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)

Another reason for HCPs preferring to deliver breech by c-section is the greater risk of cord prolapse (though the degree of increased risk varies with the type of breech presentation) - where the cord descends before the baby and which can lead to the blood supply being cut off. In addition if the baby is in distress, there's no option for a ventouse / forceps, also depending on how far the delivery has gone a c-section is pretty tricky. It's certainly worth looking into these issues and discussing them with a HCP.

LittleSilver - You obviously didn't understand.

CS is usually called "MAJOR surgery" around here, but in terms of difficulty and "majorness", it is closer to a tonsillectomy than a kidney transplant.

I am paraphrasing "What To Expect When You Are Expecting".

Cellesgirl - Why not list risks of vaginal births while you are at it?

Most of your list would be in there, along with some new entries such as:
All sorts of incontinence
All sorts of prolapse
Huge episiotomies
Painful sex, sometimes for life
Massive bleeding
Death (yes, it happens)
etc etc

What I'm trying to say is that there are risks either way and everyone has to evaluate their particular situation. For a breech baby, the risk distribution is different than cephalic presentation.

Pelvic prolapse where the pelvic floor does not support the pelvic organs (bladder, urethra,bowel etc..) - heres one type of incontinence suffered by women who have had thier first baby...and its due to pressure on the bladder when pushing baby out (and you have to be pushing really hard), when its your first baby and this happens,the pelvic floor muscles are relaxed so that baby can fit throught the birth canal, the pressure from pushing hard, pushes the bladder neck downwards very slightly and this means that the urethra and bladder neck's 'meeting point' are changed. The angle is different. This is why it is important to do kegal exercises during pregnancy and after birth so that you strengthen the fascia and (the muscle directly supporting the bladder and urethra)the pelvic floor muscles. It also can be helped by remaining in a position that lets gravity take its place so that mum doesnt have to strain while pushing.

Cord prolapse in a 'normal' vaginal birth occurs when the woman has gone into labour (started contracting and cervix has sarted to dialate)before her waters have broken. When the amniotic sac ruptures, this allows (in some cases) the cord to fall first...but will only happen when the head has not engaged. In breech birth the same thing can happen as babies head does not engage, but the above circumstances have to of happened.

Yes episiotomies do happen, but they are not routine. Not every mum needs episiotomies and this can be helped too...water births, and not lying on your back will definately help. Babies that have not engaged in the pelis at the onset of labour dont get thier heads 'moulded' as much so therefore their heads may be slightly larger than thier body, thus being harder on mum, which is why an episiotomy may be performed, but again water birth and different positions can help.

Massive bleeding can happen, very very rare. During a vaginal birth you lose around 250-500ml of blood - nothing harmful. During a c-sec you can lose 500-800ml and even more.

Pianful sex from scar tissue which can be removed. psycholical issues, tensing up, thinking of sex hurting due to having stitches is one of the major reasons sex hurts and can be helped with some therapy/relaxation techniques.

Dont state the risks if you dont know why they happen. etc etc... is not a risk.

My second had a breach presentation at 34 weeks. I had an 11 month old at home and did not want a CS because it would interfere with care of older baby.

And anyway - my mum said the baby would turn at the last minute, as that it what had happened to her with my sister.

I refused a CS and also an xray, but agreed to an induced trial labour at 38 weeks. But guess what, baby turn day before, without any of us realising, including the many many doctors and midwives who performed internal exams. 'The bony bum' they all said they could feel was her head!

Labour already induced and I was in the delivery suite before we realised she had turned, so I just delivered early.

But here's the thing. My midwife was so relieved when a scan performed in the delivery suite revealed that baby was now presenting normally, that she started jumping up and down and punching the air. Really - it was a celebration worthy of Rooney in a cup final.

It was quite clear that she had been worried sick about doing a breach delivery. If I'd have known how concerned SHE was, maybe I would have thought twice about insisting on a normal delivery. But in my case, the gamble paid off.

PS I heard doing the yoga cat position can help in persuading baby to move. I did this position like mad during my labour - I found it very comforting.

Chellesgirl - Those risks you listed for CS are also very rare.

As I said before, both delivery methods have risks. It is up to each individual to evaluate their own situation. And breech presentation requires a different risk assessment than cephalic presentation.

I know how and why these things happen, by the way, just don't have the time and energy to write five page posts on subjects many here are familiar with

Yes, different positions etc can help but nobody can tell beforehand which of us will end up with an episiotomy, 3rd degree tear, prolapse, hemorrhage, etc. Birth injury threads are full of women asking "I gave birth in a pool/on all fours/without epidural and did everything right. Why did this happen to me?". These happen rarely, but they do happen.

Just as the vast majority of women giving birth vaginally are fine afterwards, the vast majority of women giving birth by CS are also fine afterwards. Focusing on the rare complications of CS while disregarding the rare complications of vaginal birth (as if they don't exist) is just not a fair assessment of the situation.

In my recollection, the authors of "What to Expect when you are Expecting" were not big fans of an evidence base.

its funny you just said that silver...I was just reading an editorial review which said that the book can be a little 'overwhelming' and people would 'do better with a real guide'

Chellesgirl, imho that book is plain silly.

Rather histrionic and American, apparently revised for UK market but not in any way I can see. Heavily, heavily, medical model and implies at one point that doctors can override your consent. Actually rather out of date as far as I remember and I believe one of the follow ups ("WTE 1st Year perhaps) suggests breaching WHO guidance on breastfeeding duration. Hence my comemnt about evidence base.

OP, whatever you decide to do, do your homework in terms of evidence based practice. MN can be a great resource but you will get A LOT of anecdotal stuff about people's mum/sister/cat that can get very emotive.

WTEWE is a joke of a book.

My cousin who's a midwife said read whatever you like, but avoid WTEWYE at all costs as it's inaccurate to what happens in Britain and is full of 'information' which will needlessly terrify you.

I didn't have a breech birth, but my midwife discussed it and said that she feels that it's always worth giving the body a chance to start the birth naturally rather than go straight for a planned caesarean as the womb may have a memory for any second time of what is effective in carrying the baby in prep for giving birth. This might sound like mumbo jumbo, but she always seemed very credible and experienced to me. However, I wouldn't want to go through trauma like Natasha1 experienced in order to try this necessarily.

well that saves me some money then...Ive heard so many people say get the book...I was going to buy it to see hwat all the hype was about (even though i know what labour and birth is like) ..think i'll pass.

I had a vaginal breech birth. But only because it happened so quickly (I'd refused scand/examinations etc that would have identified DD as such) that there was no time for an epidural or C-section. All I had was an episiotomy, which even proved unnecessary.

IMHO the issue is one of the confidence amongst obstetricians and midwives. I could see throughout how they were mostly shitting themselves in terror. I wonder whether, if in such a situation again, they'll be more willing to standback and not rush to intervene...

Oh dear, I would panic if I felt the MW was scared! A bit like being on a plane and seeing the stewardesses panic...

I think its because in most hospitals in uk, induction and c-section are procedure for a breech birth from 38+ weeks. This has then lead to midwives not being trained in breech births as much as they used to. Hence why they dont all rush to deliver a breech baby.