Has anyone had to have a c section due to baby being breech?

[LizSpain]

Hiya,

I am due in just 4 1/2 weeks, argh! and baby is still breech at the moment. Judging by his movements I don't think he's gonna turn as he's wedged in quite tight.

I live in Spain & they don't allow natural births if the baby is breech here, i've been told that in the UK if they decide to do a c section due to breech postitioning its usually done approx 3 weeks before due date does anyone know anything about this or been in a similar situation?

middymee - any idea how I could get hold of a copy of the PREMODA study?
I've read (and been horrified) by the Term Breech Trial and a couple of the reviews. I was SOOOO mad when the registrar said pretty much verbatim "we know it's flawed but it's the best we've got so we recommend a CS". Eh??? If its that flawed you ignore it, not say it's probably wrong but hey, lets do it anyway...

Hmm.

My nephew was a full term breech birth.

He got his head stuck. Was born needing resuscitation and still has a funny shaped head.

My ds1 was breech. I had a caesarean. Not worth the risk, imo.

No experience but currently 30 wks with a breech baby and desperately hoping he'll turn as I want my Home Birth. Interesting to see the different views on here but really hard to know what to do for the best isn't it.

Good luck with whatever you decide Liz. I'm going to try and get daddy to talk from low down, worth a try

Bobbiewickham - if you don't mind me asking, how medicalised was your nephew's birth? In the experience of my midwives, which was quite significant, if a breech baby is term and normally developed, and labour starts spontaneously, progresses naturally and mother and baby are left to pretty well left to get on with the birth themsleves, the head just doesn't tend to get stuck. One of the reasons for keeping "hands off" that I've heard is that too much hands on can cause the woman's perineum to contract, which could cause the head to get stuck.

Yes, there are risks attached to a vaginal breech birth. But there are also risks (for mother and baby) attached to a CS. A breech birth is unusual, outside a lot of HCP's comfort zones so often poorly managed and is therefore perceived as risky. A CS is common place, well within the comfort zone of most consultant obstetricians and is therefore perceived as less risky. But, to my knowledge, we still don't have any meaningful statistics that allow us to compare ACTUAL risk of vaginal breech birth, vaginal breech delivery and CS for breech.

middymee do you know anything about the risks of delivering a preterm footling breech with rapid progression? They told me it was too risky, but either there wasn't time to explain why or I don't remember.

Tink's head got stuck and that was a section! She was caught under my ribs and they couldn't pull her out. They had to make a second vertical cut, so I have an upside down T shaped scar internally. They've told me that I can't have a VBAC because of it and I have to wait until she's two before I try again (she's 21 months, yay!) I'm a bit worried about not being allowed a VBAC because I have to take Heparin in pregnancy and they are expecting me to go into preterm labour again, which will prevent me from having an epidural because it will be unexpected and the GA messed with my head.

I met a lady yesterday I was in hospital with. Her fourth baby was breech and they were telling her she had to have a section. She refused, there was a row and eventually she said "Oh, I'm going for a fag!" Knowing that because it was late evening they wouldn't be able to do the section until the next day. On the ward the MW's were telling her well done and to stick to her guns. She spent most of the night walking up and down the stairs trying to speed things up. The next morning she was ready to deliver, she allowed a student who had been looking after us to go down and one MW. Dr's and MWs tried to crowd in but she kicked them all out! She delivered with only entonox for pain relief. Two hours later she was back on the ward, she got straight out of bed when they brought her in and put her size 12 jeans on! Her son is perfectly healthy, gorgeous little guy. He had to have a hip scan (which is normal for breech babies however they come) which was clear and he's had no lasting problems from it.

The risks of a vaginal breech are supposed to be just a little higher than those of a section, the difference is from a Dr's point of view is that the section is a controlled risk whereas they have no control over a natural birth. It's the same as the risks with a VBAC.

Middymee - an academic exercise and reality are two different things. So given that the TBT HAS deskilled medical staff, could you really say, hand on heart, that you would opt for a vag. birth anyway (and I don't mean with an IM)?

As I said, I had a section for a breech birth. I was advised by my midwife, two consultants, a midwife at the hospital and my own mother NOT to have a breech birth.

I'm not saying people shouldnt have a breech birth, but given what I was being told, what was happening to me when I was pregnant, I wasnt going to risk a breech delivery without support. That could just be my regional hospital. Though a friend in the next town over, her hospital told her they were going to induce her as she had a liver problem, but they wouldn't induce a breech baby, nor would they turn, so if the baby didn't turn by themselves, she'd be booked in for a section.

I think there are two issues main issues regarding vaginal breech birth in the UK (and a lot of other countries) at the moment.

The first is the available skills. As has been said, rightly or wrongly the TBT has resulted in a huge loss of skills in vaginal breech birth. There are still midwives around that have these skills, but they are growing fewer and farther between. This is most scary for the undiagnosed breech - those that are only recognised when the midwife sees the presenting part and thinks "oh $%&$". As they're undiagnosed they could, by definition, be almost any pregnant woman.

The second is the way the information is presented to patients and the quality of that information. The way the "choice" of how to birth my breech baby was presented to me by the registrar made it a no brain decision to have a CS. Talking to IMs with breech birth experience and doing a lot of reading gave me a different view of the information presented, plus a whole load of data the registrar didn't pass on.

Health care in this country is meant to be about informed choice - how can you make an informed choice if you aren't given the information? It would also be novel for your informed choice to be respected and supported, but that seems rare at times as well

I don't think anyone on this thread (or any other breech thread I've seen on MN) has said women SHOULD birth their breech babies vaginally. What has been said is that there is research out there that shows vaginal breech birth is not categorically more risky than a CS, and that this research is a more robust than the TBT such that a vaginal breech birth is an option that should be considered and investigated. Due to the skills available in a lot of hospitals it may not be a safe option - but if women don't ask how will they know? And if women don't make it known that they would like the option of vaginal breech birth, why should the situation change?

Tangle-I only have it in paper copy because I had to pay for it! It annoys me that more attention isn't paid to this study. It was retrospective and not randomised and it had 4 times the statistical power of the TBT.

Bobbiewickham-The usual cause of head entrapment is the midwife or doc panicking and pulling the baby, this extends its head and the chin gets caught.

TinkerbellesMum-I don't like the idea of preterm vaginal breech. A smaller head means it can be delivered too quickly resulting in rapid decompression of the skull and a intracranial bleed. Footling breech is the least favoured by docs as the rationale is feet can slip through an undilated cervix and give a very early urge to push.

ArrietyClock- Hand on heart, I would opt for a vaginal breech birth everytime AS LONG AS I had a midwife who was experienced in breech birth.

Everything I know about breech is gleaned from research I studied for my dissertation and from Mary Cronk (an IM who is very well known and respected and specialises in vaginal breech birth).

Things are gradually changing, the TBT has been largely discredited and there are vast amounts of research which support vaginal breech birth.

Mary Cronk and her colleagues are educating medical/midwifery in the art of BREECH BIRTH. Did you know that in a breech birth the baby actually manouvres ITSELF??? When the woman is on all fours the body delivers itself then, as the body is hanging there, the baby lifts its knees which flexes its head whilst at the same time mum drops forward into 'muslim prayer' position and her sacrum rotates over the baby's head and it simply pops out! I've seen it and it is truly amazing to watch! Mary and her colleagues have delivered hundreds of breech baby's in this way and have NEVER encountered head entrapment and they have the statistics and records to back it up (I know, I've cited them in my diss!)

I remembered something else I was told, there was a risk of the waters not breaking - which happened with my first daughter and I think partly why she survived being born at 20 weeks, she was also a natural labour and footling breech. I delivered her body when I threw up because of pushing down but no one knew, she was held inside me like that with just her head in the uterus for probably half an hour and she still survived. Her head was very bruised though, Mum thought I'd cheated on my OH with a black man!

Anyway, I'm not sure why that's a risk, it's supposed to be a regal birth and good luck to be born in the caul.

What you said makes sense. Someone told me that the Dr felt her foot when he examined me (why does noone tell you the Dr will stick his fingers inside you? I wasn't expecting it and nearly jumped a mile!) and that was part of what made him jump to it.

I have to say that although I question things, it's in a drive to understand, partly because that's my personality and partly because of the GA. I had the director deliver Tink and he has a really good reputation so I'm happy that I only had the best. They told Mum later that he was on his way home and they chased after him to come and look at me. He must have been finishing at 5/5:30, Tink was delivered at 7:20! How about that then?

God knows why waters not breaking is a risk!!!! Its the first time I've heard that one!!!!

I wish more women would question things that are said to them or look things up. What doctors/midwives tell you usually isn't the whole truth, its usually heavily edited.

I dunno, I knew about the whole "born in the caul" thing before it happened to Lily-Hope because Junior did an article on it. When I thought about it after I presumed it was a whole package thing. He said that the rapid progression footling at 31 weeks meant the waters probably wouldn't break, I thought that maybe if the waters don't break it's harder for them to control the baby or he was just telling me it as a fact. They wouldn't have let me carry on anyway, so any "risk" from the waters not breaking was irrelevant anyway.

There was no time at the time to question anything, when they checked me I was 2cm. They started me on the drip and injections to stop the labour and help her lungs, but gave me an hour because they said I might be fast after Lily-Hope. An hour later I was fully dilated and they had her out of me under GA within 15 minutes. In that 15 minutes I had my nails cleaned, jewelery removed, line put in my hand, clothes changed, GA consent explained and signed and CS consent explained and signed, not to mention at the same time they were explaining things to Mum and TD who were sat either side of me. There was about 4 different Dr's talking to me and 2 midwives doing different thing. Very overwhelming and scary.

Small hijack alert, sorry! Tangle - every time I see your name I am ever so slightly ! DD was undiagnosed breech, and I was very fortunate to be able to avoid a c-section but we had the whole theatre, stirrups and episiotomy experience. Am convinced next one will be breech too (mum had 3 breech babies) so desperately trying to save money for IM! I've read loads about breech deliveries (Benna Waites etc) and am quite confident that I could do it again.

LizSpain, sorry no advice on C-section.

It's very interesting reading all of this. One of my big concerns when thinking what to do with with my ds was that I didn't have a lot of confidence in the midwifery staff to know how to do a breech vag delivery. I know the problem is that too many people with breech babies opt for the cs as they're encouraged to so the skills on delivering breech babies vaginally are lost, but I'm not sure I felt prepared to have my first baby delivered as a vaginal breech with a team of midwives who don't do that many vaginal breech deliveries and who's skills may not be fully up to date. I know that they'll never improve their skills if women keep opting for cs, but I didn't want to be a guinea pig, for want of a better phrase.

I did a lot of research about vaginal breech deliveries, including coming on here, and one thing that kept coming up was that many midwives were not experienced at doing vaginal breech births and their skills may not be fully up to date. That really made me think I didn't want my first experience of birth to be at the hands of someone not that skilled in doing what was necessary. I may well have made a different choice if I'd had a baby vaginally before.

Sorry, that's a bit rambling, dh keeps trying to have a conversation with me and I keep losing my chain of thought!

crikey, that was a bit repetitive... sorry, dh thinks that I can type and chat at the same time (which I can't after only four hours sleep and having been up since 5am!)

In fact then Middymee, your real answer is NO. Because the reality is you CANNOT guarantee an experienced midwife unless you are prepared or able to pay. I and probably a good number of others like me have based our decision on some very careful research (TBT, Mary Cronk, etc. etc.), not just whatever it is the drs/mw's say.

fiendish - I'm very grateful that we knew DD was breech ahead of time as it gave us time to do our own research, consider the options and plan a birth we were happy with. You have my admiration for managing to birth your baby inspite of the less than ideal situation . Incidentaly, it can be worth really pushing your hospital - I've heard of one lady that got her PCT to pay for her IM as they did not have breech skills.

HeadFairy - I know exactly what you mean. I'm very glad we had an option of experienced IMs, as otherwise we'd have been down to the local surgeon as well.

So come on then ladies - how do we try and get breech skills back into midwifery in the UK without being guinea pigs and putting ourselves and our babies at risk? What's the best way forward?

ArrietyClock-I seem to have annoyed or upset you? I was not having a personal 'dig' at you or anyone else who has had a breech via CS. I work in quite a deprived area and meet alot of women who are completely unaware research even exists. I wasn't suggesting you were one of them. Apologies if thats how it seemed.

Tangle-How do you define experience? Is it a midwife or doctor who had done 1, 5 or 20 vaginal breech deliveries? I know after doing my 40 deliveries as a student, I certainly didn't feel fully confident in delivering a baby! The truth is, a huge majority of midwives have done breech deliveries prior to publication of the TBT, a study which has created a rise in maternal and perinatal mortality in the long term and has been widely discredited (personally I think it should be erased from existence!).

Midwives breech delivery skills are not truly lost. We do annual updates, skills drills and study days to ensure should an undiagnosed breech walk through the door, we know what to do. We do still get vaginal breech delivery's (2 last week) and midwives deliver them. We just need more to hone our skills, so to speak! I would love to see the Mary Cronk method of breech birth introduced, its soooo logical! If any of you ever get the chance, nip to one of her study days, they are certainly eye opening! Their web address is sharingtheskills.co.uk/

No, not annoyed or upset at all. Just very aware how backed into a corner women are by the whole situation. Tangle asks the right question. How do you fix it without being a guinea pig?

I'm interested that mw's updates deal with breechs (though of course they should).Judging by the look on the faces of those I dealt with, you would have thought I was suggesting they support a 'medical procedure' that went out with the ark. Something they had read about in history books only!

I had a c-section at 39 weeks with ds 1 who was breech. I didn't even attempt to have him turned. I am so thankful that my doctor encouraged me to have a c-section. No probs whatsoever; I was on the x-trainer the day after I came out of hospital!