Breech at 36 weeks, planned CS at 39 weeks?

[Rockbird]

Not me, SIL. Been for a check up today at 36 weeks and baby is breech. So she's had a CS booked for three weeks time. I know nothing about this as my only DC wasn't breech or CS so I just wondered if it was normal procedure. I'm not picking holes in what she said, just interested as it seems early to be making that decision. Couldn't the baby turn before then?

I was breech at 36 weeks. Have to go back at 38 weeks and only then will they consider a cs if still breech. My midwife has told me that at my hospital they scan on the morning of the cs and if the baby has turned they cancel the op.

Nooooo. My #6 was breech at 39 weeks. Section booked for due date. He had turned!

Lots's of good positioning and hopefully the baby may turn

Mine had been breech from 29 weeks too.

DD1 was breach at the 20 week scan and never moved. ELCS at week 38.

I was breech at 38 weeks, was offered a CVS (turning baby) for the next day but he had turned He moved alot though and even in labour they had to double check, but they would have done a breech birth if I wanted and this was 12 days overdue , but it is my 3rd baby - I don't think they try and turn first babies as it's less likely to work.

Spinning babies is a fab resource, wish I'd known about it last time. I had an ECV performed at 39 weeks, I'm also surprised she hasn't been offered one.

It isn't entirely out of the question for her to attempt a vaginal breech delivery. Depends on hospital policy, the type of breech and how she feels about it but it may be an option.

I was terrified when DS was discovered to be breech at a 32week examination and my consultant was practically trying to book me in for a CS there and then. No mention of ECV or advice on positioning etc. to encourage baby to move, I felt like I was being put on a conveyor belt. Thankfully I had a good community midwife who told me my options but I think the response at hospital is often the same.

How does she feel about the CS?

Thanks for all this. I'll show her this thread. She seems fairly unfazed by it, but then she's been like that since the start!

I just thought it was early to book the CS, would have made more sense to see her on that day and then book CS a few days later if it hadn't turned. But hey, I know nowt

DD1 (DC1) was breech from 28 weeks. She never turned. Our CMW booked a positioning scan at 36 weeks (under pressure from us) where breech was confirmed. We were then offered a meeting with a member of the consultant team at which we discussed ECV and CS. It was presented as "either the ECV s successful or you have a CS". So after a lot of reading and thinking we cancelled the ECV, declined a CS and had her as a breech baby at home with IMs!

We had another scan at 40+9 to check where her legs were and the Dr suggested it would be a good idea to start booking in appointments with anaesthetists, etc, as a planned CS does require some planning. But DD decided she'd had enough of being prodded and poked and came out that night

The conclusion we came to was that the study used to suggest CS is safer for breech is so badly flawed the conclusions are invalid - but that the key to the safety of a breech birth is a MW confident and competent in breech birth. Sadly, so many breech babies are now delivered by CS that MWs with strong breech skills are getting harder to find, especially within the NHS where working practices are more controlled by policy.

If your SIL is interested in vaginal breech birth, I'd recommend she google Mary Cronk 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.

Its a very personal decision and one to which there is no generic right answer. I'm very happy to answer any questions you/your SIL have about my experience, and I wish your SIL a calm and peaceful birth by whatever means.

tangle i think you are slightly biased there as (thankfully) you have had a positive breech vaginal birth.

sadly the outcome could have been so different. a breech can become a very big life threatening problem if delivered vaginally. for example if baby gets stuck once body is delivered and the cord prolapses. it poses a life threatening risk to the baby where every second counts to getting the baby delivered. so therefore a home birth could make this situation life threatening.

obviously i am not disagreeing with your choice, every woman has the right to choose, i just want to make clear to the op what choices there are and the risks involved.

op my dc2 was found to be breech at 38 weeks. elcs was booked for 39 weeks and on day of operation i was scanned to see his position and he had moved to an unstaible lie. i refused the cs and went to term+5 and had a beautiful intervention free vaginal birth, as he had moved to head down!

DD1 was diagnosed breech at 36 weeks, I had unsuccessful ECV at 37 weeks and had elective section at 39 weeks. All very pleasant and no regrets. A healthy baby and a healthy me was what we were after.

The consultant performing the section found that I have a septate uterus (I didn't find this out until my obs appointment at 24 weeks to discuss CS/VBAC for my current pregnancy) and it's highly likely that current pregnancy will be breech. I'm now 28 weeks and can feel baby already in a breech position. She may move, it's unlikely she will. I will be having another section (quite happily).

haribomum - I don't know whether we're biased, but we did a LOT of research before making our decision. Part of the problem is that for many HCP's the terms "breech birth" and "breech delivery" are used interchangeably but for others there's a huge difference (as outlined by Mary Cronk here). After doing as much research as we could, our conclusions were that:

• HCP's skilled and experienced in vaginal breech birth do not recommend proceeding unless you're >=37 weeks, have a normal pregnancy and a normally developed baby, labour starts spontaneously and progresses naturally.
• Under those circumstances and with a labour that is not interfered with or disturbed, the scenario of the head getting stuck after the body is delivered is almost unheard of.
• Cord prolapse is more likely with a footling breech than with a full breech, and more likely with a full breech than with a frank breech. However, I did here of some research that was being done that seemed to be suggesting the cord prolapsed because there was a problem (rather than the cord prolapse causing the problem) - I'm still waiting to hear the final conclusions.
• The Term Breech Trial by Hannah et al, published in the Lancet in 2000, found that CS was safer than vaginal delivery for breech babies. On the back of this, most western countries started recommending CS for breech. Since then, the study has been widely discredited and most of the authors consider the conclusions should be discounted.

Since then a study in Paris/Begium (the PREMODA study) found that, for pregnancies and HCPs that met given criteria the risks of vaginal birth were comparable with those of CS for breech babies and in June last year the Society of Obstetricians and Gynecologists of Canada issued guidance that CS should no longer be assumed for breech pregnancies that met certain criteria (and recognised that this meant Canadian HCP needed to equip themselves with appropriate skills to support women who choose not to have a CS for their breech babies).

Maybe I am biased - but I think in this country the overwhelming viewpoint is that CS is far and away the safest way to get a breech baby into the world. Yet everything I read at the time and have read since has said that that is only true under certain circumstances. Yes, I was lucky with DD1. Any birth has risks. Any operation has risks. Any scarred uterus carries risks for any future pregnancy. I don't want or intend to tell any woman that she should have a vaginal birth for her breech baby, but I do want to make her aware that it can be an option that is as safe as the surgical alternative.

Everyone has to make the right decision for them - but how can they make an informed decision if they are only given data to support one point of view?

tangle i agree that people need to be able to make an informed choice when regarding breech birth.

i think the reasons why i were considered unsafe to vb if breech were -
high blood pressure throughpout pregnancy and
a 9.8lb baby with a head circ of 38!

both of these factors alone ruled on ecv and vb.

however i am very pro vaginal birth and was so so pleased to deliver vaginally again once already having a successful vaginal birth with dc1.

i think the way the consultant explained to me the risks of delivering a brech vaginally scared me to be honest! i would much rather a cs than pose a high risk of death on my child, and still stand by my view of a homebirth breech is far from ideal. just as much as a homebirth cs would be.

I agree a HB breech isn't ideal - but if the only way to ensure that your MW's a skilled and experienced in breech birth is to use IMs, what do you do? Very few things in life are ideal, at the end of the day. I don't feel that HB breech is in anyway comparable with a home CS, though - the first is merely not ideal, the latter would be foolhardy to say the least!

Interestingly, I think your experience also underlines my point. You were presented with "information" about breech birth in such a way that you came out of the meeting scared of the idea and perceiving it as extremely risky. As you've said, in your instance there were other factors that meant it wasn't recommended, but I still find it disturbing that professional HCP's often present their own views in this way such that women are coerced into "choosing" the HCP's preferred method of delivery rather than being allowed to make an informed decision on the basis of robust data.

In our "so your baby's breech..." meeting at the hospital, the registrar told us (pretty much verbatim) "we recommend CS for breech because of the Term Breech Trial. We know there are a lot of problems with it but its the best we've got so that's what we got with." If I'd tried that argument in my degree I'd have been marked down a long way. If I'd tried that argument at work I'd have been dragged over the coals for it and/or fired. Yet they were recommending major abdominal surgery on the basis of a study that they themselves said was worthless...

The view we were given by extremely experienced MWs was that if a baby is term and normally developed then the pelvis and skull are very similar in size - hence if the bum comes out the head tends to follow. If a breech baby is going to come out under its own steam then it tends to do so fairly quickly and easily. If the labour isn't progressing then don't try and force it, switch to Plan B and have a CS. The labour for a large baby may be more likely to show no progression, but that's not the same thing as saying trying for a breech birth is more dangerous if the baby is large.

There is a risk of death for the baby in any birth, but once you step away from the usual its very hard to quantify just how those risks change. I just wish the risks were presented in a more factual way (and that HCP's felt able to admit that sometimes we don't know) and that more research existed so that we could say with confidence what the safest method of delivery was for different sets of circumstances.

I am breech at 35 weeks, only found out last week (baby was previously engaged). To be honest I am really surprised (and a little ashamed?) to find myself leaning towards a C Section being a positive outcome. I have always been in favour of natural births where possible but guess I am now just scared!!

I am doing my best to position myself in ways which may turn the baby though, and will probably say yes to the ECV if offered it.

Just posting to say I can sympathise with your SIL just wanting it booked and sorted, she might like me suddenly be having nightmares about a complicated natural labour, and secretly have a 'problem/ solution' view of the breech situation.

Hi all,
I'm now 37+6 and my baby was breech until yesterday. I too was somewhat relieved at the thought of a planned CS as it seemed so "under control" but didn't like the thought of a prolonged recovery. I was offered ECV but declined for purely emotional reasons- it just didn't feel right. I did do some yoga, lots of lying down with head on the floor and bum in the air and swimming. At my scan yesterday it transpired the baby had turned of its own accord, now I'm bizarrely relieved to have the option of vaginal birth and am doing everything I can to be well prepared for that. I suggest your SIL makes sure she sees the consultant to discuss options and prepares for a VB as well as an ELCS as mentally it's good to know what you're headed for and lots of babies turn late on between 37-38 weeks. I wish her all the best!

depends how many children she has had. tend to turn later if a 2nd or 3rd child. hospital prob just preparing for worst case scenario. my 3rd dd was breech at about 36 weeks and they talked about cs and manual turning but they just did regular scans and she came at 39 weeks naturally she had turned.

Nice video and thoughts on the Spinning Babies blog