Monday, January 20, 2014

Breech Presentation...What? Why? How?

A baby in "breech" position is basically considered an automatic cesarean, at least in the United States. Many doctors are no longer trained in breech deliveries, and so the immediate conclusion that they come to is that mom will need major abdominal surgery due to their lack of training. It is what it is, right?


What is Breech?
  • Frank Breech, which tends to be the most favorable. This is when baby’s bottom presents first and feet are by the head.
  • Footling Breech is when baby has one or both feet presenting first.
  • Complete Breech is when your baby is comfy sitting cross legged.

Why won’t my doctor do a vaginal breech birth?
This could be due to a variety of reasons:

  • They may not have a lot of experience attending vaginal breech births.
  • May not feel comfortable attending vaginal breech births.
  • May have had a bad experience in the past.
  • There may not be suitable back-up at the hospital where they practice (on call anesthetists, pediatricians, experienced midwives, 24 hour operating room staff).
  • They may not believe in vaginal breech birth.
  • Defensive practice in current childbirth culture means that doctors are more likely to err on the side of intervention (cesarean section) rather than non-intervention (vaginal birth).
  • It is easier for a doctor to perform a cesarean section than a skilled vaginal breech birth.
  • Cesarean is an accepted birth method in today’s culture.

How should I approach my child's breech position?
*Do nothing.
Depending how many weeks pregnant you are, you may decide just to wait for your baby to turn. The majority of babies turn spontaneously pre-term.

*Non-medical turning
Alternatively, there are various non-medical turning techniques you can try.  You can read more on Spinning Babies

*Look for a care-provider who will support you in whatever option you choose
Many maternity care-providers do not support vaginal breech birth and will advise a planned cesarean section at 38 or 39 weeks if your baby does not turn.  This is partly because most obstetricians and midwives do not possess skills in vaginal breech birth and so they are unable to offer this option safely. However, depending on various maternal and fetal factors, vaginal breech birth is not necessarily any riskier than cesarean section, particularly with the support of an experienced attendant. 

Before 37 weeks of pregnancy, breech presentation is much more common - about 20% of babies at 28 weeks are breech, and 15% at 32 weeks. Before term, which is defined as 37 weeks, it doesn't matter if the baby is breech, as there is always a good chance that she will turn spontaneously. Some babies do turn by themselves after this time, but it is much less likely, and some preparations should be made to decide how delivery is going to take place. About 10% to 15% of breech babies are discovered for the first time late in labor!

Very soon, I will post two guest birth stories. One of these stories is from Felicia, who had a cookie-cutter, non-complicated pregnancy but was forced into cesarean delivery solely due to a breech presentation. The second is from Kristel, whose daughter came out booty-first at home in the water. These ladies are examples of how having supportive care providers can make the difference between the birth experience you want and the experience that is forced upon you.

Further Reading:
Spinning Babies 
The Webster Technique
Breech Decision Making Sheet

UPDATE: Please click HERE for the Breech Babies tab, so you can read the birth stories mentioned above and any other resources on this site regarding breech babies.

Sources: 1, 2, 3, 4

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