DD1 (DC1) was breech at 28 weeks and stayed that way till the day she was born (41+3). We planned a HB, and went out of our way to find IMs competent and confident in vaginal breech birth.
This article by Mary Cronk summarizes the differences between vaginal breech birth and vaginal breech delivery quite nicely. We also found "Breech Birth" by Benna Waites and "Breech Birth: What are my options" by Jane Evans to be very informative.
CS has become the norm for breech in Western countries since the publication of the Term Breech Trial by Hannah et al in 2000 (it was published in the Lancet - last time I looked you get get it there if you signed up, all free). They conducted a Randomised Control Trial if vaginal vs. CS for breech babies and found CS to be significantly safer, especially for the baby. However the study has since been widely discredited due to serious flaws in the conception, execution and analysis.
Unfortunately, by the time the critiques had been done, CS had become the norm (there has been speculation that consultants were keen to adopt the recommendations as they have a surgical background and CS is a surgical solution - whether that's true or not I don't know). Whatever the cause, there has been a corporate reluctance within the NHS to advise anything other than CS (although its always worth asking, preferably the SoM of Consultant MW as there are pockets of highly skilled MWs within the NHS).
We did a lot of reading and thinking and came to the conclusion that vaginal birth was not intrinsically more dangerous than CS for breech babies as long as you had a skilled MW in attendance. Since then (2007) a study has been done in Paris (which found, for carefully selected mothers, vaginal breech was as safe as CS) and the guidance in Canada has been changed to make vaginal breech birth more mainstream.
To try and answer some of your specific questions:
In terms of delivery, is a CS inevitable?
No, although it will almost certainly by what the NHS will recommend.
Why do they tend to do them? Is it because the labour more longer/painful or is it because you are more likely to get "messed up" down there and need episiotomies etc?
Because NICE guidelines recommend it (and possibly because it within the comfort zone of most consultants). A breech birth is no more likely to need episiotomies, etc, than a cephalic birth - its only when Drs start trying to interfere too much that you are likely to get "messed up".
Also, if they decide at 37 weeks that I am breech, will they wait for me to go into labour/go to my due date? Or will I be pretty much whisked in straightaway?
From the experience of friends, you'll most likely be scheduled for a CS at about 39 weeks, and advised to go straight in if you go into labour before hand.
If I did want a vaginal birth would it be an option they would consider without too mcuh trouble or would I have to literally fight for it?
From my experience and having read other stories, it very much depends on the outlook of your MW team and the personal view of your consultant.
I'm not going to do that I don't think because I'm not going to pretend I know better than an experienced obstetrician tbh because I don't!
Bizarely, I came out of the "so, your baby's breech" meeting with the registrar thinking that possibly I did know more (about this extremely narrow field) than they did, as all they did was to quote me the guidelines with no background information.
And also what are the benefits/reasoning behind fighting for a vaginal birth against medical advice? Is it just the obvious ie. recovery afterwards etc.? Also is it inevitable that having a CS would make it likely that any other DCs I have in future will have to be born by CS?
For us some of the key points here were:
- lack of evidence that CS is safer
- CS is major abdominal surgery
- a scarred uterus is a pretty significant abnormality for any future pregnancies. It doesn't necessitate CS for all future babies but it does add to the risks of pregnancy (whether you'll be advised a VBAC or CS would depend a lot on your consultant although I think CS is always possible by request in these circumstances)
One way I heard it put was that delivering a breech baby by CS reduces risks to
that baby but transfers the risk onto future babies.
I would like the experience of having a vaginal delivery, but I was apprehensive enough about it as it was when I thought everything would be fairly textbook and I don't know if I'd feel comfortable anticipating a birth that would possible have more complications/be longer/riskier to baby/more prone to injury etc.
From the experience of our IM, breech births tend to either be pretty straightforward (and quite progressive) or they stall and go nowhere. Also, whilst there are higher stats related to various things for breech babies, they seem to be related to position in the womb (ignoring ECVs) and have little to do with method of birth.
Guess I'd just liek to know the risks/pros/cons of both.
Very wise :o
Looking back, if I had to do it again my ideal would be to have experienced MWs in a hospital - so we could go for a very hands off breech birth but with backup there if there were any problems. But that can be quite hard to achieve without a big fight (if the PCT have skilled MWs, if they will be on shift etc) - we weren't up for the fight so it came down to CS or HB with IMs for us.
Ultimately, though, its an extremely personal decision. We found that the risks of CS vs vaginal birth weren't directly comparable - so it became a case of which set of risks do we feel more comfortable with at this point in time. Its not easy, though, and you have my sympathy. Good luck, and if there's anything I can help with please let me know :)