Dangers of vaginal breech birth?

[ItsAllGoingToBeFine]

Hi there,

I asked in one of my antenatal classes about the possibility of vaginal breech birth. The midwife said that the consultant would always prefer to do a CS because, as a first time mum, your pelvis is "untried" and there is a possibility of the babies head getting stuck.

How likely is this? I am not against medical intervention if it is necessary but I thought plenty of babies are born breech? I also thought that a CS was fairly major surgery and that the risks of that might outweigh the risks of the babies head being too large?

I do understand that some breech presentations are far trickier than others, but if it was a "straightforward" presentation would it be so bad to have a go vaginally?

If the babies head did get stuck, what then? Is it certain death for the baby?

(I am currently only 33 wks so at the moment this is purely hypothetical)

My DD2 was an undiagnosed frank breech. Had easy-ish vaginal delivery with DD1 but when they found out DD2 was the wrong way round mid-labour I was STRONGLY advised to have an EMCS. Basically, they said there was too big a risk for the baby if things did go wrong. As in, the body can be born and then the head gets stuck. Also, as far as I understand, not many midwives have experience in delivering breech babies. I have been pondering this a lot since, if I had known she was breech and had had time to do my research, would I have risked a vaginal delivery? And tbh I think I wouldn't.

Don't know if this helps?

Having said all this, my grandma's first child (my aunt) was also breech and was born at home with no pain relief whatsoever!

As I understand it the danger with a breech birth is that as the baby's head is (usually) their biggest part you don't know until quite late in proceedings whether they are going to be able to get out or not.

I guess it is also a bit like sticking your head through bars, you can get it through forwards but the jaw can catch when trying to get out.

DD1 was breech and we chose to have a vaginal breech birth. We did a LOT of reading and talking, and came to the conclusion that the safety of a vaginal breech lies in the skill of your HCPs. As so many breech babies are now delivered by CS, breech skills are getting hard to find within NHS MWs - and so we opted to go with IMs and a homebirth. We felt confident in that decision as we were fortunate to live within range of a couple of IMs with very strong breech (birth) skills who were willing and able to take us on at 36 weeks.

One thing we discovered was that there is a huge variety of methods by which a breech baby can come into the world vaginally. This article by Mary Cronk summarises the two ends of the spectrum quite nicely. By these definitions we very definitely had a vaginal breech birth - if the choice were a vaginal breech delivery or a CS I'd've been in theatre like a shot.

Talking to MWs with a lot of breech experience, if the baby is term and normally developed and labour is spontaneous and naturally progressive then a trapped head is almost unheard of (as in a normally developed baby the hips are pretty well the same size). If it happens I don't think the outcome would be good - even if you had a prepped theatre on hand. However, a bigger risk is considered to be cord prolapse - which is minimised for a frank breech that engages before labour and is maximised for a footling breech (but even then is still pretty low).

The current advice to deliver breech babies by CS came into being on the back of the Term Breech Trial (published by Hannah et al in The Lancet in 2000), which found that CS was substantially safer. Since then, so many flaws have been identified with this study that the findings have been totally discredited (and more recent research found vaginal delivery to be at least as safe as CS) - but the damage to MWs breech skills has been done and to restore breech to the domain of "and unusual variation of normal" will take a determined effort on the part of policy makers. At the moment I don't see that happening .

I do believe that breech birth is safe (or as safe as the alternatives) as long as you have HCPs skilled and experienced in vaginal breech - but I also know how difficult a decision it is to make and so hope that your baby does get themselves head down in plenty of time

I also would like to add this one by Mary...Shes just a star isnt she.

www.radmid.demon.co.uk/breech.htm

ElCS is safer by far for the breech baby. Wait until 39th week, of course, so there will be no breathing issues.

It is called "major surgery" around here, but it is closer to a tonsillectomy than a kidney transplant and teams that perform it tend to be very experienced at it.

What is your hesitation re CS?

If your baby is full-term and the birth is managed well, the head won't get stuck.

The key to breech is to not interfere. If the birth progresses, then the baby will fit. If it doesn't progress, then perhaps the baby won't fit (because of its weird presentation rather than size of the head) and it is time for a c-section.

The worse scenario is when the medics start interfering with synto and weird positions. That can ram the head against the pubic bone and the baby can get stuck, and then it would be a crash c-section.

Basically, the two safest choices are to do absolutely nothing (no pain relief, no acceleration of any kind), or c-section.

You need a very experienced midwife who has attended breech births before. You may not be able to find this on the NHS.

The idea seems to be that if you go into labor spontaneously the head will not get stuck. If you are induced the body can take all different (mothers) twists and turns regarding the medicine...not every woman progresses just fine, though some do and experience births they were happy with, with a breech baby you have to define gravity a little, as Mary stated on all fours is best, baby's head flexes on its own without intervention...its when MP's decide to intervene in a breech birth that things dont go smoothly. When you have intervention...midwife trying to pull baby out (which it has been known) the baby gets stuck in the birth canal, labor halts and CS's are given, baby needs to be 'pushed' back into the uterus - and this ladies as you can guess can cause birth injury.

"ElCS is safer by far for the breech baby."

CoteDAzur, where's your evidence for this stark "fact"?

As Tangle says, the Term Breech Trial has been widely discredited, not least by those who actually carried it out! There is apparently a 1% greater risk of death to breech babies who have a planned vaginal delivery, over those who have a planned c-section, but there is a lot of evidence to suggest that the figure is skewed by early breeches born around 28-32 weeks, who don't tend to do as well (and are often undiagnosed until birth).

I found out my baby was breech five days ago. Since then, I've done a huge amount of research and although I still have ten weeks to go, if it's still breech at term I'm certain I'll be attempting a normal breech delivery.

I don't want to sound obtuse, but what's so bad about having a cs?

I'm not even sure that you need an experienced HCP. The key attribute is to be able to do nothing other than watch. Anyone can manage this.

When watching, they need to ascertain whether labour is progressing or whether it has stopped. If it has stopped, they have to summon the C-section team.

My breech birth was the first my midwife had been at, and she was great (she sat in the corner for much of the time).

I won't re-spout all that's been pointed out - The Term Breech Trial (Hannah) and Mary Cronk. But - if you wan't to have your baby in hospital and it is breech they have very clear guidelines about who will deliver (consultant) and where (in theatre) and how (on your back - probably with forceps).

tethersend Some people seem to see a CS as being as routine as having a tooth out. Whilst routine it is still fairly major surgery, with all of the attendant risks (especially infection etc), it also has a far longer recovery time than a vaginal birth.

there are ramifications to a c.s , especially with your first baby, i.e VBAC options for hte future.. c.s can affect fertility. can cause problesm with adhesions/scar tissue with the bladder, can cause problems with the placenta in future pregnancies

there are pros and cons to a vaginal breech birth and a c.s

look into them both

also, you should be offered ECV if baby is still breech at 37 weeks or os

ItsAllGoingToBeFine, I know, I've had one ... but what you say makes sense.

I just wondered what the aversion to a cs was; a longer recovery time paled into insignificance for me when I looked at the risks of vaginal breech birth.

I suppose we all have our own agenda when it comes to delivery.

tethersend, when did you look into the risks? Opinions have changed dramatically since 2001-2.

2008

One thing that we found so hard was trying to work out how to compare the risks - however you birth a baby, breech or cephalic, vaginal or CS there are risks and they aren't directly comparable. We found it very difficult to try and ascertain actual risk as opposed to perceived risks. As soon as you are breech in late pregnancy you are put under consultant led care - but consultants tend to have started out as surgeons and so nearly all will be far more comfortable with a surgical solution. I've heard of women told "your baby's breech - you have to have a CS or you and your baby will die!", which seems a bit of an exaggeration... The number of HCPs who see breech as "an unusual variation of normal" are fewer and further between, especially if you stay within the NHS.

MmeBlueberry - I think you were fortunate to have a MW with the confidence to sit back and watch! I'm glad you had a good experience, though

For those interested, "Breech Birth" by Benna Waites and "Breech Birth: What are my options" are also well worth looking at.

Scarlett - If you are researching the subject, do talk to a few doctors and ask them why ElCS is safer for breech baby.

If you give birth vaginally to your breech baby, do let us know how ig turns out. Good luck.

I bet your baby will turn anyway

I think comparing a CS with a tonsillectomy is patently ridiculous. The latter does not affect future fertility, future childbearing or the ability to drive for six weeks. The former does.

I agree silver a cesearean section has quite a few more potential risks to that of a tonsillectomy.

Risks of c sections are:
Infection. The uterus or nearby pelvic organs such as the bladder or kidneys can become infected.
Increased blood loss. Blood loss on the average is about twice as much with cesarean birth as with vaginal birth. However, blood transfusions are rarely needed during a cesarean.
Decreased bowel function. The bowel sometimes slows down for several days after surgery, resulting in distention, bloating and discomfort.
Respiratory complications. General anesthesia can sometimes lead to pneumonia.
Longer hospital stay and recovery time. Three to five days in the hospital is the common length of stay, whereas it is less than one to three days for a vaginal birth.
Reactions to anesthesia. The mother's health could be endangered by unexpected responses (such as blood pressure that drops quickly) to anesthesia or other medications during the surgery.
Risk of additional surgeries. For example, hysterectomy, bladder repair, etc.

to baby are:
Breathing problems. Babies born by cesarean are more likely to develop breathing problems such as transient tachypnea (abnormally fast breathing during the first few days after birth).
Low Apgar scores. Babies born by cesarean sometimes have low Apgar scores. The low score can be an effect of the anesthesia and cesarean birth, or the baby may have been in distress to begin with. Or perhaps the baby was not stimulated as he or she would have been by vaginal birth.
Fetal injury. Although rare, the surgeon can accidentally nick the baby while making the uterine incision.

to compare those risks to that of this is somewhat a little farfetched:
Reactions to anesthesia. (general anesthesia) can sometimes cause mild or serious reactions.
Tongue soreness or swelling. The tool used to keep your mouth open during a tonsillectomy may make your tongue numb or sore right after the procedure. This is temporary.
Bleeding during surgery. In rare cases, severe bleeding occurs during surgery and requires additional treatment and a longer hospital stay.
Risks during recovery include:

Bleeding during healing. After a tonsillectomy, about one in five adults have bleeding that won't stop. Bleeding occurs less often in children, but can still occur. It usually occurs a week or so after surgery, but may happen sooner or up to two weeks later. This type of bleeding is believed to occur when the scab comes off the tonsil area. It can be caused by eating hard-edged food, such as chips, or by strenuous activity. This requires a trip to the emergency room to check the extent of the bleeding.
Complications with anesthesia if you need surgery to stop bleeding. Follow-up surgery with anesthesia to stop the bleeding can be dangerous because you probably will have food in your stomach. This could place you at risk of inhaling (aspirating) food or liquids.
Infection. Rarely, surgery can lead to an infection that requires further treatment.
Delayed recovery. Some people take longer to heal than do others after a tonsillectomy. Although children usually recover in less than two weeks, it can take a month or longer for some adults. It's difficult to predict exactly how long it will take for you or your child to recover.
Pain. Both children and adults have throat pain after the procedure. However, adults may have more pain than do children, and in adults, pain generally lasts longer. In some cases, adults have throat pain bad enough to make swallowing difficult for several weeks.

OP I think you may find thisAIMS wbsite will give you alot of insight into breech births.

Hi there,

FWIWS my breech birth experience

My 2nd baby DD was breech, found out by chance when I went for a further scan due to measuring small for my dates.

I decided to go for vaginal breech birth as 1st baby's DS birth was straight forward & almost enjoyable!!.

They said DD was small (ended up 7ib 13 1/2 ozs) and in a perfect postion to attempt vaginal delivery & as my first baby was fairly big it should be no problem.

I researched as much as possible so I knew what should/shouldn't be done.

DD's due date came & went so CS was booked for the Monday but went into labour naturally on the Saturday before.

I took myself off to hospital, was given head midwife & the consultant on duty had lots of experience of breech births.

Got to 9cms on gas & air, midwife left room for quick bite to eat then noticed DD heart rate was dropping - DH ran to get midwife back in, they tried moving me around, into different postions then called in consultant but within 2/3 mins decision was made for ECS.

By the time I was in theatre, I had the urge to push. However, due to heart rate dropping ECS went ahead, when I came round, straight away had further contractions then a bleed.

This was the more scary thing I have ever experienced, luckily they managed to stop bleeding & I was kept in recovery overnight.

Head midwife came to see me next day & said it took just 13 mins from DD heart rate dropping to her being born, she also said her cord was short which may explain why she was breech.

I feel that the bleed (which for me was by far the worst part)was due to getting as far as having the urge to push but my body not knowing DD was born due to CS - not sure how true my theory is!!!.

It has scared the shit out of me, now pg with 3 baby (5 years later) & have been waking in the middle of night feeling very panicky thinking all sorts of things that could go wrong this time.

If this baby is breech then I will most certainly go for another CS but if not I will try a VBAC.

However, my friend had an awful first birth but then her second baby was breech - which she was not aware of & she had a really lovely birth.

Don't know whether this helps in any way & whatever you decide will be the right decision for you but to remember that as with all births what you want & what you end up with can be two different things even with all the will in the world to do it naturally.

However,my care at all times was outstanding & the one thing I feel is that when they know that your baby is breech there is no messing around, any sign of distress to baby & CS it is.