quick a couple of minutes. Then you lie down for an hour being monitored, and off you go home.

I asked the hospital how many emergency C-sections they have to do, and they said that, doing an average of 2 ECV's a week, the last emergency Caesarean had been four years ago, which sounded like good odds to me.

I don't think they can generally see the cord on scans, so they can never tell if it's around the baby's neck (or badly positioned so as to prevent the head engaging, or whatever).

I still can't make my mind up and swith daily. I spoke to the head of midwifery at my hospital she was very suportaive and encouraging about going for a natural delivery. She said that all midwives were trained and she would renew their training if she knows I may be coming in. More reassuring was that there were a number who were experienced and cofident to deliver a breech. Also said that I culd always ask for one of the senior midwives to be called if I didn't feel compftable with the team prsent when I came in. The labour she described is the same as Mary Cronk's (minimal intervention, no induction, active labour, no epidural, hands and knees for delivery). She also believed that the morbidity rate in Britain (2-3 %) is the same for vaginal delviey as it is for C Sec. However these figures seem scary and high to me - does anyone know if they are accurate?

I also worry about pressure on the cord during the head delivery - does this always cause some degree of asphyxia?

We are seeing the consultant again next week (38 + 5). I will then take DP to meet the senior midwives and get the alternative point of view (why do they differ so much?). I have made tentative decision to book a C Sec at 40 weeks. If the baby wants to make a run for it before then I will try for a natural delivery.

The only thing I have at the back of my mind is the concern that if anything did go wrong then I would spend the rest of my life blaming myself for not having a planned CSec.

Morbidity is different from mortality you know - those aren't death rates, they are complication rates.
What frightens you about the c-section?

I know but they are still frightening.

Post op pain.
Longer stay in hospital
Longer recovery
Not being able to look afte the baby independently for a few weeks.
Long term pain (I know a couple fo my friends have experienced it)
Being unable to drive
Disappointment on missing out on 'giving birth'.

I don't know anything about breached babies, but from what I read from Mary Cronk's description it doesn't seem like trying natural labour puts the baby at risk at all. If things are not progressing, you go in for a c-section, but it doesn't seem like it is the typical emergency c-section wher baby is in distress.
Do you have any data on the consequences of trying to labour and shift to a c-section if necessary?