Vaginal Breech Birth-Myths vs Facts

A Breech bay is when a baby is positioned in the uterus with head up and the buttocks or feet closest to the cervix. There are actually three common types of Breech presentations, with the most common being Frank Breech (Buttocks presenting first with knees extended like a pike position: 50-70% of breech babies). The other two types of breech presentations are Complete Breech (buttocks presenting first with knees flexed like a cannonball position: 5-10% of breech babies), and Footling or Incomplete Breech (one or both feet presenting first:  10-30% of breech babies).  It is important to note that 97-99% of babies will turn head down prior to birth if they are term. 

Babies who are in a Frank or Complete Breech position, with baby’s chin tucked rather than flexed,are good candidates for vaginal breech delivery. A complete or frank breech baby is easier to manage because the buttocks acts as a kind of head as far as blockage of the cervix (to prevent cord prolapse) and to exert steady pressure on the cervix for opening. Other factors that might increase your candidacy:

You have had a vaginal birth before.
You have not had a c-section.
You are generally healthy and not over 35.
Your baby is not measuring very large.

You are willing to be active in labor.
You are willing to labor without drugs.
You will not be induced.
Your baby is at least 39 weeks, at which time the head and body are well proportioned.

(Please note that none of these are disqualifiers, but might help with your decision making process)

 

There are also reasons that would make some women not good candidates for breech trial of labor, such as a baby who is measuring large, or a Mother with diabetes. Informed decision making and choice are important when it comes to healthcare and birth.

 

“Routine cesarean delivery of the near-term or term breech fetus increases maternal morbidity, maternal mortality, and the cost to society, but it does not provide a foreseeable benefit to the near-term and term breech fetus….Although preached with great emotion, the recommendation for routine elective cesarean section to deliver the near-term or term breech fetus cannot be substantiated by studies published over the last decade.”
-C.P. Weiner, Journal of Clinical Obstetrics and Gynecology

 

Myth: A breech baby probably won’t turn head down in the last weeks of gestation

Fact: 96-97% of breech babies will turn before labor starts, and that number goes up to 97-99% if baby is term. Scheduling an early cesarean does not give the baby time to turn.

There are things you can do to help baby turn if that is what baby wants. Remember, your baby knows best what position to be in for his/her birth. Look into the following options:

  • Chiropractic adjustments and the Webster Technique
  • Acupuncture
  • Spinning babies
  • Moxibustion
  • Playing music low on the belly and  placing frozen peas on top of your belly

At See Baby we also offer ECV (External Cephalic Version) to manually turn a breech baby. As with every procedure there is risk involved. Evidence Based Birth interperets  the studies into the below numbers:

The average success rate for turning a baby out of the breech position was 58%. The overall complication rate was 6%, and the rate of serious complications (placenta abruption or stillbirth) was0.24%.

 

Myth: All Breech positions are equal

Fact: Frank and Complete Breech babies may be good candidates for vaginal breech birth

 

Myth: If baby is in a breech position, surgical birth is the only option

Fact: There are many Doctors and Midwives (including See Baby) who are experienced and skilled, and offer breech trial of labor

 

Myth: Scheduling a Cesarean is safer

Fact: Very often a Cesarean is not any safer for baby, and barring rare health issues, it is not safer for Mom

The perinatal mortality rate does increase with breech presentation, but that is REGARDLESS OF THE TYPE OF BIRTH!

 

 

Below is an article (reprinted from gentlebirth.org) about an Irish study of 298 women with breech babies, in which 146 had vaginal breech deliveries after avoiding induction and pitocin, having maximum labor times. The result was zero negative outcomes:

(Reuters Health) Feb 10, 2003 – With proper selection based on prelabor criteria and careful management of labor, women with breech presentation can safely deliver vaginally, according to Irish researchers who described a prospective outcome study here at the meeting of the Society for Maternal Fetal Medicine.

The researchers at the National Maternity Hospital in Dublin followed all 641 women with breech presentation after 37 weeks during the four years from 1997 to 2000. Computerized records provided perinatal and labor outcomes.

A trial of vaginal breech delivery was allowed only if the presentation was extended type and if the estimated fetal weight was less than 3.8 kg. When vaginal delivery was attempted, labor induction was avoided as was the use of oxytocin, for either the first or second stages.

Slow labor was not an immediate reason to go to C-section. The threshold to send a woman in slow labor for a Cesarean was 6 hours for the first stage, and 60 minutes for the second stage, for a first birth. A woman who had already given birth before was allowed to labor in first stage for 4.5 hours.

Of 298 women who tried vaginal delivery, 146 succeeded.

“There are well-known criteria to have a safe, vaginal breech birth,” said Dr. Karin Blakemore, of Johns Hopkins in Baltimore, Maryland, who commented on the poster presentation. “You don’t offer vaginal delivery for big babies.”

The Irish study presented here found “no perinatal death and no poor outcomes,” as defined by an Apgar score of less than 7 at 5 minutes, or cord venous pH of more than 7.2, or abnormal neonatal neurology, Dr. Blakemore pointed out. “Zero is a powerful number,” she said.

 

Ina May Gaskin regarding breech birth:

“I find it sad that obstetrics has been so dumbed down in the US  that few doctors are taught anymore how to deal with a vaginal breech birth. They especially fear the case in which the baby’s feet present before its head. The  very  prospect frightens many because they have never witnessed a breech birth. …What astounded me was the speed of the change in the very content of the obstetrics curriculum. When I learned that the reason for such a change was insurance companies that began threatening teaching hospitals during the seventies and eighties that they would deny them malpractice coverage if they provided opportunities for residents to witness a breech birth attended by an experienced practitioner, I had to wonder if doctors of the future would ever regain such skills. …. I know of at least two maternal deaths that happened in recent years in the US because of fear and ignorance surrounding vaginal breech birth. In both cases, the physician chose a C-section because of presentation.  In one case, the mother died from hemorrhage during the emergency C-section performed for her second twin, whose feet presented, along with the umbilical cord, after her first baby had been vaginally born. This is the one case of umbilical cord prolapse that is NOT dangerous, because it doesn’t pinch the cord between the baby’s body and that of the mother, and a footling breech born with “the door already open” should be easily accomplished if the doctor or midwife is not petrified with fear. In effect, a mother of eight died because of ignorance that was imposed on her doctor by the insurance company. I find this intolerable.” p.114-115

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