Breech-ceaserean v active birth! Any experience?

[SnowmAngeliz]

Hello all.
Me again, i seem to be popping up all over lately!
Well as a few may have read yesterday i am 29 weeks pregnant and the baby is breech at the moment. I know it has lots of time to turn but i do like to always be informed of my choices and have been reading up on possible outcomes of breech births.
It seems there are 3 options.

ceaserean
assisted birth (induced and forceps)
or natural birth

so, has anyone any experience of any or views on it??

DS1 was footling breech, we had a section. It's definately not worth getting too bothered over yet, at 29 weeks lots of babies are breech.

Also, your options are limited by the type of breech - nearly nobody will let you deliver a footling breech baby, it's too risky. I think there was someone in Belgium doing water births, but otherwise, you're stuck with a section.

One option I wish I'd considered, though, would have been allowing labour to start, so as to be sure DS1 was properly done. Also, some contractions would have helped get the fluid out of his lungs. This probably would have been too risky, realistically. And giving an epidural is harder if you're in labour.

It might be worth looking into natural methods to turn the baby (lots of websites) and figuring out whether you'll go for an ECV if it's offered. (We had one, it didn't work, but I'm glad we tried.)

Thanks for that.
I know it could turn anytime but it's one of those things i just never looked into so want to gain a little info on. Your post helps. I have just been reading that it's good for the baby to feel the contractions and get lungs ready too.
How was you ceaserean and did you have to stay in hospital long??

My first section was ... not great. There was a bit of a flap. They thought I hemorraged (my iron count was a bit low, going in, I think ... go mad with your red meat and legumes while pregnant, if you can face it!). They thought DS1 had an infection, for various reasons, and he couldn't breathe very well becuase of too much fluid in his lungs. He ended up in special care for 30 hours or so.

We signed ourselves out, against medical advice, after 2 days.

Sections don't have to be like that, though, with DS2 (waters broke, head wouldn't engage) we had a lovely time, and were out at about 30 hours.

If you're having a section, I strongly recommend having it before noon. Hospitals count days in a very strange way, and having a section before noon gives you a better chance of getting out on the afternoon of the second day.

I looked into this in some detail, Angeliz, as dd2 was still breech at 37 weeks.

A big study was done a few years ago which showed that statistically there was a slightly increased risk of 'soft' neurological problems (that's things like adhd) with vaginal breech births rather than caesareans, and this is what Doctors will quote to you. BUT if you look at this study more closely, it averages out enormous differences between women across a huge range of countries, birth environments and birth methods, so it doesn't really tell you much to help inform your own decision.

The main problem in the UK is that because so many people go straight to caesarean with a breech, that midwives and doctors have become 'de-skilled' at assisting natural breech births (and this is what the consultant actually said to me). So there is a vicious circle, in that problems can arise from the inexperience of the practitioners rather than from the birth position itself. For example, I asked the midwife how many vaginal breech deliveries she'd done, and she said hadn't seen ANY in her 4 years at the (major London teaching) hospital.

The upshot of my deliberations was that if the baby had stayed breech, I probably would have tried for a natural birth (I'd had uncomplicated births with my two older ones, who were both 9lb+), BUT I would have wanted to be accompanied into hospital by an independent midwife with experience of doing breech deliveries.

I found \link{http://www.aims.org.uk/Journal/Vol10No3/handOffbreech.htm\this article} very useful, by the woman who seems to be the UK's doyenne of vaginal breech births, and her view is that breeches should not be induced or augmented, which seems sensible given what can happen in any birth once they add in syntocinon etc. Although I really wanted to avoid a caesarean, I would still prefer that to the legs-in-stirrups, forceps and epesiotomy-up-to-the-navel scenario, which I suspect is what would happen in a standard uk-delivery suite once the doctors got involved.

In the end I had an ECV (external cephalic version) which is a manual turning of the baby, and successfully turned dd2. It's not done till 37 weeks, though. Ignore any horror stories you hear about it -- if done by an experienced team it's pretty safe, not agony, and successful with more than 50% of 2nd time+ mothers.

hth

Sorry about your first being not so great.
I have already been on iron tablets once and they took blood yesterday so will know soon!
It's good to know you were out so early as i have a 3 year old dd and don't want to be away from her for days!
(It also happens to be her Birthday at the same time!)

Oh well, time will tell!!+

Hi from Fellow Feb club member! I am 30 weeks and also breech. However read today that at 32 weeks 10-15% are breech and by term only 3-5% so I am not worrying yet as I understand second babies turn later. If he doesn't I would expect I would have to have c-section due to having one previously.

thanks froge.
That's the srticle i read that got me thinking
I agree about the episiotimy and forceos, they tried forceps with dd for a bout 30 seconds and it was the worst part of it all! I think that i'd be leaning towards a ceaserean on the basis of staff with little or no knowledge/experience of delivering breech babies.

It's a minefield isn't it???

What NQC says about footling breech is right -- there's the risk of cord prolapse, as the feet don't fill the cervix like a nice round little bum, so that would definitely not be a risk worth taking.

In the meantime it is worth trying acupuncture, which involves not needles, but burning smelly herbs on your toes (really!) It didn't work with me, but the breech wasn't diagnosed till 35 weeks, which is too late to start most of the alternative therapies. There is a very high reported success rate if done at the right time, bizarre though it sounds.

Your chance of a successful breech delivery are much higher if it's not your first labour. I'd talk to your midwives and consultants, and see how they feel, and what their experience is.

ECVs can hurt, unfortunately unsuccessful ones hurt more than successful ones. But gas and air is an option.

Oh, although my first section wasn't great, the only longer-term effect was, it caused some problems with nursing (because of DS1 being away from me for so long). But he's fine, I'm fine, and I certainly knew what I was doing a bit better for the second section, which is why it went better.

i'll do that, (caht to them to gage opinions) and if baby is still breech on 29th Dec(next app) will look into methods of trying to hep it trun.
It's great to have all this input!

Having said that, I was apparently born as a footling breech, and I think I'm normal enough. I also heard from a friend who delivered her own (undiagnosed) breech baby in the back of a minicab, stuck in London traffic.

On balance, probably not a first choice, though.

Hi there, There are some really interesting posts at the website www.radmid.demon.co.uk (sorry don't know how to add a link)! Go to the Archive section and you'll see the Breech birth discussion. Mary Cronk contributes to the discussion, too.

DD1 was breach and turned by the docs at 37 weeks. Well worth doing I thought. I would have done anything to avoid a c section.

If it were me (which it isn't!) I'do have a home birth for a frank breech (not footling).... with an independent MW.

You need to speak to Mary Cronk. She is the country's expert and travels around training midwives on breech birth. If you join the yahoo group UKMidwifery she is on there and will answer questions though at this stage she will probably just say don't worry, there is plenty of time.

You need to speak to Mary Cronk. She is the country's expert and travels around training midwives on breech birth. If you join the yahoo group UKMidwifery she is on there and will answer questions though at this stage she will probably just say don't worry, there is plenty of time.

The Uk Midwifery group is a good idea, Julie is right Mary is your woman to ask about breech.
I would say though (and I think she will too) that over a 3rd of babes at around 30wks gestation are breech, yet only about 2% present this way at term. Any m/w would tell you the same at this stage, no need to worry until 37ish weeks.

Lots of research to say that stress and anxiety in pregnancy can be not a good thing for baby, some people even believe breech babies can be connected with stress! so do both of you a favour and try to forget about breech + options for now. Btw had a breech baby myself and know how it feels to be worried, but best to get on and enjoy your pregnancy rather than be stressed.

UK midwfery is \link{http://health.groups.yahoo.com/group/ukmidwifery\here}

DS was breech but not diagnosed as such until after labour had started. Had hours and hours of contractions and he still had fluid in his lungs after the inevitable c-section. I would have much preferred to have known ahead of time and scheduled the section ahead of time.

My last baby was breech. I knew that she was breech, but didn't tell anyone about it (even DH in case he panicked). My midwife didn't detect anything! It was a very good experience - nothing negative about it at all.

I was very encouraged by midwife Mary Cronk's articles and her writings on UKmidwifery (Yahoogroup). Her view is that you have a completely natural and hands-off trial of labour.

If you let nature takes its course completely, the labour will either progress well and the baby will be born without incident, or it will stop progressing and then the best course of action is c-section.

The worse course of action, backed up by the Term Breech trial, is a medically mananged vaginal birth (in theatre, lithotomy positions, huge episiotomy, piper forceps). If an obstetrician led birth, babies do better with a c-section; but midwife-led births have fewer complications. It's only really a frank breech (baby folded in half) that is a candidate for natural childbirth, but I think that labour just doesn't progress with the others so you know to go to a c-section. A bad thing to do involved in is any kind of induction and acceleration.

my first dd was breech and then turned at just after 30 weeks... my second was also breech but didn't turn, I went on to be the first vaginal breech delivery in our local hospital's history! Luckily I had an asian doctor who was experienced in his own country with this type of birth and was extremely relaxed throughout... very quick delivery, no complications, no pain relief, but quite a lot of bruising! And terrible panic throughout the hospital!

So I guess I'm saying, it does really help if you have someone present who has some experience, the midwives were used to breech babies being born by c section at 38 weeks, but i was so glad not to have to recover from an op...!

jaberwocky, an emergency section is always worse than an elective. (DS2 was an "emergency" section, but only in the faintest sense.) Weird that you had fluid issues - DS1 was breech, no labour, had big fluid issues, made no noise until he was suctioned. I don't think he was suctioned enough - he needed oxygen for his first hour because of going blue.

DS2 was right-way-up, but wouldn't engage. I had contractions for weeks, not really hard ones, but still, loads of them (no progress though, not even effaced). Waters broke, wouldn't engage, we went for a section. He could shout (ok, gurgle, but still!) when he came out. And he breathed fine once he was suctioned. I just assumed the difference was all those contractions. I'd like them to have done something!

I was lucky enough to meet Mary Cronk yesterday and she is an inspiration. She talked me through photos of a recent breech she had attended (where the mother had had a previous third degree tear as well!) and I agree that you should speak to her if you can, angeliz. You can contact her through the Yahoo group as others have said and also through the contacts page on \link{http://radmid.demon.co.uk\association of radical midwives}

I thought it was strange too, NCQ. From what I had read all those contractions should have helped. Luckily all was fine by the time we left hospital 3 days later.