If you have tried our tips for turning your breech baby then…
Your baby is breech and is showing every sign of staying that way. First thing is, don’t panic but do get researching! Caroline May, our midwife, is here to give you advice.
As a starting point I would recommend reading the books Breech Birth, Woman Wise by Maggie Banks and Breech Birth by Michel Odent, Gloria Lemay and Ina May Gaskin. A breech baby does not automatically mean that you need a caesarean, but this is likely to be the first or only option you are given. The option of caesarean is certainly a valid one and can be justified in a number of cases, but there is good evidence to suggest that it is not necessary for all types of breech presentation. Your suitability for a vaginal breech birth versus a planned caesarean should be assessed on an individual basis, but unfortunately many obstetricians have a blanket caesarean policy based on the term breech trial which was published in 2000. This study showed better outcomes for the baby in a planned caesarean and largely put a stop to vaginal breech births. However the study has been very widely critisized since it was published and should not be used as a justification for a blanket caesarean policy. In the light of new (and old) evidence numerous countries have once again recommended that vaginal breech birth be considered. Some hospitals such as Westmead in NSW have now set up specialist breech birth clinics.
Criteria for vaginal birth of a breech baby
The ideal criteria for a vaginal birth include a baby with an estimated fetal weight of between 2.5 and 4 kilos, a frank or complete breech position, an adequate pelvis, spontaneous labour at term and a skilled birth attendant. The experience of the birth attenddent seems to be one of the most important factors. With all of these criteria met the outcomes for the baby are very similar to an elective section but the outcomes for the mother and for subsequent pregnancies are better, having avoided all of the risks associated with a caesarean. Like with all births there is no guarantee that a vaginal birth will be achieved, but there is hope that you can at least try.
Do you want or need a caesarean?
So the question you need to ask is do you need or want a caesarean? You will likely have no trouble finding someone to support you if you do, but if you want a vaginal birth you will need to consider your care provider more carefully. You may even need to consider changing care provider to give yourself the best chance of a vaginal birth and you definitely need to ask questions regarding their experience. If you are told your only option is a caesarean ask why, and if necessary, seek a second opinion. What you need to establish is not what is the risk of vaginal breech birth but what is the risk of vaginal breech birth for you and your baby, given your particular set of circumstances. You don’t need to know that there is a 2% risk of something, what you do need to know is, is it likely that you will be one of those 2%? And an experienced care provider should be able to give you some guidance here.
Caroline May qualified as a Midwife in 1999 and has worked in both community and hospital settings around Australia and in the UK. Currently residing in Perth with her partner and two young children, Caroline is particularly interested in home and waterbirth and is passionate about enabling women to make an informed decision and play an active role in their care. You can find all her articles here.