Let Me Breech The Subject

Ha ha. I’m so witty that I put a play on words to a subject that many pregnant women might be a little bit bothered with. Some aren’t. I fit into the former. And with BOTH babies being breech right now, I’m scared out my 30 year old mind. There. I said it. I’m scared. I’m scared, I’m scared, I’m scared.

For those of you who don’t know, here is a semi-brief explanation of breech presentation of a baby from birthingnaturally.net:

Breech Baby

What is a Breech Presentation?

The most common position for a baby to be in during labor is called the vertex, or head down position. A breech baby is not head down, but rather feet or buttocks down. There are three different breech positions a baby can be in:
  • Frank Breech – buttocks are down and legs go straight up.
  • Complete Breech – baby is sitting cross-legged.
  • Footling Breech – either one or two feet down.

  • In any breech position, the baby will exit the uterus feet or buttocks first, the head being the last part to be born. Approximately 15 % of babies are breech at 29-32 weeks, 7% of babies are breech at 38 weeks of pregnancy, only 3-4% are breech at 40 weeks pregnancy.

    Why is a breech baby a labor challenge?

    Babies who are in a breech position fare worse than babies who are in a head down (called vertex) position regardless of the way they are born. This is due to many factors not necessarily related to the babies position. First, babies who are born prematurely are more likely to be breech than their full term friends because they have not had the opportunity to move into a head down position yet. Breech position is also more common in babies with neuro-muscular problems because they do not have the coordinated movements to move to a head down position. Breech babies with either of those issues will have problems whether born by cesarean surgery or vaginally.
    Childhood handicap is more common among breech babies whether the baby is born vaginally or through a cesarean surgery. This means it is not the breech birth that causes the problem, but may be a problem the baby was already dealing with which caused the breech. Because of this, experts are beginning to see the head down position as a baby’s first developmental milestone. However, it is also possible for a baby to be stuck in a breech position because of issues with the mother’s pelvis.
    Whether it is safer for a breech baby to be born vaginally or by cesarean is still under debate. There is currently a study underway which may help unmuddy the waters, but until that happens, concerns about the possible complications from a breech vaginal birth make it almost impossible to find a care provider willing to catch a breech baby. But having risks in a vaginal birth does not erase the risks of cesarean birth, which are also higher for breech babies than for vertex babies.
    During a vaginal birth, having a compressed cord is not able to provide oxygen to the baby. Additionally, because the head is coming out neck first, it is less likely to mold increasing the risk for the head to get stuck. If the baby is in the frank or complete breech positions and the body passes through without a problem, the head generally follows without problem. Still, the death rate for breech babies is 4 times higher than for head first or vertex presentation babies. Thankfully, in developed countries, death rates for babies are very low.
    Because of the increased risk, many doctors and midwives have stopped attending vaginal breech births. Instead, the standard treatment is to schedule a cesarean section at the earliest possible date. As fewer doctors and midwives participate in vaginal breech births, the skills necessary to safely attend the mother are lost. The main skill when working with a breech birth is to keep your hands off (i.e. don’t pull on the baby). The baby must be delivered by the mother’s pushing because pulling on the body can cause trauma to the head and neck. This is the most common cause of trauma to a breech baby during a cesarean surgery but is unavoidable when surgery is performed.
    There are many techniques that can be used to assist a vaginal breech birth. Positions such as hands and knees or at least squatting help to avoid the baby being stuck. There are also techniques to release arms or legs that do not release on their own. How much experience your midwife has with breech birth depends on many factors, so the only way to know is to ask her.

    In breech birth, the head is the last part of the baby to be born.

    Coaching Solutions

    Try techniques to turn the baby before labor begins. If the baby will not turn, find a caregiver who is experienced in assisting at a breech labor.

    Things to discuss with your caregiver:

    • As you near the end of your pregnancy, you may want to discuss ways to encourage your baby to move into a head down position. Some women have success with chiropractors familiar with techniques for encouraging proper positioning. Other women spend time with their hips higher than their head by either lying upside down on an inclined ironing board or by placing pillows under their hips. If your doctor feels your health is good, you may want to try one or both of these techniques. Learn how to determine your baby’s position for yourself.
    • Some women try placing a flashlight or headphones near their pubic bone, in an attempt to encourage the baby to move head down. Some experts recommend talking to the baby and telling him it is time to turn. Although no studies support the success of either of these methods, they seem to be harmless and your caregiver may encourage you to try them.
    • A medical method for turning the baby is called an external cephalic version. In this procedure, you will be given a medication that relaxes the uterus (tocolytic) and some doctors also use an epidural to minimize discomfort. Your caregiver will push and press your baby into a head down position. A Cochrane Review of the studies of external version has found that use of the tocolytic improves the success of turning the baby. This procedure is easiest to perform earlier in the pregnancy, but a large number of babies return to the breech position when it is done early and the risks to baby are higher before 37 weeks gestation. Waiting until at least 37 weeks to attempt a version gives your baby time to turn on his own and makes the version safer because if any complications occur the baby can be born immediately.

      An external version is an attempt to make the baby turn.
    • A Cochrane Review of the literature found that cesarean section did decrease the rate of death for breech infants. However, it did cause an increase in problems for the mother after the baby was born. If you know that your only option will be a cesarean (either because of lack of professionals who can attend a vaginal breech or because of other concerns for health), you may be able to delay the surgery until early labor begins. This would give your baby every opportunity to turn into the head down position.
    • Breech Birth is definitely a challenge for which it pays to shop around. Different caregivers have different skills and experiences, so will treat the breech birth according to what they feel is safe. If your caregiver does not feel comfortable with the way you want to handle things, interview others. You may find a caregiver familiar with the techniques you want to try. Some questions to ask:
      • Is there any problem with my trying alternative methods for turning my baby (such as moxibustion, pelvic adjustment with a chiropractor, hypnosis or positioning to turn the baby)?
      • When do you consider it time to try an external cephalic version? (Note: research indicates that early ECV is more successful)
      • Under what circumstances will you recommend a cesarean surgery?
      • Will I be disqualified from attempting a vaginal breech if this is my first baby?

    Insert big eye blink and me chewing on my fingernails here. After my incredibly lengthy appointment today with the hospital that I have come to love and hate at the same time (how is that possible?!) I came home and cried. Sure did. Sat down and had a good cry. I cried for many reasons, and some of them may not make many parents, or mothers in general feel very good about me right now.

    I cried because I SWORE I was done with having children after my incredibly difficult pregnancy with the Ladybug.

    I cried because I was MAD. I was mad at my husband for talking to me in April of this year and TRICKING me to do what married people do.

    I cried because I did not want four children. Heck, I wasn’t even trying to get pregnant with a third.

    I cried because now there is this HUGE possibility that I may have to have a c-section and that bothers me. It bothers me because birth in my head is supposed to be natural, and there is nothing natural about having to cut me to get the babies out. IN. MY. HEAD. So, no judgement to those who have had them, or even those who wanted them, it’s just my preference not to have to go under a knife. I really don’t want pain medication either – and nope, it’s not because I actually enjoy the contractions and bask gleefully when each comes – it’s because I hate feeling loopy after anything. I had a hernia repair while I was pregnant with the Ladybug and I swear, I walked like a baby learning to walk for the first time for a full day. I couldn’t eat, and I couldn’t even pee. They wanted to put a catheter in – yeah – I fought that too. I admit, I’m stubborn. I don’t like tubes, I don’t like feeling like a lab rat, so I try to do things to avoid it.

    I cried because I immediately thought about the days and weeks after this looming subject of a c-section and thought about how with the ladybug here in the house I’m going to have to depend on someone to help out.

    I cried because I felt helpless.

    And then I decided to post about my feelings of the babies being breech and I got total gems in the way of advice. *can you feel my sarcasm?* I don’t think that people who don’t have the ability to get pregnant (men) or those who just haven’t had any children yet (my young single friends) realize just how much a simple, seemingly innocent statement can really just get under someones skin. I realize that mostly all of the things that were said weren’t to make light of my situation, but to try and get me out of something that they thought was just a fleeting feeling.

    At this point of the blog, I know that I am now venting and just might need to shut it down, but I will leave with these words – I want healthy babies, and I want to be healthy. If that REQUIRES a c-section in order to make it happen, then I will bite the bullet – but I will never stop hoping that by some vast miracle both babies will choose to flip one more time for me and make this birthing process a bit easier on their already anxious mama.

    ~Make it a great day!

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    1 Comment

  • Reply
    December 8, 2010 at 4:10 am

    I hope this for you, too. I'd feel very similar, were I in this situation.

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