Ok so I am curious and trying to understand why so many breech babies go straight to cesarean instead of being delivered vaginally.

How many midwives and doctors here can deliver breech babies and what are your techniques? When you can and can't a breech baby by delivered and why is this? Why aren’t more people pushing to deliver breech babies rather than just going straight to C-section? Another question that pops up in my mind is multiple births sometimes both babies are head down other times one up one down why C-section multiples if breech delivery is possible?

I guess I also would like to push that more people to try and deliver breech babies depending on the position.

Believe it or not a year ago my neighbor delivered her baby breech because the hospital staff didn't know the baby was breech until she was coming out!! First one leg came out then her body along with the second leg then finally the head. I told her she was lucky because they usually do Cesareans on breech babies. The baby is fine and over a year old now.

Thanks for reading I am looking forward in reading comments and posts! :-)

Tags: Breech, birth, breech, delivery

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Hi, Anna!

My youngest son was born complete breech (sitting cross-legged) in a beautiful home water birth last December. My understanding, after talking with a couple of obs and many midwives is that breech leads to cesarean for 3 main reasons- 1) because breech presentation is rare, most docs, and many midwives don't see them, and therefore don't know "how" to deal with them 2) there are some inherent risk with breech birth, not the least of which is cord prolapse- if the cord collapses, and the baby's head isn't birthed, they can be deproved of oxygen. Also, when you are birthing breech, you have to make sure you are REALLLLLLY well dialated, as bums and feel are smaller than heads. A footling presentation could begin to birth at 4cm, but there wouldn't be room for the head to follow. 3) occasionally, there are congenital or situational things going on that make it less safe to birth a breech presentation- high placenta with a short cord may result in placental abruption, or a higher placed placenta with a cord wrapped around the neck. As far as multiples, the concern is more if baby A (closest to the cervix) is breech, and becomes stuck, it could risk baby B. They are more likely to "allow" a mother of multiples to "attempt" vaginal delivery if baby A is head down, and baby B is breech, on the premise that once baby A is birth, baby B might have room to spin.

Hope this info helps!
Well, breech babies do have slightly more fatalities than cephalic babies, most of the time a vaginal breech is still safer than a C/S, esp for mom! Drs do C/S to "CYA". I've done complete and footling breeches as well as twins at home, without any problems.
As Carrie said, when birthing a breech, it is important NOT TO PUSH, unless reassured you are completely dilated, as the legs &/or butt can come through a partially dilated cx, but then the head can't. a fetal part coming through the cx and down the vagina, can make it hard to not push, but it is important to oversome this urge. And as Carrie also said, sometimes the cord can prolapse too. One must be sure this is not happening, if it is, the mom must transport to hosp, for C/S in a knee-chest position, to keep the pressure of the babies presenting part off the cord so it doesn't cut off the babys O2 supply, however, if this happens when baby has soft parts coming 1st, it is not as lethal as when this happens when baby is head down.
It is also important not to rush a breech (or any!) delivery. The baby however must be kept warm. if the body hits cold air, it will attempt to gasp, from the sudden change in temp, and may sufficate. If room temp is the same as moms body temp (such as in a water birth) the baby will not attempt to breathe until it is totally out and up at moms breast. A greater % of breech babies do need to be resuscitated, whether they are born vaginally or cut out, but then, even cephalic babies are more likely to need resuscitation if born by C/S!
I don't know about other types of midwives, but CPM's need to be proficient in breech & twin births to get their certification.
There are many safe ways to encourage the breech baby to turn. I don't do many breeches, not because I risk them out, but because most of the time we get them turned! BTW, I've even seen babies turn during labor & after 40 weeks, so I never give up on them!
Everyone has offered really good information so far. After experiencing a surprise breech birth in July I did some research about breech and wrote a blog post about it:

Breech Presentation: Risks and Options

We didn't know my baby was breech until I started pushing. He was frank breech and was born at home in the birthing tub. If you want to read my birth story, it's here:

The Home Water Birth Breech Delivery of Liam Samuel
We have a doctor in my area who has been in trouble quite a bit for delivering breech births. He doesn't encourage doing it, and makes strides to turn the baby if it is breech, but he won't force someone to c/section if they don't want one. (hence the repercussions).

I know in one instance the mom got to the hospital and was feeling the urge to push, upon inspection it was discovered that her baby was breech and he though it safer to deliver the infant rather then try to literally, push it back up so a cesarean could be preformed.

His argument for education on teaching breech delivery methods is specifically for this purpose. If we lose the ability to do so, what happens in an emergency?

I think with multiples, baby B is usually head up, and then is "supposed" to turn to be born. If they don't then an emergency cesarean is done.

I think breech deliveries don't happen because they are viewed as a liability. I could be wrong, but I don't think breech delivery is covered by ANY insurance companies anymore. So if a hospital can't get coverage, then they aren't going to deliver a breech birth, period.
I feel that I have read and seen a lot about breech babies delivered peacefully outside the hospital....my idea of a breech birth is not scary or bad. That being said, I'm not sure what I would do with a breech presentation. My daughter was 11lbs 4oz (39 wks BTW, w/ conf. conception date and NO GD). I pushed for over 5hrs to get her out. (head circ. was measuring at 6-9 months range at her week one baby check). So personally I would be worried. IIRC it's the difficulty in birthing the head that causes increased risk and the head is what we got hung up on, pardon the pun.
Well, breeches are not totally w/o risks, just that the risks of surgical removal OFTEN, not always, outweigh the risks of a vaginal birth. In your case, Guggie, I probably would not want to attend you at home with a breech, in the hospital, I would still think it worth a try. I had one lady push for 6 hrs, before birthing a very cone-headed baby. I thought this would be one that shouldn't be attempted if breech! Her next pregnancy, I was ready for marathon pushing again, but she only pushed 15 mins, and it was a bigger baby! GO figure? So your experience would not definitely r/o a vaginal breech birth, just would need to proceed with extreme caution. I have also had a VBAC client who had the C/S for CPD with a 10 lb baby, have a breech baby in labor, so we headed to the hospital at 7 cms, and when we arrived, she was 9 cms & the 10.5 lb baby had flipped to head down! She has gone on to birth two more home VBAC babies, each one a little larger than the last, her last one was 11.5 lbs.
A lot of the reason also comes because OB's are not trained in doing vaginal breech deliveries any more. In fact you'd be hard pressed to find a new OB who had even seen one. It's mostly older doc's, and most of them will only do a vaginal breech if the mom isn't a first-timer.
I would recommend getting a hold of Ina May Gaskin's breech video that was produced on The Farm back in it's heyday. It's very eye opening and I think would help anyone who was wanting to birth their breech baby vaginally. Here's the link:

http://www.inamay.com/archive/videos.php

It's the second one down. It's a little pricy but it would be well worth it. My local birthing center just got and it was required for everyone who worked there (doc's included) to see it.
I like "Normalizing Breech Birth" by Valerie El Halta & Rahima Baldwin better than Ina Mays, IMHO. Michel Odent has had some really good insights to breech birth too, shows one standing in "Birth Reborn"
Breech presentation used to be considered a variation of normal. My grandmother had 4 kids and 2 were born breech. Docs were trained to manage/handle the situation. As of now Breech presentation is considered a problem, a medical situation. Docs are no longer trained to deliver vaginally for breech babies. IMO a lot of the risks that we are warned about when it comes to delivering a breech vaginally is because of this. C/S do carry more risks--unless the doc attempting to do a vaginal breech has absolutely no training or experience in handling them. Sad. Older docs and MW are much more likely to be trained and have experience in handling this "variation of normal." Its just hard to find them.

My daughter was a footling breech and I was scared into a c/s. My MW now won't deliver me breech b/c I am a VBAC but the OB that she consults with will. If this baby doesn't turn then I will be "taking the risk" and delivering a breech baby vaginally. I feel lucky to have access to a doc that offers this as an option. Too bad he wasn't my doc when my daughter was born.
Sara,

It's nice that you have a hospital in your area that will allow you to deliver a VBAC/breech delivery. That's very fortunate.
km, I don't think "allow" is the right word. A pregnant woman can HIRE any Health Care Provider she wants to. It only makes sense to hire someone who shares the same birth philosophy. Your birth, your body, your way! If you are at odds with your HCP, change HCP's! There are a vast variety to choose from, anyone from a surgeon to a midwife can give good prenatal and birth care for the majority of women. As the number of docs offering VBAC's shrinks, the number of midwives doing them increases. Every woman deserves to have the kind of birth she chooses, but it is also up to every woman to take responsibility for choosing the HCP she feels most compatable with.

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