Recently a former classmate of mine lost her baby during birth.  I don't have all the details, but from what I can piece together she went into labor, he came feet first, and they weren't able to get his head delivered in time.  This was her first baby, and I know she was at a hospital.  But I believe the hospital she would have been at, would have been a very small community hospital, that, I'm sure, would have little experience in this.

 

We all know that almost all breech babies born in a hospital are thru c-section.   But, if a breech baby is born vaginally, would it be safer for them to be born at home with a qualified midwife??  I've heard countless stories of woman having breech homebirths with no complications.  Many times because of the quick thinking of their midwives.

 

 From everything I've heard vaginal delivery of a breech presentation is a lost art in the hospital setting.  Is it possible that doctors don't have the knowledge to best assist in these births??  

 

Anyway, this is just something that I've been thinking about since hearing her story.  Again, I don't have all the facts.  And I know that no matter where or who you have assisting you during your birth the unthinkable can and does happen.  But it's raised a lot of questions in my mind. And I'd like to hear your thoughts.

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I don't have any experience with this, as all my babies have come head first, but I definitely think so. I know what Cherylyn will say. I absolutely think it's a lost art. You just hardly ever hear of vaginal breech births in the hospital anymore. I'm sorry for your friend.
When I had an ultrasound at 32 weeks, we found that my baby was breech. So, I did a TON of research on this. Yes, it does seem that a home birth with an *experienced* midwife (one who has attended and delivered breech before) is safer even than a c-section for breech birth. The problem with breech birth is that doctors (OBs) are not trained in delivering a breech birth anymore.

My own home birth midwife has a lot of experience with vaginal breech birth and was very comfortable with helping me deliver at home even if baby stayed breech. At this point, baby has turned head down, so it is no longer an issue. But, after all my research and talking with my midwife extensively about the options, I would have continued with my plan for a vaginal breech delivery at home.

Here are some of the articles and other info I found interesting/helpful on this topic:
http://www.birthingnaturally.net/birth/challenges/breech.html
http://pregnancychildbirth.suite101.com/article.cfm/turning_a_breec...
http://www.youtube.com/watch?v=Et7JuuMrr-Y&feature=related
http://www.beautiful-births.com/content/resources/breech.html
http://flymmflamm.blogspot.com/2010/02/how-firm-foundation-birth-of...
http://www.youtube.com/watch?v=jD5939e5PZ8
http://spinningbabies.com/baby-positions/breech-or-bottoms-up/305-b...
I'm so sorry for your friends loss. I hope she is doing alright.
My personal opinion is that "if" you can find an OB or CNM with advanced breech delivery skills, you would be safer to deliver in the hospital than at home. Simply because more things can go wrong with a breech and access to emergency surgery seems essential. This is something that should be discussed at length when hiring a care provider. If you can't find a provider in a hospital, I think the next best thing would be an experienced midwife who can deliver at home and has privileges and/or a working relationship with an OB. A c-section for a breech is seriously unfortunate, but it is much safer than trying to deliver a breech baby vaginally without an experienced care-giver.
Yes, I think you know what I'll say ;) I have really strong feelings about this because Liam was breech, and I have a really hard time when people talk about how risky and scary breech birth is. Maybe it's because his birth was so smooth, peaceful and absolutely wonderful. Keep in mind that because of this I'm coming from an emotional place when I talk about breech.

I actually think it depends on the type of breech position. Footling is scary because the feet can come through before the mom is fully dilated, and it can be tricky when it comes to delivering the head. Frank breech (butt first) is the safest for vaginal delivery because the bottom is about the same size as the head, and less likely to come out before full dilation, which is good for delivery of the head. Babies born early (small babies) are more difficult to deliver vaginally compared to full term breech babies. I won't go into all the risks, because I don't think it's particularly helpful to list them all off. I think it creates more fear, and fear is not the kind of motivator you want.

The hard thing for me is will moms who are planning a home birth be getting ultrasounds to check the baby's position? Then what? A good skilled midwife can detect the position just through palpating the belly, but even my midwife didn't catch Liam's breech position until I was pushing. I still don't know if he was breech all along, or if he moved during labor. I actually had a nurse practitioner tell me that she wasn't sure if he was head down, and she suggested I have one of the OB's check the position at the next appointment. I never scheduled the next appointment. I thought about it and realized that even if I knew for sure my baby was breech I still wouldn't change any of my plans for a home birth. I knew my midwife had caught a surprise breech at a home birth recently (within 3 months of my due date) and I wasn't worried about her being able to handle whatever came up. I felt really good about that.

For me, it comes down to how the mom feels about her choices. I felt peaceful about planning a home birth and trusting my midwife and her skills and experience. As I moved forward during the pregnancy I checked in with myself and how I felt about each choice along the way. I prayed a lot. I continued to feel peace and didn't feel a need to change any of my plans. I believe women intuitively know what's best, and if we can really pay attention to our bodies and how we feel about things we can know what to choose. The trouble is that most of us are so busy with life that we don't take time to check in and really reflect on things.

I think that no matter where you are giving birth, it's really key to have the right care provider for your needs. If you know your baby is breech and you want to have a vaginal delivery, then you should find an OB or midwife who really knows how to help you with that. It can be hard to find. My own midwife actually doesn't have a lot of experience with breech birth, but the midwife who supported her at Liam's birth is the one who has caught almost 30 breech babies and knew exactly what to do. That midwife sat back for most of my labor and supported my midwife until we discovered his position. Then she stepped in with peaceful grace and authority, calmed my midwife and instructed her on what to do and how to help me. There was never any moment of panic or fear, and it was so perfect.

My sister interviewed her OB during her last pregnancy and specifically asked him about vaginal breech birth. He was an older OB who is more natural-minded and he said he was perfectly comfortable supporting her in a vaginal breech birth under the right circumstances (full-term frank breech was his criteria for vaginal delivery).

Personally, I do feel home birth with a skilled midwife is safer in general. However, I feel there are circumstances where a c-section is needed. About 6 months after Liam was born my midwife had a client whose baby was transverse and there was so much amniotic fluid that the baby was just floating around in there, even when she was fully dilated. The bag of waters was still intact and they transfered her to the hospital for a c-section. The hospital staff panicked because they were worried the bag would rupture and the baby's arm would come out, but they were able to get her into the operating room and everything worked out. That mom had said during her pregnancy that she never could picture her home birth. That's a clue right there. If you can picture your beautiful birth as you want it, then move forward with it. If, for any reason you can't picture it happening, as badly as you may want it, maybe you should consider another option. It's important to follow your intuition and go with what feels right and peaceful.

I don't know if I've shared this with you yet Jamie, but my midwife also prayed about who to have at Liam's birth to support her. Normally she has two apprentices, but in this case she felt very strongly that she should ask this other more experienced midwife to be there. It all worked out.

I also think that sometimes, despite our best efforts and all the praying in the world, things happen, like what happened with your friend. Maybe that was unavoidable, and she may never know why that happened or what she could have done differently. I hope she will find peace and comfort after what she's gone through.

OK, I've rambled enough for now. I could go on and on about this, and I'll be happy to share whatever information I can.
Thanks for the feedback guys! I appriciate your answers. And I agree that you need to make the decision for yourself. I honestly don't know what I would choose should I have a baby presenting breech. But what if we take out the knowlege that the baby is breech?? With my friends case, I'm not sure they knew the babies position. I'm sure it wasn't a case of "baby's breech, but we're still going for a vaginal delivery". So, what if you're caught by surprise?? What if you don't realize the babies position until its to late for a c-section, or to transfer to a hospital, like in Cherylyn's case?? What if you don't have the opportunity to question a caregiver about their experience?? Who would you feel most comfortable with in that situation?? Who do you feel would have the most knowlege to give you the best outcome???
Honestly, it really depends on the midwife or OB and their training and experience. Even an OB will have limits on vaginal breech, and they would likely want you to labor in the operating room just in case they decide a c-section is needed. Personally, I'm more comfortable with an experienced home birth midwife than with an OB in the hospital, but that's because of my own experience. I think midwives can detect a possible problem before it becomes a problem, if they're paying close enough attention and have the training. In the case with the transverse baby, the transfer was made when the mom was stable and there really was no rush to get her to surgery. She was fully dilated and the amniotic sac was intact and the baby was stable. To hear the midwives tell about it, the hospital staff made it more scary than it needed to be.
If it's something you're concerned about, talk with your OB or midwife early in the pregnancy, like my sister did, and ask them what their actions would be in the case of a surprise breech. I recently asked a L&D nurse about this, and she said that when a woman comes into the hospital in labor and they find the baby is breech 95% of the time they don't even discuss options. They automatically do a c-section. It depends on the doctor, and in her hospital only 5% are willing to offer the option of vaginal breech delivery. It may vary according to hospitals as well, but I think the majority will automatically do surgery. In general, c-section increases the baby's chance of survival, but increases the risks to the mother. I think each breech case needs to be considered in its own circumstances. I don't think there's a clear-cut answer to all cases.

In my case with Liam's birth, even though his position was discovered while I was pushing, it was not an emergency. If we had thought we should transfer to the hospital we still would have had plenty of time to transfer and go to surgery. We just never felt the need.
My daughter was born breech and at home! We did not know she was breech until our midwife got there and I was ready to push. I know that the midwife was a but more nervous, but it all went well and we have a healthy 20 month old girl. She later told me that if I had been at the hospital I would have a a c-section. I am SO blessed to have a wonderful midwife.
Thanks Cherylyn, I'm not really concerned. Just got me thinking. I've always felt that in a true emergency where seconds count, it wouldn't matter if I were at home or hospital. That the outcome would most likely be the same. This just got me thinking about all the breech homebirths I've read about and seen videos of, none of which had a bad outcome(not that they aren't out there, I just haven't heard of them!). I'm sure if I had all the information it would help me make better sense of it all. And I'm not sure that the baby was full term. And as you said, that can make a difference.
I understand that. Whenever I hear a sad birth story, especially if it's someone I know personally, it affects me deeply. I go through scenarios in my mind and wonder what I would do in that situation. A childhood friend of mine had a baby the same month Liam was born, but hers was by c-section and her baby died of SIDS within a week after birth. I was so heart-broken for her and I wanted to make some sense of what happened, for my own sake. I started doing research about c-sections and SIDS and found some connections, but I knew I'd never be able to really talk with my friend about it. She and her family had to find their own peace, and I took comfort knowing that she had a really good support system in her area and with her family.
My third baby presented breech 8 days before my due date. A lovely doctor (who backed up my homebirth midwife) was able to turn the baby manually. It was painful but ultimately satisfying because I went home after, went to sleep, woke up at 5 am the next day with an intense contraction and my water breaking and my son was born 2 hours later at home in my bathtub (as planned)! Truly thrilling! My midwife said that she felt confident in her ability to deliver a breech at home, but I wanted to see if he could be turned to avoid that scenario. While I agree that midwives are the ones who have the knowledge about delivering breech babies (because doctors don't get the opportunity to ever see this done in a hospital setting), I personally wanted to avoid it. A low-risk homebirth is what I felt comfortable with. I've also heard of women having success turning baby through accupuncture and visualization. Good luck!

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