Breech - what are the options these days?

[M D]

Bub is currently breech and I was wondering what the 'procedure' is for Ob's and breech births.

Obviously I will ask my Ob but I wanted to get a feel for what 'others' have experienced.

I understand bub may very well turn by delivery date but I just want to have some idea in my head just in case bub doesn't.

TIA

[Arimeh]

Luckily you have heaps of time left for baby to turn. Most OB's won't let you have a vaginal birth if bub is breech but they will do an external procedure around 38 weeks to attempt to turn it. It's somewhat successful I have heard.

My bub is still flipping around, so I have been doing some exercises off the spinning babies website to try and get it to turn. I've got a couple of weeks left to get it to stay head down, and then will probably be made to go to the hospital for the procedure to see if will turn, definitely not wanting another c-section but if bubs won't turn - so be it! My midwife strongly recommends a certain butt massage that is supposed to help

[LionsandBears]

It depends on the type of breech, whether your attendant is competent with breech and often whether or not it's your first bub. I had a vaginal breech in a public hospital. We had to fight for it and we were lucky to have consultants rostered on who were confident to handle it.

Personally, i dont understand what all the fuss is about. It's one of my pet hates that most ob's dont seem qualified to handle breech. Breech is just a variation of normal and is perfectly safe within certain guidelines (like all vaginal births).

I'd look up the spinning babies website for tips on how to turn baby. An ecv can be done 36-37 weeks but you want an expert to do it. You can also research private obs who are prepared to do vaginal breech.

[Lenny]

tashybabe - it seems to be one of those nasty spirals, the less that breech births are allowed the less competent the medicos get the less they do them etc etc.
kts64s - in my limited experience it all came down to what your ob/hospital was insured to do. My local public and private hospital have an absolute rule - no breech vaginal deliveries becasue they are uninsured for them. Sucks, aye, that insurance comes into it. However, i think you'll find that most obs do view breech as a variation on normal, but they are not used to women wanting to try to birth a breech bub.

You still have a while, so try the spinning babies website. And you can do acupuncture as well. (It's on the foot)

Start thinking about what kind of birth you want - and explore whatever options are available to you. Maybe even ring the midwives at the hospital - i found them to be a wealth of advice and knowledge and help.

[Persephone1]

My bub was breech until we had an external cephalic version (ECV) at 36 weeks. Apparently doing it at 36 weeks is ideal because any later and there's less fluid for bub to move, and any earlier and there's too much fluid, so they're more likely to flip back.

When we looked into our options, we considered attempting a vaginal breech birth, but at the time my DS was "footling breech" which is considered the most "unsafe" (or maybe "risky" is the right word). Neither our Birth Centre or the hospital would have supported me to do a footling breech, and when I searched for an experienced Ob to support me for a footling breech I discovered that even the most experienced would probably refuse to support me in such circumstances. I considered Dr Lionel Steinberg in Melbourne ("Lionel Vaginal") and apparently he would not have been supportive even though he is known for assisting in breech births. Had DS been frank breech we probably would have found someone supportive, even if it meant transferring hospitals.

Anyway, we elected for the ECV and it was successful at turning bub, and he remained upside down. Apparently ECVs are only successful 50% of the time, so we had to take a punt. We had a tough time deciding, because it was a matter of having an ECV that might work but might not, and the ECV itself has some risks, or electing to have a c-section. Neither is particularly attractive. I was also worried that by having the ECV I was "forcing" my baby into a position that he might have had reasons not to move into himself (ie, placenta position, etc).

The ECV was painful. I had to do it without pain relief because they couldn't get a vein. It was really hard, and I had to remain relaxed because if your body tenses against the hands of the person doing it, it's less likely to be successful. I chanted to myself "vaginal birth , vaginal birth!" throughout the procedure. But for us, it was worth it, as it worked and he remained head-down, and had a vaginal birth at 41 weeks.

Do your research and make a decision for yourselves. I've heard of Obs who don't offer ECVs but do offer c-sections, which to me is unfair as it really should be the parent's decision either way.

GL.

[*Beema*]

There are a few things you can can try to "spin" your baby yourself.

Spinning Babies has some great suggestions, there is Moxa, in conjunction with accupuncture (Traditional Chinese Therapies), ECV.

DD2 was a breech bubba, we got her to spin very early, but she went back, I was having ctx from very early on and have a septate uterus so we needed to get DD2 to spin very early and my OB didn't think we were going to get much further than 30 weeks, so she attempted an ECV at 28 weeks, extrememly rare for this to occur, but things were in the right place for the attempt and my amniotic fluid was at an all time high, whichw as still at the bottom end of average. It was uncomfortable and she had to stop a couple of times as I was contracting, she got bubs around by she decided to go straight back, she attempted it twice to no avail.

We then planned a Vaginal Breech delivery as long as we got bubs up to over 2kg, we went through it it all, which is a "hands off" approach, the important thing about breech delivery is to not interfere with the delivery, you have to let the body and baby do their own things. I did my reaserch and I was confident that I was going to fear it, and I had an OB who had a lot of experience in breech delivery so knew I would be in the best hands.

In the end we didn't get to attempt it as we managed to get to 35 weeks, but bub had stopped growning, I had no amnitoic fluid left and we were both not coping any longer... so she ended up being a CS that week.

So while my OB was very supportive of it, her partner OB wasn't as she hadn't had experience, and like said above it is a vicious circle and less and less are being willing to support it, yet it can be a completely safe way to birth.

You still have plently of time for bubba to spin, but I would start doing the things suggested on Spinning Babies before the Moxa/Accupunture as it isn't recommended until 32 weeks or so.
Goodluck

[Arimeh]

I thought the ECV was done at 38 weeks? Crikey, I'll be 36 weeks tomorrow and bubs is still flipping.. my midwife didn't seem alarmed at the prospect of it turning around again until 38 weeks, then she said we would do something about it - I thought she was meaning the ECV? Although she does seem to be a fan of the butt massage before trying the ECV.......

Having said that, my bub was head down on saturday but I'm not expecting it to stay there since its my 4th and there is plenty of room in the old uterus! LOL

[Persephone1]

I thought the ECV was done at 38 weeks?

I only know that my hospital "policy" is 36 weeks but I've heard of them being done much later and still being successful. I considered waiting a few weeks and we researched it and decided that 36 weeks was a good enough time to try it. The pamphlet that my hospital gave me said that the success rate drops after 36 weeks but no doubt there's as many opinions on the subject as there are doctors.

[Arimeh]

Hmm ok.. I have no idea what the public hospital policy is down here cos I'm not going through there

I know my IM doesn't handle breech vaginal births though, my chiro couldn't turn her last bub and the IM made her go to the hospital to have a c-section. I know my old midwife suggested it to me, but its a bit risky because I carry my babies high and they don't engage until labour, so the risk of that cord prolapse thingy is pretty high in my situation...

[Hannahbanana]

There is actually a DVD out at the moment called A Breech in the System. Its an aussie documentary about a woman's fight to have her breech baby in a public hospital (I think she is located in NSW somewhere??). It shows the birth and everything I think. There is a trailer of it on youTube. Might be worth a look of you are considering having a vaginal birth?

[Persephone1]

There is actually a DVD out at the moment called A Breech in the System. Its an aussie documentary about a woman's fight to have her breech baby in a public hospital (I think she is located in NSW somewhere??). It shows the birth and everything I think. There is a trailer of it on youTube. Might be worth a look of you are considering having a vaginal birth?

My Doula recommended this DVD to us as well, but we never watched it cause he turned. But yeah, sounds like a good resource.

[Hannahbanana]

oh, I didn't know he turned. Bit dissapointing!! Would have been good to see the birth in a hospital setting!! Still it would be good info for how she delt with the medical staff!

[Persephone1]

No, MY baby turned, not her's.

[*Beema*]

There are a few good videos on Mutinany of a Midwife of breech deliveries, they are beautiful

[Hannahbanana]

....lol...... Then definatley a docco worth seeing if you have a breech baby!!

[misty]

definitely depends where you live and where you are birthing.

Here in ACT at Canberra hospital I was looking likely to have a breach birth, but bubs decided to turn in the last couple of weeks. The midwives talked about attempting to turn bubs (with lots of monitoring) and failing that, provided bubs was the right kind of breach, there wasn't a problem with having a vaginal birth. Even if he had of been a more difficult type of breech the midwives were saying that they would prefer me to attempt vaginal, with the theater on standby for emergency c-section as an absolute last resort.

[~me~]

My SIL is a Chiropractor and recently successfully turned a breach baby using the Webster technique. Not sure what it involves.
I also know of lady who successfully vaginally birthed a breech baby, no drugs and she was explaining it was probably her best birth.
Good luck with everything.

[Michelle71]

There are a few things. As long as there is no uterine abnormality that is keeping your baby breech / preventing it from turning.

Spinning babies website. Our current slothful existence increases the chance of posterior and breech births because of the lack of positioning that occurred through normal activity - think scrubbing the floor on your hands and knees

Webster technique - works on chiropractic manipulation of the broad ligaments in the pelvis and aims to improve pelvic positioning to optimise the chance of turning.

ECV - mine was done at 38 weeks in a public hospital. There are risks but they are all relative. I was even offered this for DD who was a VBAC so even my previous c-section was only a relative risk (with the right OB with the right experience)

Vaginal breech delivery - frank (bottom first) is your best chance. Footling is often not a good choice because of the risk of cord prolapse during delivery. The reason we now have a deskilled OB base is due to a dodgy piece of research from 2000 that indicated there was significantly poor outcomes from a vaginal breech delivery. That research has now been shredded and proven to be dodgy but unfortunately there is a generation of OB's that are not skilled in the vaginal breech delivery. And the insurance companies got in on the act too.

All of my live births have been breech or transverse. I have a slightly sub-septate uterus. DS1 was stuck between my placenta and rib cage, failed ECV and ended up distressed during a trial vaginal breech delivery. He was an emergency c-section. DD was transverse to 36w, breech to 38w, flipped to cephalic the day before the ECV and was a VBAC. DS2 was transverse with a fundal placenta and the cord around his neck twice. He was early (36w3d) and an emergency c-section due to transverse lie.