Please talk to me about natural breech births

[Backgammon]

What are the advantages of a natural breech birth over a planned c-section please?

Am looking for advantages for the baby only (obv know about recovery for mothers from c-section).

Thanks!

[laweaselmys]

Very exciting! Glad you don't have to choose now g

For other people's reference much family knowledge leads to the opinion that it is really 50/50 but the evenness of the stats depends on how comfortable/practiced your doctor's/midwives are at doing either one. The danger of vaginal delivery is supposedly that the amount of time one has to fix anything that might go wrong is much shorter (a doctor told my dad when I was being born that it was eight seconds! But would need a doc to double check that memory). C-Section in contrast has all the usual risks of major surgery. Statistically the risks come out the same.

I expect to be in this situation (lots of breeches in my family, I know it doesn't mean that I will have one necessarily - but it's best to be prepared) and have decided that since I have no really strong desire either way I would just go with whatever the consultant was comfy with and recommended!

[happyfaceschildcare]

Congrats - well done so pleased for you and the baby will make things much easier I'm sure, good luck with everything x

[madmouse]

wahee backgammon, that is the best ossible outcome!

[Alishanty]

I was a breech baby delivered naturally. My mum decided that she didn't want a c-section. It all went ok apart from she had to have an episotomy. In a way she said it was easier as she didn't have that horrible feeling of the head pushing down. Just to let you know that it could be done.

[Tangle]

Backgammon - so pleased for you. Makes life much easier! Fingers crossed the baby stays nicely head down and you have a good birth

[Backgammon]

Hi,

thank you everyone for all your replies, they are really helpful.

I saw the consultant today and the baby is not breech (confirmed with a scan). I am so relieved!!!

This was all really useful info though, thank you all for sharing your experiences with me

[morocco]

all I can add is it is also worth considering the risks to future pregnancies as a c section tends to load risk onto the next pregnancy. this might not be mentioned by the consultant, i don't know if it is part of the 'talk', but is worth knowing about now rather than later

[Tangle]

Lynniep - that sounds awful. I'm so glad things seem OK now.

I think knowing DC is breech in advance of labour is a huge advantage - at least you have time to try and make an informed choice when you're not under pressure.

madmouse - the version of "hands-off" breech birth that I experienced and that I am advocating is that used by Mary Cronk: The midwives remain completely hands off until they catch the baby. If it looks needed, the mother is encouraged to drop from all fours to a knees/elbows (or shoulders) position which rotates the pelvis and releases the head. I didn't need to do this for DD.

Backgammon - Some recent papers (dicussed and referrenced here) show that vaginal breech delivery is as safe as CS as long as strict criteria are met. This research seems much more rigorous than the Term Breech Trial (which found much poorer results for vaginal breeches than CS, but has since been widely dicredited). These papers are still looking at vaginal breech delivery or extraction rather than vaginal breech birth, however, and talking to experienced midwives would suggest that a vaginal breech birth may be safer still.

Some generalised risks to the baby of a CS are the risk of premature birth (if your dates are wrong for whatever reason) and the risk of being cut by the surgeon. As you say upfront, a lot of the risks in CS relate to the mother rather than the baby and some of those risks are far more significant if you want more children.

Hope your appointment went well

[beforesunrise]

my cousin had a natural breech delivery (bottom first) 3 months ago. she had a scan at 36weeks, all was fine but then her baby decided to turn around overnight and come out the next day. it all went so fast there was no time for a section, and this is in scalpel-happy Italy where they do a section almost automotically if not textbook labour. she was therefore incredibly lucky to find an old midwife on the shift who completely took over from the young obstetrician who was nominally in charge (all births in Italy are consultants led) and delivered her little girl safely and soundly. she told me one look at the consultant's face was enough to scare her out of her wits, but the mw was cool and collected throughout.

all went well, save for a massive episiotomy, but she told me she would never repeat the experience and if shed known baby was breech she would have gone for a section any time. the reason is not so much the pain or recovery, but the way she lived the birth, she said she was in complete and utter panic the whole time and felt really lost and scared, imo that counts for a lot and if you go into the labour AWARE that there is a higher risk, it makes the whole thing much harder on the mum.

previous posters have given lots of very good advice based on first hand experience, but whatever you decide- best of luck!

[happyfaceschildcare]

Hi there, not wanting to scare anybody but my daughter was extended breech and my midwife and doctor encouraged me to go for a vaginal delivery because she was only small, her being my first and not knowing any different I went along with it, everything went against us she went in to distress,she had the cord around her neck and got stuck, she was to far out to push back in and to far in to untangle her, I wouldn't recommend it to anyone but that's my personal opinion I'm sure some people have breech deliveries that are perfectly normal but I would have recovered from a c section alot quicker than it took for her to get better and discharged from hospital - good luck

[Rolf]

Lynniep - I'm glad your DS recovered and hope I didn't upset you. I am aware of how very lucky DD and I were. Your experience sounds terrifying.

[motheroftwoboys]

DS1 (now nearly 18!) was breech so I had an elective C section. I was 34. It was a wonderful experience and it took me much, much less time to recover from that than from DS2 "natural"/forceps birth a couple of years later.

[lynniep]

I'm afraid I don't have any offerings on the benefits front to give you either. I was unlucky - like Rolf my breech baby was undiagnosed. Unlike Rolf, however, the speed of the birth as well as him being feet first resulted in a very poorly baby. I chose not to have a c-section (he was halfway down the birth canal by the time they realised he was footling) but his shoulder was stuck so it was v. traumatic for him trying to get him out. They didnt know how long he was without oxygen due to cord compression. I dont think it helped that he was quite big (8lb2oz)

The midwife actually called for the consultant when they realised - he had never delivered a breech either, so he did the delivery - she watched with about 7 other people who were on stand-by to resusitate.

DS has recovered fully but the first week was touch and go - all his organs failed, he was ventilated the first night and fitting regularly. We had months of waiting to see if there was evidence of brain damage.

If it happened again, I would be hard pressed to choose a natural birth. I'd rather go through the pain of a c-section than see my baby suffer like DS did. But it is very much the 'luck' of the draw. Rolfs experience was totally different to mine.

[Backgammon]

Thanks everyone - madmouse I'm 38+5 today and they are talking about a section next week.

This thread has been useful to hear other's experiences of natural breech births, but I'm afraid I'm still not clear on what the benefits to the baby would be if I took the natural birth route.

[Rolf]

I had a natural breech birth - not by choice - the baby turned sometime between term + 5 and term + 8 so we didn't know she was breech until she started coming out. It was an unplanned homebirth, and was a lovely delivery.

My midwives hadn't done one for many years but they do have emergency obstetrics training every year, so they knew the theory and had practicsed on a dummy!

I hadn't done any research about breech deliveries so didn't know the issues between birth v extraction. One risk, as I understand it, with an extraction is that if you yank at the baby it will fling its arms up over its head and get stuck. I had an extraction but done very slowly and calmly and the baby came out easily (no distress, apgar of 8 at 1 minute). Although my midwives didn't have breech experience, they are very experiences, confident and competent midwives and were able to take things gently. IMO that's what kept me and the baby safe.

[madmouse]

You will need a midwife with the confidence to be hands off. A breech needs to deliver itself, except for some guiding out of the head after the body is born. Some say that too much touching of the body can start the breathing reflex whilst the head is inside, but I have also seen that discredited.

When weighing up the risks you also have to ask at what point a csection would be done,as there is increasing evidence that early c-sections (38 weeks) give rise to breathing difficulties in newborns.

[Tangle]

gothicmama - why is it up to the consultant?

[gothicmama]

I had natural breech with dc1 just been told by MW dc3 is breech so will have to check with consultant if I can have a naturla birth again hope so

[Tangle]

giddly - without knowing all the details I don't want to comment on your recent case, other than to say that whatever happened it must have been very sad for all involved . Do you have details of the study you mentioned? I'd be interested to see what their criteria were. My guess would be we're talking the same risk, and the asphyxia is caused by cord prolapse - I'd like to know though.

Backgammon - from talking to the MWs, the skill in breech birth is having the confidence to do nothing while things are moving forward and the experience to recognise when things have stopped progressing. I had a homebirth with IMs, although we were pretty well decided on both of those before DD was confirmed as breech. As others have said, it was a very calm and peaceful afair. DD was my first. I don't know that you actually need to have more trust for a breech birth than for any vaginal birth (one reason we were looking at IMs to start with was our CMW had dented our confidence in her and, by proxy, the CMW team), other than its so much easier to go into a vaginal breech birth with low confidence in your body's ability to do this due to all the scare stories around.

Its not an easy decision to make and it will inevitably be very personal to you and your circumstances. All that matters is that you are comfortable with the decision you make. You do not have to make a decision during the meeting tomorrow if you need time to think.

If you do want to follow up on the vaginal birth at the hospital after your consultant's appointment, call the supervisor of midwifery - in theory the consultants should know the score, but its always worth making sure the midwifery team are working off teh same hymn sheet. If they do have a small number of midwives with experience, it may be possible (and would be in their best interests) to make sure at least one will be available when you labour.

(Oh, and just in case the consultant is less enlightened than we currently have reason to believe, if they start quoting "research shows vaginal birth is less safe than CS", check what research they are referring to - its almost certain to be the Term Breech Trial published by Hannah et al in The Lancet {full text available for free if you're really interested} in 2000, and generally considered to be so flawed in conception, execution and analysis its not worth the paper its printed on.)

[giddly]

Tangle: there was one recently (HB) in our trust . The College of Obs and Gynae also did a study that found aspyxia was the commonest cause of death in breech normal deliveries although is still very very rare. I'm not at all anti ND for breech with skilled midwife, but do think there are some different dimensions.

[Backgammon]

Tangle, from what you say it sounds like you need to really trust whoever is caring for you to go for a natural breech. Did you have a homebirth or hospital birth? I'm booked for a hospital birth and haven't met any of the m/w's there so I'm not too sure how I feel about trusting them.

[Tangle]

giddly - one of the reasons why MWs that support natural breech birth say the baby should be normally developed and full term is because, under those circumstances, the baby's bum is pretty close in size to the baby's head. If you talk to MWs that have experience, they do not know of a single case (in the UK or other countries) in the last 40 years where a baby has got its head stuck.

SqueakyPop - another breech birth mum

The guidelines I was given were basically that you don't muck around with a breech - labour should start spontaneously (they wouldn't even give me a sweep) and progress totally naturally. If it doesn't start or doesn't progress thats telling you somethings not right and you go straight for a section. The breech's that have problems tend to be the ones where the HCPs have felt an urge to "help"

[Backgammon]

Thanks, I'm still favouring the section at the moment. It is my first and I'm pretty risk averse when it comes to the baby's safety. Plus, as I say I don't have any kind of emotional attachment to the idea of a natural birth.

BUT - if I can be convinced that a natural birth will be the best thing for the baby then I will obviously entertain it. TBH, I'm not totally confident that the staff at the hospital will be skilled/experienced in breech deliver but I guess that's something I need to discuss with them tomorrow.

[SqueakyPop]

Mary Cronk's website is excellent - it was what gave me the confidence to go ahead.

I was of the opinion that I would see how labour went. If it progressed smoothly, then great; if it stopped, then I would go straight to C-section. I would not have allowed any kind of acceleration or forceps. That is where the bad statistics come from.