Breech Vaginal Birth Or C-Section – You Choose

You all know that my son was breech and born via c-section right? Well, if not he was. I made that decision after a lot of research and a lot of discussing my options with not only my doctor, but with a nurse in the hospital that I was to deliver in.

Let me give you a little information about my pregnancy with my son.  He was my 3rd pregnancy.  I was 28 years old (turned 29 the day after he was born) and I had chronic hypertension and was also diagnosed with Gestational Diabetes which was controlled with diet.  When around 32 weeks my doctor noted that my son had not turned head down she began preparing me to make a choice.  I would need to decide if I wanted to attempt an external version which would have to be done at 36 weeks, or just a scheduled c-section.

For the next four weeks I weighed the pros and cons with my doctor and really everyone in my life.  If we attempted the external version and things did not go well, then I would end up having an emergency c-section at 36 weeks.  The thought of a slightly premature baby and emergency situation scared me.  My doctor however had no reason to believe it wouldn’t work.  Her exact words to me were, “You’re a perfect candidate because you had two babies before.“  Everything was stretched so there would be room to move him.  If anything I felt like she was pushing me to do the version however she also made it very clear that if she were in my shoes she did not know what she would do.

My other option was the planned c-section.  I questioned delivering him vaginally and I was told that was simply not an option.  They did not have the training to do it, but even if they did the risk to my son was greater than having the c-section.

So I began questioning the risks of c-section.  I mean my chances of a c-section at this point were greater than my chances of a vaginal birth so I needed to know what I was in for.  Obviously in an emergency situation the only reason they would have to get him out right away was if something bad happened to him or me.  The risks of a planned c-section however were more to me than to my son.  So not wanting to lose my son and him being so tiny and vulnerable I decided that I could better handle the risks than he could so after 4 weeks of back and forth I said planned c-section.

And when the day came and my doctor got in there she said, “It’s a good thing we didn’t try to turn him!“  He had the cord wrapped around his neck twice.  So confirmation to me that I made the absolute right decision.

However, since then I have been told I don’t know how many times that breech vaginal birth is perfectly safe.  Most recently I read this article on Cafe Mom which tried to prove that c-section is not the best option in breech birth.  Now of course anything on Cafe Mom one must take with a grain of salt, but since it was filled with complete anecdotes I would like to get out there what we’re really talking about when we say breech birth doesn’t have to end in c-section.

The ACOG Has Something To Say On The Matter

Studies have been performed and the ACOG has set forth their model of care for singleton breech birth.  Basically their stance is it can be performed with a qualified birth attendant and only if certain criteria are met.

A qualified birth attendant means someone who has been trained in breech birth.  However, because more than 86% of breech births have resulted in c-section over the last decade plus that implies that there aren’t a whole lot of trained birth attendants in the area.  Considering breech birth only happens in 1-3% of all pregnancies to begin with and almost 90% of those cases have resulted in a c-section, then I would say it’s pretty safe to say that there are only a small handful of doctors capable of such a birth.  And while we’re at it American home birth midwives who already have very little training in birth to begin with, we can’t honestly think they have the experience needed to safely deliver a breech baby.  Here’s what the ACOG has to say about the training of doctors in breech birth:

The number of practitioners with the skills and experience to perform vaginal breech delivery has decreased. Even in academic medical centers where faculty support for teaching vaginal breech delivery to residents remains high, there may be insufficient volume of vaginal breech deliveries to adequately teach this procedure.

So what do you think about the qualified in breech birth now?  Still think you can find a qualified birth attendant who can safely deliver your breech baby?  Well, lets look at the numbers.  Here’s what the ACOG says about c-section vs vaginal breech birth and its safety:

In 2000, researchers conducted a large, international multicenter randomized clinical trial comparing a policy of planned cesarean delivery with planned vaginal delivery (Term Breech Trial). These investigators noted that perinatal mortality, neonatal mortality, and serious neonatal morbidity were significantly lower among the planned cesarean delivery group compared with the planned vaginal delivery group (17/1,039 [1.6%] versus 52/1,039 [5%]), although there was no difference in maternal morbidity or mortality observed between the groups.

Planned vaginal delivery has over a 3% chance of perinatal mortality, neonatal mortality, and serious neonatal morbidity than having a planned c-section. There were no noted differences to mom in this study.

And this is exactly why I said when push came to shove for me I was willing to take whatever risks surgery had for me than to put my son in danger all to prove some point that it’s completely safe to deliver a breech baby vaginally.

What If I Meet Certain Criteria

But ACOG does still take a bit of a wishy washy stance on the situation even in spite of this study.  They have gone on to add, but if you’re going to do it then the best outcomes come when you meet certain criteria.  The ACOG found that women had the best chance of having a successful breech vaginal birth if these criteria are met:

• Gestational age greater than 37 weeks.
• Frank or complete breech presentation.
• No fetal anomalies on ultrasound examination.
• Adequate maternal pelvis.
• Estimated fetal weight between 2500 grams (5.5 pounds) and 4000 grams (8.8 pounds).
• Fetal head flexion and adequate amniotic fluid pocket (3 cm vertical pocket).

Now I have to say I find it ironic that when you talk to people who support natural birth they are always quick to tell you how inaccurate things like due dates and late term ultrasounds are in determining a baby’s weight.  As a matter of fact the size of all of my children were a complete surprise.

I didn’t have any ultrasounds late in my pregnancy with my oldest, but she was 8 pounds 12 ounces which was a complete shock because to look at me people thought I was only 5 months pregnant when I was full term.  My middle daughter, I asked the doctor how big she was.  He told me around 7 1/2 pounds.  She weighed 8 pounds 15 ounces.  With my son and the gestational diabetes they were estimating his weight to be around the same as his sisters which actually risked me out of a vaginal breech birth anyways even if I had a doctor who had training in it.  Turned out he was just 7 pounds 12 ounces.  And my youngest the doctor feared that she was over 9 pounds and she ended up being my smallest at 7 pounds 9 ounces.  So go figure, I had gestational diabetes with only my two youngest and two smallest babies.

Lets Bottom Line All Of This

Bottom line in all of this is ACOG recommends c-section for most practitioners as there is a diminishing amount of expertise in this area.  External versions should always be offered though.  And if you are a doctor who has experience in vaginal breech delivery, then you must disclose all of the risks.  This means informing women that the risk of perinatal or neonatal mortality or short term serious morbidity are greater than a planned c-section.

So the next time you think a doctor is fear mongering by presenting you with all of the risks which are associated with a certain procedure understand that they are just doing their due diligence to make sure you have informed consent.  And isn’t that what we want women to have?  Make the choices based on all of the most accurate and up to date information.  Not based on what our ancestors did or what a friend of a friend of a friend did.  Birth should be respected and we should do whatever we can to ensure the best possible outcome.

For me given my already complicated pregnancy even if I could have found a doctor who was experienced in vaginal breech birth that late in the game would he have taken me on with all of my other medical complications?  I have no regrets what so ever over my planned c-section because of breech presentation with my son.  He is here and he is 5 years old and he is wonderful.  The fact that he didn’t come out the same way his sisters did means absolutely nothing.  I just have more visual evidence now of the suffering I had to endure to get him here.

My hope is that no woman ever feels that she made a wrong choice because she had a c-section and did not seek a doctor who was trained in vaginal breech birth.  Because it’s just not conceivable to think that you could have found such a professional and that if you had that your outcome would have been a good one.  3% means a lot when it could be your child that is part of that percentage.

If you were faced with the choice of vaginal breech birth or c-section given the facts which would you choose?

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