vb and a breech baby

[flippineck]

Quick bit of background: DD was breech, but not diagnosed until I was well into labour. I was very lucky that the consultant 'allowed' () me to carry on labouring, and she was born vaginally, bum first - but in theatre, feet in stirrups, episiotomy and an attempted (though failed because of broken pump!) syntocinon drip to speed things up.

I'm pregnant again, and given my story, and the fact that there is a history of breech babies in my family, I'm expecting this one to be breech too - the mw has agreed that I should have a late scan to confirm the position, whatever external examinations say. The mw has also agreed that as I've done it once, I should be able to have have a vaginal birth if it is breech, although I would have to go to the hospital, not stay at home or mlu.

So, after all that, does anyone have any top tips for breech births? Positions, tips for dealing with mws, arguments to be prepared for, anything? What should I be asking the mws at the hospital? Should I meet the hospital mws in advance to discuss it in more detail?

I have read the Benna Waites book (although quite a while ago, and can't get it from the library atm as someone else has it), is there any other recommended reading?

In an ideal world, I'd have an independent midwife who is experienced in breech births, but the money I had earmarked for that had to be spent on a new car .

My vote is for doing as much as you can in advance to try and avoid breech happening at all if poss. Try someone like www.barnes-chiropractic.co.uk This kind of treatment (chiropractic, with specific pg experience) is all about getting your pelvis etc aligned in order to get things all in the right place from early on and then kept in the right place. Good for you and good for your baby.

(In case anyone has seen any of my other posts, sorry to be repetitive! But this treatment has been completely brilliant for my pregnancies, labours and babies).

chilledmama - thanks loads for coming back to this, I hadn't checked for a while so missed your wonderful post! I hope everything is going well for you at the moment, and that the babymoon was/is great.

Your very detailed plan has given me a lot to think about - in my head I'd got as far as no continous monitoring, no episiotomy, no syntocinon, staying active throughout, no lying on my back or feet in stirrups, and skin to skin, BF not FF etc so there's plenty more there to consider. I'll be seeing the community mw the week after next (32 weeks) so will start pushing then for conversations with the right people at the hospital. I need to know about their policies, experience etc.

ballonslayer: I appreciate your point about the risks (and given the family history it's not something I'm ignoring or would be allowed to ignore) but I've done this once before, I just want to do it better this time!

foodonthecarpet - sorry, missed your post. Thanks for your suggestions, have researched what I can do to reduce the risk of this one being breech. I'm already seeing a chiropractor, because of hip/pelvis stuff and he is aware of the situation.

Hi, I don't have any personal experience of this area but thought you might appreciate knowing that a friend of mine recently had an unexpected breech baby (her second baby, first breech) very quickly and easily. In fact, the whole thing was so quick, the baby was very nearly born in the hospital car park. There was a specific Breech Team at the hospital who were apparently wonderful - may be worth enquiring if there is one at yours? Anyway, it was a positive experience for everyone (apart from the dad who was a bit shell-shocked by the car park thing) and the baby and mother were both perfectly healthy and were allowed home only twelve hours later. Hope this is encouraging for you.

BalloonSlayer - I don't think anyone is denying that there are risks.

I think I see what you're saying re. the cord prolapse, but I'm not sure cord compression during a "normal" breech birth is comparable with cord prolapse in a cephalic presentation. Statistically, vaginal breech babies tend to be more floppy and have slightly lower AGPAR scores at 1 minute than their cephalic counterparts - probably because there is a cord compression effect while the head is delivered. However, the time between the head entering the pelvis (when cord compression starts) and the delivery being complete so the baby can breathe independently is, for a breech baby, a fairly short period of time and so whilst there is a noticeable effect it isn't (assuming the birth is straightfoward) usually severe. From what I know that's a very different scenario to a true cord prolapse where a loop of cord is delivered before the presenting part, especially if the presenting part is a very firm skull.

When DH and I were trying to decide what to do for the best, one of the biggest problems we had was trying to get true like for like comparisons. "Breech birth" is a phrase with a wide variety of meanings - as used by Mary Cronk it defines a pretty specific set of circumstances and (lack of) management of a vaginal breech, but it was also used by the hospital registrar I saw to define a highly managed and medicalised version (epidural, lithotomy position and forceps). If the birth your Dr friend saw was a breech birth as defined by Mary Cronk (here) then I'd encourage him to contact either Mary and/or Jane Evans, who lecture around the country on breech birth (details here) as I know they would be extremely concerned to know that this has happened.

Hi Tangle

Thanks for that information, it's really interesting, and reassuring. I know extremely little about breech vaginal births I will happily confess; I only posted what I did because because I was worried that what you said made it all sound a bit of a breeze to the casual lurker or googler. Hope you didn't mind.

Mary Cronk's ideas sound wonderful. The story I heard from the Doctor friend was that the mother had "refused a section and insisted on a vaginal birth" ( you can tell that's a doctor talking can't you?). I think it was more than 15 years ago, definitely not recent. The story was told in the context of the Doctor - a woman - saying she'd never contemplate a breech vaginal delivery because of the horror of that experience.

Not at all - its always good to have different view to see .

My only comment, though, would be that if you have MWs that know what they're doing then a vaginal breech birth (of a normaly developed, term baby with a spontaneous and naturally progressive labour) usually is a breeze - they tend to either be fairly quick and straightforward as the experience of women here shows, or they don't happen at all (don't start or don't progress). There was also a study done in Paris last year that found, for a rigorously selected group of mothers with competent, skilled Drs, a more medicalised vaginal breech delivery was at least as safe as CS. There are, of course, a small minority of cases where everything looks fine but things don't go to plan, and the consequences of that can be devastating for all involved - but that's true for any birth; breech or head down, vaginal or caesarian.

From the information I've gathered, the vaginal breeches that are most likely to run into problems are those where the HCPs ((be they MWs or Drs) don't really have sufficient experience of vaginal breech babies to recognise and manage problems in a safe way.

flippineck- without giving too much away...where are you located????

Chilledmama - I'm close enough to London for there to be a reasonable selection of IMs should we win the lottery between now and the beginning of May, including Jane Evans on a good traffic day!

i'm in south hampshire...I spoke with an IM recently who said that she doesn't know any IM that wouldn't consider part payment in kind...don't know if you or your DP have any specific skills but a bit of painting and decorating could be the answer.

flippineck- I should have added...my birth plan section about being in hospital was based on the protocol list for breech deliveries. Not all hospitals have the same policies, my local PCT (Portsmouth) just has particular attitude to breech birth. Guildford on the other hand has a much lower CS rate for breech hence their hospital MWs and CMWs have more experience.
My lead NHS MWs both came from Petersfield and regularly work out of Guidlford whereas there is very little breech experience within the MW teams in Portsmouth...sad really and obviously why I had so many MWs depserate to attend my homebirth for the experience
You've got loads of time to get your baby turned anyway so hopefully none of this will be necessary but FULLY undertsand why you want to feel prepared.
I went to a chinese herbalist doctor who said that in China if you are breech you start a course of Moxibustion which lasts 30-45 minutes every day for 6 days then you get re-scanned and if still breech you do course again and this starts at 35 weeks.

I put breech birth in to you tube and saw some dreadful ones where they pulled hard on the babies can't see how that wouldn't damage them, there were also some lovely ones which were completely hands off.

The pulling ones were so dreadful that I couldn't watch to see if the babies were ok or not it was so awful to see. That sort of care is what gives breech births such a bad name.

I am convinced that they are safe hands off, not too big or small, good progress in labour etc. Such a shame that the NHS doesn't support it better.

Wish I had been able to come to your birth chilledmama, did you video it?

Will do my best to promote active breech birth in the NHS, but does feel like banging head against a brick wall sometimes.

forgot to say CONGRATULATIONS to you chilledmama, chilleddada and chilledbrother

Thankyou Maxbear.
Yes we did video it. I haven't plucked up the courage to watch it yet...not becuase I'm worried about the gorriness of it but because I don't really fancy looking at my spotty bum and listening to me grunting!!
There are loads of pics too which I have promised to the MLU and I will endevour to give a copy of the video too but need to do some editing first probably. If it can help develop skills then I'm all for it as I know how lucky I was to get the MWs I had! Thanks to the Supervisor who made it all happen!!!!!!!!!!!
How's DD and DS??

Hi flippineck - oh that's fab. If its a structural thing then hopefully your chiro will be able to sort things. Great that you've got that possibility covered.

flippineck-how are you getting on??

sorry chilledmama - only just seen this due to dodgy internet connection.

TBH, I'm feeling fairly relaxed about it all now. All the great posts here (thanks everyone!) have made me feel calmer and like I'm not being unrealistic, and I'm certainly feeling more prepared. Seeing the community MW next, so will discuss everything with her in more detail and get the name of who I need to talk to at the hospital, then follow that up.

It'll be interesting to see which way the MW thinks this baby is at the moment. I'm wondering if it's breech at the moment - all the movements/discomfort are the same as they were with DD, and I seem to have a hard lump under my ribs on the right hand side.

That should have been 'seeing the community MW next week' of course.

Thanks for asking, and thanks for your help.

any news???

I'm sorry - only just seen this! Rubbish at keeping up.

Saw MW last week (different one again - grr, haven't seen same one twice yet!), and there was a student mw there too. Both were absolutely convinced almost instantly that this one is head down, no hesitation or extended examination, and positive that heartbeat is in right place (and little chance of it being 'referred' iyswim). She wasn't bothered at all though about my concerns of another undiagnosed breech and just said that as soon as there is any suspicion that it is breech I'll be referred to the consultant and will have to discuss options then. So not a negative experience, but not entirely as positive as it could have been. She did compliment me in my knowledge and understanding of the situation and said that she didn't think I would be the kind of person to just accept what I was told!! So I suppose she got that right.

Anyway, based on last week's appt, my home birth plans have started, and I guess I'll just have to be prepared for a fight later if necessary. Hoping that hb booking appt (next week, or week after - waiting for yet another mw to call!) will be slightly more productive.

I'm 35 weeks tomorrow and last day at work today so will have a bit more time to get organised too!

Just thought I'd post another update! Had my homebirth booking appt today, saw my 'named' MW - for only the second time this pregnancy! Anyway, she is also convinced that this one is head down, but suggested (I didn't even have to mention it!) that I had a scan to confirm. So that's next thursday, at 36+6, and if cephalic presentation is confirmed it's hb-a-go-go!

If LO is breech, then it's an appt to see the consultant to discuss the options but again the MW agreed that it's highly likely they'd let me attempt a vaginal birth as long as I went to the hospital, but that I'd have to talk to the consultant about how the birth happens, iyswim.

One more update, just in case anyone is stll there...sorry to be boring!

Anyway, I had my presentation scan this afternoon (am 37 weeks tomorrow) and the LO is quite definitely head down, and the consultant said that althoug it isn't impossible for it to turn now, it's unlikely. Fingers crossed that everything goes smoothly now and I get my hb.

Thanks everyone for all your advice - I was feeling well prepared for all the discussions I might have had to have and so wasn't worried. Thanks again.