C section Vs Breech

[ASecretLemonadeDrinker]

Probably jumping the gun abit but I don't know when I have to decide, or if I can etc. I am having a ECV tomorrow, I am sure I have felt baby roll in the last day or so so am confident it'll work, but need to prepare I guess if it doesn't. I do not want to have a c section - I have had 2 'normal' births, plan on having more and just all round don't want one. Obviously I will if it's best for baby, but what are the options for a breech delivery? I am not fussed on having an episiotomy or anything, or it being more painful as I am hoping for an epidural anway, but do they prefer not to do it because of any risk? Or is it because people generally prefer a c section to having a breech delivery? It is quite a big hospital, not a MW unit or anything and there is another 2 big hospital in my area, one of which I am sure is 'bigger' so am prepared (if it's allowed/OK) to change hospitals if that's what it takes, but I have no idea if these are options or what. Does anyone know anything about this? Thanks

In the 1960's, home birth was normal and breech wasn't considered reason for a mother to give birth in hospital - let alone a reason to have a CS!

In the 1990's most breech's were in hospital, but so were most births - but breech was still within the domain of "normal" and handled by MWs

In 2000, Hannah et al published a paper in The Lancet colloquially known as the "Term Breech Trial". This was a large, randomised controlled, multi-centre study that tried to look at the safety of breech delivery c/w CS. They found that CS was much safer. In consequence, the vaginal breech rate in most western countries cratered and CS become common place.

Since then the Hannah study has been widely discredited (that's a whole other thread in itself - but there were major flaws with the planning, the execution and the analysis). But by then CS for breech was the norm and, as the years have gone on, the number of MWs with the skills to help a breech baby birth safely have plummeted.

There are MWs with good breech skills out there - some still work for the NHS but more work independently. DD1 was born as a breech baby at home with IMs - after doing a LOT of reading, talking and thinking we came to the conclusion that breech birth wasn't intrinsically more dangerous than a CS - but that trying for a breech birth with unskilled MWs increased the risks significantly.

For more info google Mary Cronk (there's a good article here and try and get hold of a copy of "Breech Birth" by Benna Waites and/or "Breech Birth: What are my options" by Jane Evans.

You might also want to talk direct to the Head of Midwifery at your hospitals (or all the hospitals in your area) - consultants are fantastic at what they do, but they are specialists in the abnormal and tend to view breech as an abnormality best resolved with surgery. MWs are more likely to see breech as an unusual variation of normal.

re. changing hospitals - you always have a choice to do this, but it would be worth doing some investigating first to make sure doing so is going to give you a better chance of achieving your goal.

Trying to decide how to birth DD1 was one of the hardest decisions I've ever had to make. And I still question it today (she's 3 now). All any of us can do is to make the best decision for us at the time.

Thankyou, I have just come across Mary Cronk in the last hour of googling Given me alot more confidence to not just agree to a CS straight off. I have seen my other local (ish) hospital have a leaflet for breech births so I am guessing it's an option there, but I haven't discussed it with 'my' hospital yet - and who knows, maybe baby will turn tomorrow I think i'd be a good candidate for vaginal breech birth, I don't have any other problems, 2 other vaginal births and one of those was 10lb4oz so I don't think there will be any heads getting stuck, esp. as this baby is on about the 50th for head. The 10lb 4oz er is only 22 mo so everything is probably still quite flexible around there I didn't realise though how much CS was 'the norm', I thought it was just going to be a possibility, about as likely as a CS with induction.

I was told the danger in a breech birth ia that as the heasd is born the wrong way, it cannot compress correctly and can be born too quickly. I the worst case brain damage can be caused.

BUT many, many breech babies are born and are ok? I think it depends whether you trust your own body, or whether you want to err on the side of medical caution for the what if. And are the risks of breech birth greater that that of a cs anyway??

I had a cs due to a breech baby. Can't decide whether I would again.

There's a more recent study that was done in Paris (2008 ish?), which found that a birth is marginally safer for breech babies than a CS. (They did have extremely stringent criteria for the women and babies that were accepted into the trial - but then Mary Cronk also has a pretty long list of recommendations).

I find it highly depressing how CS has become normalised to such a degree. I completely agree that it can be life saving surgery (for both mum and baby), but if the WHO is to be believed the optimum CS rate is around 10% - beyond that and you're doing more harm than good. Last time I looked the UK average was around 25%

I don't think that a vaginal breech birth is the right choice for all women - and I suspect that if you aren't committed to it in the first place its far more likely to go wrong. But I would like more women to be given a realistic choice rather being told they need a CS, no questions asked...

Basically it comes down to how confident the hospital are of breech delivery - if they don't want to do it at all I wouldn't insist, and if you are sure this is what you want to do having read up, you could go Tangle's route and employ an independent midwife (I think I'm right, Tangle? Have seen your comments on previous breech threads). I had a c-section after an ECV didn't work- it was absolutely fine, nothing to worry about.

A tip for the ECV would be to have your bag packed and with you in the car, as my ECV kicked off my labour and sometimes babies' heartbeats drop etc and they would rather just whip it out on the day.

Bag is all packed - I am glad they are doing it tomorrow instead of today The only thing that now worries me was I was definatly going to have an epidural, and I see if I want to give a breech birth a proper bash I will need to be mobile, that the problems mainly occur when you are induced/epidural/not left alone etc. I have also been 10 days overdue (induced) and 13 days overdue (went into labour a few hours before induction but they still broke my waters (no real reason)) and from what I can make out you aren't induced if you are breech, which given my history seems likely. DH talked to the delivery suite when he re booked me for tomorrow and asked what would happen if I went into labour, and they said they would make the decision then but they did say breech birth was an option based on certain things, so it does seem it's an option at Frimley

Good luck with the ECV - I had one three weeks ago that didn't work, but I had a pretty imobile baby, small bump and was 39 weeks when we tried.
I'm also pretty local to you - we were at the Royal Surrey and a vaginal breech wasn't an option here, so I had a section and whilst I'm disapointed (it is also my third baby) it is my last one and so isn't going to affect future births. The only thing is that I'm recovering well, however, I have found that the recovery from a section is far worse than a normal birth.

Hope the ECV works and you can have the birth you want

Also meant to say re. pain...

DD1 was 9lb 12 and footling breech.
DD2 was 6lb 3 and cephalic.

Crowning with DD2 was a very unpleasant experience - DD1's nice squashy bottom did a good job on stretching so her head didn't really hurt

If you do go into labour, just make sure your DH is primed on what you consider acceptable within a vaginal breech birth so that he can support you in your choices - some people (like Mary Cronk) use birth and delivery as distinct and different things, but that isn't always the case.

(and yes we did use IM's in the end - who were fantastic but don't come cheap. Have done it again and will do it again like a shot, though)

Asecretlemondaedrinker just to let you know that Frimley MWs would have been quite supportive if I had wanted a VBAC waterbirth so I think they are quite happy and experienced to handle slightly off the protocol births, the one thing I would probably insist on is talking to/having a midwife that is skilled in breech births. You might also have to make sure everyone is on the same page as you in the type of delivery you want, DS was a footling breech at Frimley and from the minute they found out it was all hands on deck to give me a c-section, now that wasn't a problem for me but if you do want a vaginal delivery it might be best to ensure everyone knows about it (i.e. talk to the head midwife) as it maybe a bit overwhelming to say mid-labour "would everyone just hold on a minute and calm down" IYSWIM.
Good Luck.

Was your breech baby no.1? Good to hear Frimley are abit open minded - under 2 hours until I go now

Yes breech baby was no.1, no.2 will be ELCS. Also
" Waterbirth Information evening

This is held on the first and third Tuesdays each month at 7-30 pm in the antenatal clinic. No need to book in advance. "

If you can hang on in another week. I went for my first and they were very informative.

which dr are you seeing?

How did the ECV go?

I didn't need it in the end - baby had turned , but I have a feeling he has turned back again I don't know at what point they try again, I have no more MW visits booked or anything

guess you're in having the baby post ecv??? fwiw, having read your history of previous births, in your case I would go armed with the stats and my preference, and look the midwife/doctor in the eye when after presenting your views you ask what they are prepared to do. If they say cs is is best for you, i'd go for it.

phone your midwives and ask for an appiontment, they'll give you one usually.

My MW only works Wednesdays, so will only be able to give me one then (i.e I can't book one until next week). MW is a different area to hospital, I am basically shared between two areas, bit of a nightmare. Any idea if this needs checking alot, or is checking again at 39 weeks about right? I am trying to have a good feel but bums and heads and backs all feel the same to me

Just as a matter of interest did they do a scan to check the baby had turned?

I think you need to decide what you would like to happen if the baby is breech.

Yeah they scanned, another MW had had a feel and said it was still breech but I think she was feeling the bum.

I would phone Frimley I would ask to talk to the Midwife Supervisor/Manager/Thingamyjig to get an appointment to discuss a possible vaginal breech birthplan as it sounds that is what you would like to attempt if the baby is breech. I would then read up on everything you can about breech birth (i.e. Mary Cronks site).

If you want to attempt a vaginal breech birth then I think you should give them some warning!

Don't want to jump the gun though as yesterday he was cephalic. I'll phone the comminity MWs office there and see what I am supposed to do with regards to baby turning alot and when to discuss birth options.

I don't see it as jumping the gun I see it as being prepared for every eventuality hope the community MWs are helpful.

My nephew arrived bottom first with his feet over his shoulders after sis being told he had turned- she insisted otherwise but was ignored. They finally realised and decided on CS after meconium came out of his 'head' but it was too late. 40 stitches later...
I personally feel a planned cs must be less traumatic (having had the other type!)
However, I knew someone whose 1st dc arrived ok feet first at home- 8 minutes, 3 contractions, no stitches and a new lounge carpet