Sunday, September 5, 2010

If Your Baby's Breech

I have had several couples over the years who were planning natural births only to be told at the end of their pregnancy their baby was breech. This is a very upsetting situation. First the medical establishment doesn't give the parents much options or hope. Second they don't seem to understand why the mother is upset; surgical births are second nature to them. For them it is no big deal. For the moms it is a very big deal. They feel boxed in, frightened of a cesarean, frightened of a vaginal birth, the clock is ticking, they scramble about to educate themselves on ways to get the baby to turn, and they begin the grieving process for their dream birth before the birth has even begun. All of my moms have tried hard to get their babies to turn. So far none of them has been successful. I feel some of this is due to how late in the game they were told about the situation. Some have toyed with going ahead with a vaginal birth and what that would entail; finding a care provider in or out of the hospital willing and qualified to assist the mother, dealing with everyone else's opinions on the subject and facing down their fears. Some were completely demoralized by their cesarean experiences others were not. No matter what you decide here are some things you should know.

All of my moms seemed to intuitively know something wasn't right about what they were feeling in their uterus before anyone confirmed their suspicions. They would say, "this just doesn't feel like a butt to me" or "if this is his bottom why am I getting kicked way over here?" Most of these were first time moms but they just knew. If you think this might be your situation ask for an ultrasound to verify position earlier rather than later. Don't rely on the doctors skill in "feeling" baby positioning because they can be wrong. Don't let your doctor talk you into putting this off until 37 weeks. The best time to start natural turning methods is 35 to 36 weeks. The bigger your baby, the tighter the space, the more difficult she will be to turn!

There are many alternative things to try: acupuncture, homeopathy, slant board, Watsu massage, prenatal massage, chiropractic adjustment, headstands or somersaults in a pool, frozen peas on your belly, and more. Use this link to learn more: One Midwife's Collection of Breech Turning Techniques

If the natural methods don't work you can try an external version where your care provider tries to manipulate the baby into turning by pushing on your abdomen. If this is done by a doctor they will want you in the hospital. They will have an i.v. in place so they will be ready to do an immediate c-section if the process causes the baby fetal distress which can't be resolved any other way. This is one of the reasons they will try to put you off and tell you not to worry until 37 weeks. They have nothing else to offer you and they want the baby to be considered "term" in case it needs to come by emergency c-section. I have watched this done a few times now. For some moms it is quite uncomfortable and for others only mildly uncomfortable. I have to say the doctors all spent quite a bit of time and really tried hard to get the babies to turn. Here is a link to view a version.

If none of these methods turn your baby you will need to say to yourself, "now what?"

Consider going for a vaginal birth anyway. Some of you may think I am being reckless, too "radical", in even suggesting such a thing. But guess what? In Canada, that bastion of radical thinking the Society of Obstetricians and Gynecologists new guidelines say to NOT automatically go for the cesarean with a breech. Here is a study from Canada on which they are basing this new approach. For them the "wisdom" of doing a c-section depends upon what type of breech position the baby is in. Study.

Do your own research! Read the chapter on breech birth in The Thinking Woman's Guide to a Better Birth by Henci Goer. Then go more in depth with Breech Birth by Benna Waites. Watch this video of a breech homebirth: Aurora's beautiful and inspiring frank breech home birth. 

If you are going to go for a vaginal delivery of a breech baby who will be your care provider? Ask your doctor or midwife. Ask them if they know any doctors or midwives in your area who do breeches. It is very hard to find any doctor willing or skilled anymore in breech deliveries because with all breeches being automatic surgeries non of them have had much practice at it. This of course compounds their distrust of a vaginal delivery because they don't have the skill. Talk to the homebirth midwives in your area. Are any of them skilled in breeches? Will any of them do a planned breech baby at home? Ask yourself if you are comfortable with the idea of having a baby at home?

If you find a care provider and a place you will need to prepare yourself and anyone else who will be at your birth with positive images and stories of vaginal breech births. You can find this in the book, Breech Birth-Woman Wise by Maggie Banks. Find a copy of Birth Reborn, the movie, through your birth educator or a midwife. This video has some intense footage of a breech birth which made me hold my breath with fear the first time I watched it because it was so foreign to me. You and your partner need to get beyond that feeling.

So what do you do if you can't find a care provider willing to "let" you birth your baby vaginally? Well you can be really radical and just show up at the hospital in labor and then refuse to go to the operating room. Once they have informed you of the risk you are taking you have the legal right to refuse consent to any procedure. This is not an option I am advocating because for labor to go well the mother needs a peaceful and relaxing environment. This sounds far from peaceful to me. My point is you have this option; it is your right. Some women have chosen this path; it has been done before.

If you are still thinking you want to have a cesarean birth the next decision is whether or not to let labor spontaneously happen or to simply choose a day, book the O.R. and schedule your baby's birthday. Here are some things to think about. We know that labor is physiologically good for babies and for mothers. It stimulates the babies breathing, pumps the baby full of hormones that spring the brain into activity, and prepares the baby for life outside the womb and for bonding. The down side to this approach is not having control of the cesarean itself. If you schedule it you can have a meeting with the head nurse of your hospital's labor and delivery unit and make special requests. The number one thing to ask for is to have mom, dad and baby together continuously. In other words the baby and dad stay with mom in the O.R. throughout her repair and go with her into recovery. At most hospitals this is not the standard procedure. It may require special staffing or shuffling of staff at your hospital. It is much more likely to happen when it is arranged ahead of time. You can also arrange to have a lactation consultant be there to help with latching the baby on in the recovery room or perhaps even in the O.R. Of course your doctor may be concerned about "allowing" you to go into labor at all because your water could break. They have concern about "letting" the water break because of possible cord emergencies with a breech presentation. Again this comes down to presentation. If your baby is presenting their butt firmly down into your pelvis and not a foot or feet than common sense tells us the risk of cord prolapse is about the same as for a head. If not than you need to consider that about 30% of the time a woman's water breaks before any signs of labor and the risk of cord prolapse with a foot presentation is considerably higher.

If you are scheduling a cesarean consider asking your doctor to try to do the external version one more time after you have an epidural. Sometimes with the mother unable to feel anything her muscles will relax enough for a version to be successful. If you are successful you would have to decide to go forward with an immediate induction or risk having the baby slip back into breech position.

So much to do. So much to learn. So much to think about. So many decisions to make. So little time and so little energy for any of it those last few weeks of pregnancy. This is why it feels so overwhelming. Of course the easy choice is to simply abdicate your authority and responsibility for your birth to your doctor and say yes to a cesarean without any further thought. Unfortunately abdicating your responsibility isn't what motherhood is all about. Whatever you decide make it your choice because you will have to live with this birth for the rest of your life. Your heart will heal better if you take the time, think it through and take up the role of mother. Parenting starts now!

Read one of my birth class client's breech birth story.

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