Breech Birth: No Cesarean Needed

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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.

Breech Without Borders 

At Midwife360, Fadwah has been trained in the art of VBB and has attended a handful of pVBB in and out of the hospital setting, as well as several breech births in the hospital during twin births where the second baby is coming breech. She has attended and is working with Breech Without Borders Breech Pro Workshop to add to her skill level and to bring this valuable training to other providers in our community. All birth providers – CPM, CNM, OB, DO – are welcome to attend.

As a birth worker, there is always a risk of a person showing up in advanced labor with a breech baby. Rather than trying to rush into the OR for a cesarean that carries its own set of risks (not only for this birth but for the next birth and baby) why not learn the art of physiologic vaginal breech birth to assist the process safely? Go to midwife360.com to learn more about the upcoming Breech Without Borders workshop.

Home Birth: Is it Possible to Have a Breech Birth at Home?

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What is a Breech Birth?

A breech birth is when the baby is in position to descend bottom first instead of head first.  Believe it or not, 3–5% of pregnant women at term (37–40 weeks pregnant) have a breech baby. Medical professionals will often consider this to be a high risk for natural birth however with proper monitoring and birth assistance there is no difference.

What Causes a Breech Birth?

The breech position is normal and throughout your pregnancy your baby will move around and change position (you may notice this during your ultrasound). However as the body prepares for birth your baby often moves into a head down position.

Baby’s Choice

In some cases, the body and baby make the choice not to turn into a cephalic (head down) presentation. Though it is rare, it can be completely normal and nothing to worry about with the assistance of a professionally trained midwife and doula. Your certified nurse midwife, Obstetrician-gynecologist (obgyn), or a maternal-fetal specialist will determine the causation ahead of labor to ensure there aren’t special measures that need to be taken.

Amniotic Fluid

The amniotic fluid in your uterus plays a role in your baby’s ability to move around.  Your baby may have too much or too little space to move around as a result of your uterus having too much or too little amniotic fluid.

Uterine Abnormalities

Another reason for breech birth is an abnormally with your uterus. Sometimes it’s a deformity in the shape. Other complications, such as fibroids in the uterus or placenta previa also can cause a breech birth. In cases like this, you and your medical team know months in advance to your labor preparation.   Which brings us to the next question…

Is it Possible to Have My Breech Birth at Home?

The answer is often, yes. It is possible to  birth a breeched baby naturally in any setting entirely depending on the reason your baby is breech. The reason and your risk level should be explored by your team of birth professionals before a decision is made.
Photo Credits: First Light Doula Services
Mama would like to remain anonymous
Axel Alexander
7 lbs 6 oz, 19 1/2 inches
Born on Jan. 29th at 2:01am

Born at home during a planned breech birth.

“I couldn’t be more grateful for my wonderful birth team , they didn’t try to discourage me for one second when realizing at 37 weeks that my baby wouldn’t move from the breech position because there wasn’t much room. Although I tried everything he remained in the same spot. I was given the confidence with the experience and expertise from my wonderful Midwife and her amazing assistant midwife by cheering me on, while learning the proper hypnosis techniques I learned with my amazing doula My breech birth was simply 2 hours long, with beautiful meditation music in the background, essentials oils in the air, and relaxing ambiance in my husbands & my very own bedroom; it was intimate and beautiful.”