Breech Birth: No Cesarean Needed

Breech birth is one of the most misunderstood and controversial subjects when it comes to women’s pregnancy and delivery. A breech birth occurs when the baby has its head positioned up instead of down in the uterus. Therefore, coming into the world butt or feet first. Most women will never have the option to decide what they want to do when faced with a breech baby. A planned cesarean section is performed for 94% of all breech babies.

If your provider is an OB, DO, or hospital CNM, you most likely will not be given a choice. Breech births can be successfully carried out without a cesarean. In this blog, we will be discussing the different methods used to deliver these babies without a forced cesarian section. 

How Breech Birth Can Be Fixed Internally 

You may be given the option to try to turn your baby in a procedure called ‘external cephalic version’, or ECV. (This is a procedure where the provider attempts to shift the baby from head up to head down using a deep massage technique.) It can be quite painful, or not, depending on the provider’s technique and how difficult it is.

This procedure is about 74% successful and most people who have a successful ECV will go on to have a vaginal birth. For those whose baby doesn’t turn, the majority (88%) will have a cesarean birth – either by choice or because they are forced as they cannot find a provider willing or able to help them birth their breech baby vaginally.

Most hospital providers have not been trained in physiologic breech birth. Rather, they may have been trained in a procedure called “vaginal breech extraction”. This is where the pregnant person is on their back and the baby is pulled out using various maneuvers and ending with a forceps delivery of the head. This is dangerous and often results in damage to the baby, mother, or both. No wonder most providers are unwilling to provide vaginal birth as an option for clients with a breech baby.

How Breech Birth Can Be Done by Changing Position 

In contrast, there is a technique that uses the gravity of the baby moving naturally through the mother’s pelvis. Called “physiologic upright breech birth”. As the name implies, the client is either standing, kneeling, squatting, or on hands and knees. The baby births itself most of the time. A skilled provider will know if the baby needs any help and when to apply which maneuver.

There have been multiple studies that have found no differences in the long-term outcomes between planned CS or planned VBB. Some studies have found a slightly higher risk for the baby between pVBB and pCS. Although, some studies found no difference. The unknown factor is the skill level of the provider

Why Breech Birth is Usually Solved by a Cesarean 

There is almost no option for having a pVBB in the hospital, in the United States. Many people seek alternative options for the birth of their breech baby. Even though this is not their first choice. Home breech birth has been shown to have poorer short-term neonatal outcomes compared to hospital breech birth. But, we don’t know what really causes these poorer outcomes. Anything from an inexperienced provider, possible congenital anomalies, delays, or miscommunication during transfers are all potentially at fault. It’s very possible that home pVBB outcomes could be significantly improved by improving provider training for breech birth.

By eliminating the option for a hospital birth for pVBB, lawmakers, hospital administrators, and Obstetricians are effectively forcing people to have cesareans. This goes against state and federal rulings that protect a person’s right to refuse surgery, as well as moral and ethical mandates to respect bodily autonomy.