Hi Everyone,
I am looking for some evidence based advice. My sister is expecting her first baby and has just discovered that he is breech. (butt first, legs up). She is so upset, and I am too. She was nervous but really looking forward to a natural, vaginal delivery. She has been working with a midwife for her pregnancy; the doctor they work with is very cool, however, like most caregivers in the OB world they are forced to recommend a C-section if she is still breech at full term. They are OK with her going into labor naturally, so she still potentially has a few weeks. The doctor attempted an external version yesterday and was unfortunately unable to turn the the baby. My sister is doing all the alternative stuff, lying on the board, moxibustion, etc. There is also the option of trying for a vaginal breech--there is 1 doctor in the area who will do them, but she has not consulted him yet. What I am interested in is if anyone has any knowledge or studies to compare the risks/outcomes of vaginal breech VS. C-section for a first baby. Such a tough decision, made tougher by the lack of clear information. Thank you in advance for the help!

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There was anther post on this site called Options for a Breech Baby which had a lot of great responses you might find useful. http://mybestbirth.ning.com/forum/topics/options-for-a-breech-baby?...

You can find by entering Breech in the search box on the upper right of the page.
A fact you may find interesting is that the US is the only country that doesn't consider this type of presentation to be a normal presentation. It happens enough that it's considered normal in other countries and woman deliver this way all the time.

I have a friend who delivered her son this way in April. No one knew he was breech until his butt presented first. They are and were just fine. I recommend that she go with the Dr who is experienced though. It makes a difference. And for the record, NO ONE can make her have a C-section. If she chooses to "push" they can't stop her.

Good luck and best wishes. I'm sure she is as nervous as can be.
Tammany:

As an alternate route, your sister can call upon her own innate power and visualize the baby going into the "appropriate" position; she can do this in partnership with her baby, by asking for his/her support. She can also receive the assistance of an Energyworker to energetically turn the baby by using her hands. Energyworker can consult with her in-person or over the phone. Feel free to contact me if you would like more information.

All the best,
Nicole
Holistic Maternity Practitioner & Educator
www.WholeCreations.com
http://twitter.com/OrganicWomBaby
I suggest she finds a Chiropractor that is certified in the Webster Technique!
She can find one at www.icpa4kids.com
http://www.cbc.ca/health/story/2009/06/17/c-sections-breech-births....

C-sections shouldn't be 'automatic' for breech births, Canadian doctors say
Last Updated: Wednesday, June 17, 2009 | 3:04 PM ET
CBC News
Most women could deliver a breech baby by pushing.Most women could deliver a breech baby by pushing. (CBC) Doctors should not automatically opt to do caesarean sections for breech births, according to new guidelines released Wednesday by the Society of Obstetricians and Gynaecologists of Canada. In about three to four per cent of pregnancies, or about 11,000 to 14,500 pregnancies in Canada, according to Statistics Canada, the baby presents with its feet or buttocks first, instead of head first — a breech birth. "Breech pregnancies are almost always delivered using a caesarean section, to the point where the practice has become somewhat automatic," Dr. Robert Gagnon, a principal author of the new guidelines and chair of the society’s maternal fetal medicine committee, said in a release. "What we’ve found is that, in some cases, vaginal breech birth is a safe option, and obstetricians should be able to offer women the choice to attempt a traditional delivery." When a vaginal delivery is an option, breech births should be done in a hospital, the society recommended, as some will still require a C-section, the group noted. Many Canadian obstetricians lack training in a technique to accommodate vaginal breech birth, so universities, hospitals and health professionals need to work together to provide the training so more women may choose to attempt to deliver that way, said Dr. André Lalonde, the society's executive vice-president, who has delivered many breech babies vaginally. The technique is performed when the cervix is completely open and it's time for the woman to push the baby out. No forceps or vacuum can be used until the baby is delivered to its umbilicus, and then pressure is applied over the pubic bone to deliver the baby's head and shoulders, Lalonde said from the society's annual meeting in Halifax. The technique was done before, but doctors stopped using it after a study in 2000 suggested C-sections were safer. When long-term followup showed no difference, and women continued to request vaginal breech deliveries, the society reconsidered its approach. About 70 per cent of women could deliver a breech baby vaginally, Lalonde said, but they need to be carefully selected since the baby's head could become entrapped. Attempting a vaginal breech birth is not recommended: * In any situation in which a C-section would normally be recommended. * If the baby weighs less than 2,500 grams (5.5 pounds) or more than 4,000 grams (8.8 pounds). * If the baby presents with one foot towards the birthing canal, since the umbilical cord is likely to drop into the vagina, reducing the baby's blood supply. * If the mother has a narrow or small pelvis, tumour or fibroids. * If the baby's umbilical cord is positioned in such a way that it is likely to become entangled or compressed during delivery. * If the baby's head is hyperextended. An experienced obstetrician should be present to attend the delivery and to offer a C-section if labour does not progress smoothly or complications arise, the society said.
I have also heard of high success with a skilled chiropractor--up to 85% turn with the webster
I read an article about acupuncture being successful at turning a baby. Personally, I would try anything to avoid a c-section, but that is me. I know the article said the little toe was where then acupuncture was applied. The article said there was an 80% success rate.
There is also a very successful technique for turning a breach baby that involves medical hypnosis. It is up to 80% effective, usually requires only a few appointments with the hypnotist. I have done that with my first baby who turned breach at 38 weeks when a very traumatic event happened in my workplace - possibly because I felt so traumatized and shaken. It only took 1.5 weeks, and one night she just worked really hard, keeping me up, but by the morning I saw my midwife and she confirmed that my daughter had turned! Hypnosis is completely non-invasive and it can range from $90-$120 per session, depending where you live.
Good luck to your sister!
My last baby was breech up until 39 weeks but then turned around just fine into the head down position. There is still time. Maybe find a midwife who is experienced in helping "turn" a baby from the outside.
Funny that I just joined this board about a minute ago. My midwife sent me this link. My name is Pam. I just gave birth to my 7th baby. She sat frank breech the entire pregnancy. We had her turned for about the last two weeks, with the help of the Webster Technique, and things looked great for a normal home birth as we had planned. Then when I was 8cm and my water broke, my midwife checked me and found a butt instead of a head. As far along as I was there was no way we would make it to the hospital, but in the truck we went. With the help of a great midwife/coach and some counter pressure I held off pushing, (not an easy task in that state). The butt and body were born on their own and the head pushed through with only a simple push or two. My girl was born completely healthy and crying. She was a wonderful shade of pink and came out perfect. Her abgar scores were 9. We decided no hospital help was needed, and we turned around and went home. We spend a beautiful day at home with all our children loving on their new sister. It was a great day to remember. She is now 5 days old!
Although I am no doctor, and this was my 7th birth, not my first, I would have to say that people have been birthing for a few thousand years without the aid of a C-section at the first sign of a butt. If you decide to have a v-birth, my thoughts are to be as educated as possible with breech v-births, remain as calm as possible through the whole thing, and never push, just allow God do deliver that baby. Have people there to help you to remain calm, listen to them and concentrate. At 37 weeks, you have time to plan and study. Keeping a level head and having counter pressure made my birth experience a wonderful one. I was not nervous. I knew it could be done.
I wish you the best with your decisions and your birth. Again, I am not a doctor and claim no responsibility for the decisions of others. I am just a mother with a wonderful v-birth experience despite having a breech babe. God bless you!
I am so sorry. :( Try a chiropractor, too. I haven't seen the reports myself, but my OB, who is very MEDICALLY inclined and works with many high risk pregnancies says the danger between vaginal breech vs c-section is very small. Like 2% ??? I am not sure how accurate this is or if I am remembering the percentage right. I was asking him out of curiousity and because I am a big fan of natural and I am always "testing" him to see how he really feels. He is so good with me going natural and never even attempts to get me to do anything against the natural process. Anyway... it just stuck out that it was a small percent. I would google it if I were you. I am sure you will find something. GOOD LUCK!!
Dear Tammany, since you are searching for evidence based info here is a review of the literature published in 2000- 2006. My summary: if your baby is not too big and if you are in the care of a midwife or doctor, who does vaginal breeches and if there are no other factors complicating the situation - go for it.
Milena Ruzkova, MD, IBCLC
Xanthi
Greece


2000 published randomized multicenter trial –Term Breech Trial Collaborative Group
conclusion “Planned c.s. is better then planned vaginal birth for the term fetus in the breech presentation, serious maternal complications are similar between the two groups.” (Hannah ME, et al, 2000)
2001 American College of Obstetricians and Gynecologists ACOG committee opinion number 265 “As a result of the findings of the study (i.e. of Hannam et al.), planned vaginal delivery of a term singleton breech may no longer be appropriate.”
Similar conclusions from France (Golfier F, etal. 2001) and Britain (Shennan A. et al. 2001) and other studies emerging from The Term Breech Trial of Hannam ME, et al.
(Hannam ME. Et al, 2002; Su M. et al.,2004).
Then a big study in the Netherlands France and Belgium makes a similar conclusion i.e. “an increase in early neonatal morbidity and mortality, following a trial of labor in cases of breech presentation.” But the authors add “These data require carefully weighted consideration against increased maternal (long term) risks due to a rise in c.s.”(Reitberg at al.,2003).
In 2003 a review is published by the Cochrane Database with the conclusion: “Planned c.s. compared with planned vaginal birth reduced perinatal or neonatal death or serious neonatal morbidity for the singleton breech baby at term, at the expense of somewhat increased maternal morbidity. Information on long term consequences of c.s., such as reproductive function and emotional adjustment, is limited….The data from this review cannot be generalized to settings where c.s. is not readily available, or to methods of breech delivery that differ materially from the clinical delivery protocols used in the trials reviewed.” (Hofmeyr GJ, et al., 2003).
In January 2004 the British Royal College of Obstetricians and Gynecologists criticized the Term Breech Trial for comparing c.s. only with “medicalised” vaginal birth, in which the mother is on her back, anaesthesized and with her feet in stirrups.
(The Times, 2004).
Follow other critiques of the Term Breech Trial
From the US the ACOG Committee Opinion No. 340 stating : “Planned vaginal delivery of the term singleton breech fetus may be reasonable under hospital specific protocol guidelines for both eligibility and labor management. (ACOG Committee Opinion No.340, 2006)
From Germany, Krause states “increased concerns about the validity of the Term Breech Trial” and concludes “because of mistakes in the study design the results are unreliable and that the study group should withdraw the recommendations.)(KrauseM, 2006).
From Israel Glezerman also concludes: “The original term breech trial recommendations should be withdrawn/” (Glezerman M, 2006)
From France and Belgium the study of Golffinet et al. concludes: “In places where planned vaginal delivery is common practice and where strict criteria re met before and during labor, planned vaginal delivery of singleton fetuses in breech presentation at term remains a safe option that can be offered to women.” (Goffinet F. et al, 2006).

1.. Hannah ME. et al. Planned caesarean section versus planned vaginal birth for breech presentation at term: a randomised multicentre trial. Term Breech Trial Collaborative Group. Lancet, 2000 Oct 21; 356 (9239):1375-83

2.. ACOG committee opinion: number 265, December 2001. Mode of term single breech delivery. Obstet Gynaecol. 2001 Dec; 98 (6):1189-90

3.Golfier F et al. Planned vaginal delivery versus elective caesarean section in singleton term breech presentation: a study of 1116 cases. Eur J Obstet Gynecol Reprod Biol, 2001 Oct : 98 (2):186-92

4.Shennan A et al. How you manage term breech deliveries.
BMJ 2001; 323:244-245

5 Hananh ME et al. Outcomes at 3 months after planned cesarean vs planned vaginal delivery for breech presentation at term. The International Randomized Term Breech Trial. JAMA, April 10,2002, Vol.287, No14, pp1822-1831

6. Su M, Hannah WJ et al. Planned caesarean section decreases the risk of adverse perinatal outcome due to both labour and delivery complications in the Term Breech Trial. BJOG.2004 Oct;111(10):1065-74

7. Reitberg CC et al. Term breech presentation in The Netherlands from 1995 to 1999: mortality and morbidity in relation to the mode of delivery of 33824 infants. BJOG 2003 Jun; 110(6):604-609

8. Hofmeyr GJ et al. Planned caesarean section for term breech delivery. Cochrane Database Syst Rev. 2003;(3):CD000166

9.Views turn on breech births, Doctors are re-examining whether surgery is best for feet-first deliveries. The Times, 4.2.2004

10.ACOG Committee Opinion No.340. Mode of term singleton breech delivery. Obstet Gynaecol 2006 Jul;108(1):235-7

11.Krause M. The term breech trial : the rise and fall of a randomised controlled trial – a critical survey. Z Geburtshilfe Neonatol. 2006 Aug;210(40:121-5

12.Glezerman M. Five years to the term breech trial: the rise and fall of a randomised controlled trial. Am J Obstet Gynecol. 2006 Jan;194(1):20-5

13. Goffinet F et al. Is planned vaginal delivery for breech presentation at term still an option? Results of an observational prospective survey in France and Belgium. Am J Obstet Gynecol. 2006 Apr;194(4):1002-11

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