Breech Vaginal Delivery
"Many studies have concluded that the shift to planned
cesarean delivery has not improved breech outcomes.
Both vaginal and cesarean delivery of a breech baby
carries risks. More babies born vaginally will have
birth injuries [often due to labour mismanagement] but
almost all of them will recover. The same cannot be
said for cesarean deliveries where the risk to the
mother is much higher, including postpartum infection,
a scarred uterus which will increase her risk of
uterine rupture and placenta accretia (a condition in
which the placenta grows into the uterine wall,
causing complications with retained placenta and
hemorrhage) in subsequent pregnancies. Though rare,
cesarean sections do pose life-threatening risks to
mothers and babies. Depending on the individual case,
vaginal birth is as much a reasonable, responsible
choice as is planned cesarean section."
Excerpt from The Thinking Woman's Guide to a Better
Birth by Henci Goer.
Who should be eligible for labor?
The ideal vaginal breech presentation is a frank
breech position in which baby's buttocks are down and
the legs in pike position, hips flexed and knees
straight. Frank is the most common type of breech and
with the buttocks about the same size as the head,
this minimizes the concern that the cervix will not
dilate enough and possibly trap the head. Also the
umbilical cord prolapsing (coming down ahead of the
baby) is greatly reduced.
At the same time, other breech presentations are ideal
for breech turning techniques because they tend to
turn much more easily than those in the frank breech
position.
Babies with hyperextended necks (with their heads
tipped back) should be born via cesarean section due
to the high risk of entrapment of their aft-presenting
head.
Note: Shortly before a planned cesarean birth it is
recommended an ultrasound be done to confirm breech
presentation and to rule out congenital anomalies
incompatible with life. If baby is found in a vertex
position, a cesarean section is then not needed.
Finding an experienced vaginal breech caregiver
Having a skilled and gently caregiver will greatly
enhance your chance of a vaginal breech delivery.
Unfortunately, the experience needed or desired to
support a woman with a vaginal breech delivery is
becoming harder to find as doctors and obstetricians
rely on cesarean sections to be the only option
available for breech babies. Interview potential
caregivers, ask about their complication rates and
find out what they recommend to minimize the chance of
problems. Start looking and inquiring as soon as you
find out baby is breech.
If you are unable to find a caregiver who will attend
you, the midwives at The Farm in Tennessee headed by
senior midwife Ina May Gaskin, the renowned author of
Spiritual Midwifery, are very skilled at vaginal
breech birth.
Vaginal breech birth protocols
Having a first baby should not disqualify a woman from
a vaginal breech birth.
The jury is out on the routine use of epidurals during
a vaginal breech birth. Though it prevents the
premature urge to push and allows the use of forceps
and manipulation of the baby without causing pain, it
also hinders pushing, which is essential when a woman
must rapidly and effectively push out the baby's head.
Also the common lithotomy (flat-on-the-back) or
semi-sitting positions are contraindicated for a
vaginal breech birth (indeed, for almost all births)
due to their impacting the sacrum (the back of the
pelvis) and decreasing the diameter of the pelvis.
Delayed pushing until full dilation is important as
when you do push, you want the baby to be delivered
quickly and without resistance.
Forceps should only be reserved for emergencies, not
as a routine method to control the delivery of the
head. The use of forceps is minimized with the absence
of epidural anesthesia and with the Mother in a good
pushing position.
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