My baby is breech, now what?

So you go to your 37 week prenatal appointment and the doctor feels your abdomen like usual, only is taking a lot longer this time. Then the words are said “I think baby is breech now”. So you have an ultrasound and it confirms that baby is now head up and butt down.

Now what? Your mind is likely racing with questions with the biggest one being ‘I have to have a c-section now, don’t I?’ The answer to that question can be a bit complicated. The biggest factors will be your care providers and your preferences. Is your doctor skilled in breech vaginal births? Do you want to have a breech vaginal birth? Is your doctor only giving you one option, having a cesarean birth? Would you prefer a cesarean birth?

In 2001 the choice of vaginal vs cesarean birth for breech babies went away. Many doctors since then have not been trained how to handle breech vaginal births in medical school. Most care providers that do still attend breech vaginal births are older and are starting to retire out of the baby catching business. So finding one who will give you the options you desire can be difficult.

Like all things in life it is a matter of weighing risks vs benefits. Depending on who you ask will determine the type of answer you get about which method is safer or better for mom/baby.

ACOG states that the preferred method of delivery is cesarean birth. But they go on to say that women should be counseled on their options and be able to make informed choices. You can read about their full opinion here.

There are a few studies that have been done more recently and they seem to have differing opinions on which is the best method of delivery for a breech baby.  Some like to point out the risks of attempting a vaginal breech birth, while others point out the risk factors with cesarean births. Both are valid arguments.

Let’s talk about those for a minute. The risks are usually small, but they are still there and a chance these things could happen. Risks of a cesarean birth:

• Infection
• Excess blood loss
• Blood clots
• Nausea, vomiting and severe headache due to spinal anesthesia(also known as a spinal headache)
• Bowel problems
• Injury to other organs(bladder, bowels,etc)
• Maternal death
• Injury to baby during surgery
• Need for baby to go to NICU
• Respiratory distress and other breathing complications, immature lungs
• Premature delivery (since due dates are often wrong)

Risks of a breech vaginal birth: again, small risks but still chance of happening

• Head entrapment (this is where a skilled provider is key)
• Cord prolapse (which can happen in head down babies too)
• Insufficient head molding
• Internal organ injury (seems to happen with inexperienced providers)
• Shoulder dystocia and nuchal arms
• Nuchal cord (common, happens in 1 out of 3 births regardless of presentation)
• Fetal death

I want to take a minute and talk about the risk of head entrapment. In our Southern Illinois area there is one provider that I have had a conversation with regarding breech vaginal births. I specifically asked about a baby’s head getting stuck after the body has emerged. He explained to me that in full term sized infants that the buttocks and hips are the same size (or almost) as the head and if those came out, usually the head does as well with little to no issue. After some research, I found that to be true. Not that I ever doubted him or his skills. If you are interested in learning more about this care provider please message us.

Here is a link that goes in-depth about the risks of a vaginal breech birth.

Now let’s talk about after birth. If you have a vaginal birth, you will likely have an easier recovery and shorter healing period versus a cesarean birth. If you are planning more children, then having a cesarean can cause complications in future pregnancies. Depending on your care provider having a vaginal birth after a cesarean can be difficult to achieve. You can read Sarah’s personal VBAC stories here. Making a decision that is often time sensitive can be stressful. Take a breath, do research, talk to a professional(or two or three), talk to your partner, express concerns and talk it out. Be prepared to hear opinions or advice from well-meaning friends and family members and to take it with a grain of salt.

Make your decision based out of confidence and not fear, not a decision that was made for you from a lack of options. Your body, your baby, your birth.

No matter what you decide, Trinity Doula Services supports you.