Vaginal delivery of a breech baby

[Hemlock]

I am currently 36 weeks pregnant and my baby has been breech since my 18 week ultrasound. My OB has suggested that I could still try for a vaginal delivery if I wanted to. He does not feel that the baby has enough room to turn before my due date (although it is not impossible!). He told me that I would need an epidural due to the "manipulations" involved to get the baby out. He also advised me that I may likely need an episiotomy. My other choice is a scheduled c-section at 39 weeks.


Does anyone have experience with delivering a breech baby?

[justlearning]

They tried unsuccessfully to do an inversion and I had a c-section. My doctor never discussed the possibility of delivering DS vaginally.

[zukeypur]

Ditto. I had a cs at 37 weeks (not scheduled, I actually was complete when I got to the hossy with my super fast labor but they knocked me out and took her). Honestly, either way they come out sucks. My VBAC was just as painful as my cs, just in different places. I prefer the cs.

[Tondi G]

I have a friend who delivered her twins vaginally with no medication. Baby A was birthed head down... 6lbs 10 oz. Baby B decided to flip breech at the last minute and she delivered vaginally... and she was 7lbs! It can be done... and before Ultrasounds were used regularly, it was done more often. I think the suggestion for an epidural is probably good... were you planning on having one or thinking you might want to go natural?

[citymama]

My sister, first born child, was delivered breech vaginally but that was 40+ years ago! When my DD1 was breech, and we were discussing my options, I asked my midwives about delivering breech vaginally. They said that the hospital I was delivering at (a major academic hospital) would not permit it due to liability issues. But they also said that the reason is that there are fewer and fewer OBs with experience delivering breech babies vaginally - they called it a lost art. One of the OBs in the group was around 70 and had delivered many breech babies vaginally. He performed my manual version (to turn the baby) at 37 weeks - another skill that old timers have but fewer younger docs as more and more women and hospitals equate breech with c/s - and it was successful.

(I ended up with a c/s after all that due to positional issues - she was transverse - and my OB said I was the first woman in his 40+ year career who ended up with a c/s after a successful version! So in other words, most women whose babies are flipped late in pregnancy go on to have successful vaginsl births - just not me. ;))

Does your hospital allow breech babies to be delivered vaginally, and does your OB or midwife have experience with this?

[llama8]

Mt DD was transverse breech and my top notch OB (highest rated in my area) wouldn't even consider manually flipping the baby. She heard of a few cases where that led to fetal demise. I was very happy with my c-section and my recovery.

[trcy]

My friend was breech and her mother had a vaginal delivery (this was 30 something years ago). DD was breech and because of low amniotic fluid, they recommended against trying to manually flip her. I had a c/s, but was ok with that.

[swissair81]

My OB told me he would do a vag breech delivery with me if my last baby was breech. I do believe that part of his reasoning was that she wasn't my first baby and I would have more room up there for maneuvering as needed.

[JBaxter]

Doctors and midwives used to do it all the the time 30-40 yrs ago. Some will still try if they feel your pelvis is proven <delivered a baby the same size or larger> My 5'2 aunt delivered my cousin who was nearly 8lb breech 40 yrs ago. Now its all about lawsuit prevention. There are risks but there are risks with csections.

Given a choice I would do it if your doctor is suggesting you can try. My mother is now a retired nurse and assisted several breech deliveries at the small country hospital she worked at. Discuss how many breeches your doctor has done. I did have an episotomy with my first and it was sore but wasn't horrible.

[karstmama]

the current thought is that if your pelvis is proven and the baby isn't 'too large' (whatever that is), that a term breech is acceptable. but that's the official word - in real life they are very very rare. doctors won't try, hospitals won't try, midwives might like to but their docs won't hear of it...yadda yadda.

personally, i'd attempt it with a proven pelvis and average baby. i'd make sure my provider(s) had experience, which is tough nowadays. i *wouldn't* get an epidural, so i could push and move more effectively in case i needed to radically move positions.

all that said, external versions are usually effective. look into moxibustion, which certainly can't hurt. consider some tilt-table lying with headphones playing music to your pubic area - give the baby some incentive to wiggle around.

best of luck. whatever you decide is the right thing.

[mikeys_mom]

DS1 was breech and average sized. I delivered him via c/s. I'm in Canada where we don't have the same fear of liability as in the US and don't have hospitals or doctors with a no VBAC policy like in the US. My OB told me that with a first baby who is breech, he feels the c/s risks are lower than the risk of the baby getting stuck. At the time, he said that if this would have been a 2nd or subsequent delivery and I had a "proven pelvis" from a prior vaginal delivery, then he'd attempt a vaginal delivery. He does do external versions but in my case he couldn't because the placenta was right near DS's head and he felt it was unsafe to manipulate the baby around the placenta.

My c/s went well and recovery was pretty uneventful. Good luck with your decision and delivery!

[daisymommy]

I don't think I could do it myself, I'm too chicken ;) And I really don't think I would do it without an epidural, just me personally. But it is done in home birthing circles quite often...so it's certainly possible to deliver a breech baby au'natural! Nothing wrong with that!

Delivering breech babies vaginally is a lost art. The famous midwife Ina May Gaskin has much to say about this, if you do a search for her speech's and articles. It is sad that doctors do not know how to do it anymore. That in itself is dangerous, IMO.

And most people would be surprised to hear that science does not back-up the belief that c-section delivery of breech babies is safer than vaginal delivery, in a typical low-risk birth.

Here's a good article on the subject:
http://www.fitpregnancy.com/labor-delivery/labor-delivery/turn-baby-turn

[mikala]

No experience with a breech birth but I did want to point you to this site if you haven't already seen it. Two of my friends had babies flip out of breech at 36 weeks after following some of the techniques, no idea if the flips were related or if it was pure coincidence but it would be worth a try.

http://www.spinningbabies.com/

[gcc2k]

No experience with the vaginal delivery, but I have a friend who is due any day now. She had a c-section planned for tomorrow since the baby was breeched, but when she went in for an appointment yesterday the baby had turned. So I suppose there is still hope your baby will turn!!

[AnnieW625]

My best friend is 35 and was born breech. I would be too chicken to have the manipulation done. I would try something like Spinning Babies, but in all honesty if it was safer for the baby to have a c section then I would just do it. I'd also see if I could schedule the c section at 40 weeks to give the baby more time to flip.

Good luck.

[american_mama]

First, is an external version an option? I will try to find links later, but I have read threads here from people who thought it was very painful and others who thought it was no big deal. It seems to vary a lot, in comfort and in success rates, so I wouldn't discount it as too painful or not worth trying.

Is this your first baby? I think vaginal breech birth is generally not advised if it is your first.

What kind of breech is your baby? http://www.umm.edu/pregnancy/000152.htm for pictures and http://www.birth.com.au/Breech-baby/Types-of-breech-positions for info. I know vaginal breech is only advised for one or two of the positions. For instance, if baby was a footling breech (rarest, I think), a vaginal breech is ill-advised because the presenting part (foot) is so small that it doesn't adequately stretch the cervix and the head (biggest part) might get stuck. That's less of an issue when the baby is folded in half, and the presenting rump and legs are roughly the size of the head.

Assuming you had a previous vaginal birth, did you have any long-term pelvic issues like bladder leakage or pain? It sounds like an episiotomy is a lot more likely with a breech birth, as is a longer pusing phase, and one or both can icnrease the likelihood of pelvic damage (bladder leakage, pelvic pain) for you. If you already have or had issues with these, you might want to avoid risking that again.

How important is a vaginal birth to you? Are you willing to make whatever accomodations your doctor recommends for a safe vaginal breech birth? Do you have sufficient help to help you with the longer recovery time from a c section? How many kids do you anticipate having? Having a c section now may make it much harder to have a vaginal birth later, plus brings some complications (placenta previa or accreta, risk of uterine rupture during labor) increase even at the third or fourth c section.

I will try to pm you some stories of vaginal breech births that I collected for another poster. I am not sure what I would do in your situation; I would rely heavily on my doctor's experience and comfort level, plus my own gut. I think this is a decision that is highly individual.

[ast96]

Hi!

I contracted Fifth Disease during this pregnancy and had no immunity, so I ended up going for high tech U/S at the hospital every week for the last four weeks of my pregnancy (they eventually induced me due to possible anemia in the baby).

Between 35-36 weeks, the baby flipped breech. I was terrified -- she's my fourth and I had never had a C-section. So I did the whole ice on the top of my belly while sitting in a warm bathtub thing, I saw a chiropractor who specialized in the Webster method (twice), and I did flips in the pool. That last one was very awkward -- the baby was already over 7 pounds when I was doing this. Well, that week, she flipped again! When I went in at 37 weeks, she was vertex. I was induced that night and she weighed 7 lbs, 15 ounces, so it IS possible to flip late in the game and at a good weight. And I didn't even feel it -- which is a little scary!

Good luck. I wanted to try a version, but she was floating around so much my doctor said she wasn't sure she would be able to get a good "grip" on her. Things worked out for the best, thank goodness. But I wouldn't have tried a vaginal delivery (I don't think it was an option at all anyway) -- my kids have big heads, and that would have scared the you know what out of me.

[Hemlock]

Well I just had an ultrasound this afternoon to confirm the placement of the baby (confirmed still breech). This evening, I received a very unexpected telephone call from my family doctor. Apparently the hospital sent over my ultrasound results right away because my amniotic fluid is low. My doctor told me it is not low enought to be concerned, but that the low amniotic fluid will likely prevent the baby from turning. Any attempts to "encourage" the baby to turn are also out. I need to confirm all this with my OB, but it looks like a c-section is the safest option at this point.

Thanks for all the input.

[Jenn850]

Hang in there Hemlock. It is really disappointing to have a section, but at least you may know ahead of time and can get over it before baby comes. I was just going to say that if you go for the vaginal, just make sure you doctor has experience in it. I would have tried with my DD who was breech, but I couldn't find a local doctor who had any confidence. I have seen data on procedural learning curves to know that I don't want to be on the early side of it. Best wishes.

[wallawala]

Best wishes to you!!

I had a planned C/S for breech with my first (39.5weeks) after external eversion failed at 37 weeks. My C/S was uneventful, I nursed in the recovery room, ate lunch that same day, and walked that night. I had a history of a complicated abdominal surgery previously, so I was quite anxious about the c/s. It was SOO much easier than I expected. I also had a planned c/s at 40 weeks with my second who was not breech, but my ob was not pro-vbac. He said he would support me if I choose VBAC, just did not encourage it. I had a second easy c/s and glad that I feel made the choice right for me.

My co-worker had a planned C/S for breech with her first, and although uneventful, she said she felt cheated by her birth experiance. She also wanted to have several more kids. She has now had 2 VBACs and is very happy.

Just wanted to give you two good stories of c/s if you end up needing to go that route, and to reassure you that you aren't locked into a second!

[wallawala]

Duplicate-deleted.

[Jenn850]

Silly sleep deprived me. What I should have added was that I had two beautiful healthy brilliant babies by c/s and am due for my third. I nursed them both in recovery and for over a year and they have the most beautifully round heads;) And my little breech dd was so cute with her legs tucked up under her for what seemed like a month. My grandmother kept saying "where is the rest of the baby" when she was swaddled because she looked so petite.

[MacMacMoo]

I was induced at 38 weeks with my last. At the start of induction baby was head down all ready to go. When they were about to break my water at 7cm they noticed he had flipped. They held off breaking my water and we created a nice long what if plan. We had the head high risk OB on duty that night and he was willing to try anything and not go straight for a C-Section. (We heard that he got a lot of flack for not doing a c-section from the women's issues OBs). They were able to external flip him back. But had they not worked they would see if he had been small enough and I wide enough for a breeched vaginal delivery. Regardless I was prepped for a c-section as a just in case measure.