Birthing Your Breech Baby – What Are Your Options?
About 3-4 per cent of babies present breech at term. This means that the baby’s head is at the top of the uterus and its buttocks, knees or feet are at the bottom. Some breech babies have their legs straight up so their feet are around the head (frank breech), others sit crossed legged (complete breech) and others crouch, kneel or stand.
Most of the time, there is no obvious reason why a baby is presenting breech – it is just one of those things. I like to think that my breech baby was keeping her head next to my heart. However, sometimes it is due to the shape of the mother’s uterus (for instance, bi-cornate or heart-shaped) or something to do with the baby. Although babies with congenital problems are more often breech than other babies and breech babies (however born) have a slightly higher chance of neo-natal issues (such as developmental hip dysplasia) than other babies, most breech babies are completely normal.
Nevertheless, finding out that your baby is breech can be a great source of stress. For some women, that stress occurs in the latter part of their pregnancy. For other women, that stress occurs in labour: even with ultrasound, a reasonable proportion of breech presentations are not found until labour.
Turning The Baby
Most women with known breech presenting babies attempt to turn their babies – although some do not. There are a variety of non-medical methods. There is insufficient good quality evidence to suggest these methods actually work but women still like to try. And why not? The best place to find information on baby turning is www.SpinningBabies.com. The most common techniques include adopting postures such as the ‘breech tilt’, a traditional Chinese Medicine treatment called Moxibustion, which involves burning a herbal stick near the corner of your little toe and a chiropractic treatment called the Webster Technique. Some women also try taking pulsatilla, a homeopathic remedy or Rebozo.
Women are normally also offered a procedure called External Cephalic Version or ECV (manually turning the baby to head-first externally) at 36-37 weeks. This involves about half an hour of foetal monitoring, then an injection of a tocolytic drug to prevent contractions (it makes you feel a bit dizzy), and then the ECV is performed with ultrasound gel or talcum power on the abdomen. Afterwards, the baby is monitored again to make sure it has tolerated the ECV. Occasionally, a baby finds it stressful and the woman has an emergency caesarean. However, this is very rare. Some women find ECV to be stressful, some find it to be sore and others find it to be no big deal. If it works, it removes the ‘breech issue’ and for that reason, most women will give it a go if they can. Other women feel that ECV is not right for them and that choice should be respected.
Research About Breech Birth
In Australia, as in most of the world, the norm is for breech babies to be delivered by planned caesarean section at 39 weeks. This is because a large randomized controlled trial (the Term Breech Trial), determined that planned pre-labour caesarean section is the safest option for the baby. However, despite its wide application, the study has met strong criticisms about its methodology and a follow up study of the children showed no differences between those for whom caesarean was planned and those for whom vaginal birth was planned at the age of 2 years. In other words, whatever the problems were, they were not long term.
Other studies have shown that in centres which have particular skills and experience in breech birth (i.e. those few that didn’t stop supporting vaginal breech birth after the Term Breech Trial), planned vaginal breech birth is equally safe for the baby as planned caesarean section (see this recent study from the breech clinic at John Hunter Hospital in Newcastle, Australia). It is important to realise that these studies are comparing relative risks (which is the safest mode of delivery): in absolute terms the risks of a problem occurring in a planned breech birth, are real but they are low. Some of the same immediate risks apply to caesarean section too (such as head-entrapment), and caesarean section has greater implications for future pregnancies.
It is also important to remember women with one breech baby have a higher (about 1 in 10 in Australia) chance of a subsequent breech baby compared to other women, and that the chances of a subsequent breech baby are also higher if you have a caesarean birth. There is therefore an increasingly large group of women who have a caesarean birth for a breech presentation and go on to have another breech presenting baby. These women face double obstacles if they wish to birth vaginally.
Birthing a Breech Baby Vaginally
All midwives and obstetricians will have education about breech birth but not all have had the opportunity to practice. This is one of the factors which makes vaginal breech birth less safe than it might otherwise be. In the event that your baby does need some help birthing, its best if you are supported by somebody who knows what they are doing. Happily, although there is a long way to go, many Australian hospitals are working to improve their experience in delivering breech babies and to make this option more accessible to women. There are now several breech clinics formally set up – the most well known are at John Hunter Hospital in Newcastle, Westmead Hospital in Sydney and the Royal Hospital for Women in Sydney. Australian women have also planned breech births at King Edward Memorial Hospital and Armadale Hospitals in Perth, and the Women’s in Melbourne to name a few.
Unfortunately, this normally means hoping that the ‘right doctor’ is on duty when you labour. It also normally means an obstetric-led birth, although there are midwives who are competent in supporting women in breech birth. In some parts of Australia private obstetricians will accept late bookings by women with breech-presenting babies for a planned vaginal breech birth too. There are also some private midwives who will support women in a planned breech homebirth.
It is common for women to be given very partial information about the risks of breech birth (for instance only being told about the Term Breech Trial, and not being told about factors which might suggest vaginal birth is a safe option for them). It is also common for women to have to ask for the option to birth vaginally and for this to meet resistance. Remember that you have the legal right to refuse a caesarean section, except in very narrow circumstances (if you are unconscious and its an emergency). If you are not happy with this option, the hospital has no choice but to allow you to labour. You do not need their permission. However, birthing a breech baby vaginally is probably safer when you are supported by experienced people and your labour is more likely to go well if you are NOT in conflict and so many women take the view that they will only birth vaginally if they can successfully negotiate this in advance.
Connection With Other Breech Mums
A breech pregnancy can be very isolating. If you would like to connect with other women who have ‘been there’ and seek information about where to seek a second opinion about your birth options, or seek moral support before your planned caesarean, get in touch with Breech Birth Australia and New Zealand (BBANZ). I formed BBANZ after my own breech baby was born and I was left feeling disappointed and isolated (see Matilda’s birth story on the website www.BreechBirth.net )
We are now part of an international coalition of women, midwives and obstetricians who are seeking to renormalize vaginal breech birth.
Our website has a range of breech birth stories, suggestions for questions to ask your care-providers, and links to other sources of information such as medical studies, books and other relevant websites. You can also request to join our network on Facebook Breech Birth Australia and New Zealand. The Facebook group is very active and members can empathise with each, share experiences and sometimes even recommend potential midwives and obstetricians to contact for a second opinion about birth options.
If you are pregnant with a breech baby, my advice is this: remember that breech doesn’t mean that something is wrong with you or with your baby; try not to be too swayed by other people’s opinions – see how you feel about the birth and then look for support for whatever you choose; and whatever way you are leaning, look up BBANZ – it’s a great supportive online community.