Saturday, May 14, 2011

Don't Schedule Cesareans for Breech babies!


Breech presentation is not a valid reason to schedule a cesarean. Yet, whenever a care provider finds a baby in the breech position in the last few weeks before the EDD, they ask the parents to pick their baby's birth day.

Now, people consider breech presentation one of the main reasons to have a cesarean. However, while I'll agree that with the prevailing ignorance of the average obstetrician in catching breech babies, in the hospital, it may be safer to have a cesarean--if the baby is presenting breech in labor.
http://4.bp.blogspot.com/_jnncY1mcCiw/TVH0Rrs-MRI/AAAAAAAAAIg/Z-xoTxG3umI/s320/BreechPositions2.jpg
Babies can turn in the womb as late as in active labor, into a vertex, or head down position. So, scheduling a cesarean is foolish, especially if it's scheduled before your EDD. An EDD is not a good measure of when the baby is coming, unless you see it as the middle of the average: 38-42 weeks. So, scheduling a cesarean for 38 weeks is not a good idea unless you have full placenta previa or another reason that labor must be avoided.

Ideally, you should go on with a breech pregnancy with the belief that baby will turn. You can use the techniques at Spinning Babies to help a stubborn baby point in the right direction. If you are approaching the big day and you've tried positions, inversions, chiropractic care, shining a light down low, etc. and baby is still breech, many obstetricians can perform what is called an external cephalic version.

A version should be a last resort, as it is uncomfortable and comes with its own set of risks, including PROM (premature rupture of membranes), premature labor, bleeding and fetal distress leading to the need for an emergency cesarean. The success rate is around 65%.

Ideally, you will have a care provider who is trained in breech vaginal birth, which 70% of breech babies are candidates for. This is not a 'new' thing. In fact, it is an old skill that has been virtually lost with the popularity of the cesarean. A transverse baby is a definite risk out--you can't birth a baby shoulder first! Footling breech is considered too dangerous by most care providers to attempt a vaginal breech birth. Baby breathes through the cord and it can become dangerously compressed in a breech birth. The likelihood of this in a footling breech is 15-18%.

Frank breech is the ideal for a vaginal breech, as the baby's legs protect the cord. In full-term, vertex babies, 0.4% suffer from cord prolapse. In frank breech, 0.5% will experience this complication. So, you can see the rate is very similar. The next risk comes with complete breech babies, which have a compression rate of 4-6%, a significant rise, though not as dangerous as footling breech.

Ideally, you should give baby time in labor to finally turn vertex. At the worst, if you end up with a cesarean due to an unsafe breech position that will not resolve or you are uncomfortable with the risk of breech vaginal birth, you will have given your baby all the time he or she needed to 'cook' and even a brief trial of labor can give the baby the benefits of labor, which prepares the baby for life on the 'outside.' At best, your baby will turn in early labor and you will go on to have the birth that you desired and that gives your baby the best start in life.

At the very least, you should research your options and remember that you have the right to make this choice! A cesarean is major abdominal surgery. As common as it is, so are complications--for both you and baby. Scheduled cesareans may be more convenient, but they are not safer than vaginal birth (except when labor would be dangerous in the first place).

Happy Birthing!

5 comments:

  1. Wonderful information as always! This one will go in my "Sunday Surf."

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  2. Thank you for your help! This article give me great ideas!

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    1. Hello, I looked through the images but could not find one showing both legs and head facing the birth canal. Would this be classified as breech?

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    2. Ah, that sounds more like a form of transverse lie, which is a dangerous complication and not a natural position. I'm not sure it's anatomically feasible, but it IS possible (and rare) for a foot to come out at the same time as the head, which is called 'compound' position. http://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000623.htm

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