Nursing Birth

One Labor & Delivery Nurse’s View From the Inside

Why Is Vaginal Breech Birth Going the Way of the Dodo? April 9, 2009

I recently was sent a link to The Coalition for Breech Birth website and I wanted to share it with all of you because it is both interesting and informative.

 

I learned in nursing school and have since witnessed as an L&D nurse the hard truth that all breech babies are born by cesarean section in the United States nowadays unless 1) the baby turned from vertex to breech during the labor and no one realized it or 2) the baby actually delivered in the bed before her doctor could wheel her into the operating room.  I knew from books and stories told to me by older nurses that in the “old days” they used to deliver breeches vaginally but never learned why it isn’t even presented as an option for the women of today. 

 

According to the Coalition for Breech Birth website:

 

“Vaginal breech birth was practically banned following a significant international research study in 2000. This study, the “Term Breech Trial” or TBT, appeared to prove that caesarean section was substantially safer for the delivery of all breech babies. The trial was highly criticized, but many birth care providers took this opportunity to do what they wanted to do anyway – to stop offering vaginal breech birth to their clients, and to insist instead upon a surgical delivery.  In addition to all the professional criticism, the TBT’s own two year follow up negated the original results, suggesting that any difference in safety between vaginal and surgical birth of a breech baby is negligible – for both mother and child. Despite this evidence, many birth care providers (BCPs) still avoid balanced informed choice discussions with their clients, denying them the opportunity to make an informed choice.”

 

It is disappointing enough when a woman is not given the choice and is just scheduled for an elective pre-labor cesarean section (often at about 39 weeks, which could still be early for many babies) related to her baby being breech.   It’s also frustrating when a provider doesn’t even offer the patient an external version before scheduling her for surgery.   But what I find really upsetting as an L&D nurse is when a woman comes in 8, 9, or 10 centimeters dilated and because she is found breech is rushed of for an emergency cesarean section.  Many doctors say that one of the reasons they don’t “do” vaginal breech births is because the buttocks are not as effective at dilating the cervix as a nice round head is and labor can be too long and difficult.  But when a woman comes in at 10 centimeters dilated clearly her body did just fine!!  And when a woman “accidentally” delivers a breech baby in the bed before we could get her to surgery, everyone (doctors, nurses, midwives) seem to be so excited that the patient was able to “avoid” surgery, yet this hasn’t EVER made ANY doctor think twice about scheduling every one of their breech patients for surgery anyways.  So frustrating! 

 

If you have never seen a breech delivery before, this site has links to pictures and videos as well as other resources for mothers wanting to be more informed of their birth choices. 

 

The sad thing is that if things continue the way they are now, less and less doctors and midwives will be properly trained to assist in the delivery of a breech baby and by this vicious cycle, less and less opportunities for women to make this birth choice will exist. 

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13 Responses to “Why Is Vaginal Breech Birth Going the Way of the Dodo?”

  1. Mama Kalila Says:

    Wow. I knew they tried to push women into c-sections for that, but didn’t realize it was that bad. Reason #213123 I’m glad we’re going w/ the birthing center next time. The midwives there have already mentioned that breech is not a problem and that they have experience with it. Also makes me glad my first wasn’t…

  2. nursingbirth Says:

    Briome, Thanks for the link! I really appreciate it! The funny thing is, when I started this blog my husband tried to “prep” me saying “Don’t be upset if no one reads your blog, it is probably just going to morph into this cathartic online journal that makes you feel better but not many people read.” LOL I totally agreed with him at the time. That is why I am so FLOORED that amazing women like you are reading and liking my blog! I really really REALLY appreciate it!

  3. nursingbirth Says:

    Mama Kalila, Reason #213123 that I am glad women like you are doing their research and learning about their birth choices!! Rock on!

  4. Katherine Says:

    I have to confess — I never heard about that study. But wow! I’m so glad I wasn’t in that position (or rather, the baby wasn’t 🙂 ha!). I had always said that I’d just move to Tennessee temporarily if I had a breech baby (go to the farm!).
    With the midwife group we used when our second was born, one of their back-up OBs will actually attempt a version, and will let the mom try for a vaginal breech birth. But, as far as I know he is the only one in our metro area who will . . .
    Our second was transverse at 35 weeks — so I went to a chiropractor and spent LOTS of time swimming to encourage him into a head-down position. Thankfully, it worked!

  5. nursingbirth Says:

    Katherine, I have recently learned about chiropractic care in pregnancy to help correct the baby’s position and I think it is facinating. Thanks for sharing your story!

  6. Dr. Alyssa Says:

    I just discovered your blog, and am a huge fan! I am a pregnancy chiropractor, a doula, a childbirth educator, AND mom to Emily Rae, who was born at home 2/28/07, a (surprise) vaginal breech waterbirth, so this is a topic that is near and dear to my heart.

    I regularly see mamas whose babies are breech, and I use both Webster and Bagnell techniques to address the pelvic and spinal misalignments that can contribute to a breech presentation. I find it is much easier for babies to turn when misalignments are addressed at 32 weeks or before. Recently, I had a mama come for breech presentation at 39 weeks. The baby did not turn, but was delivered vaginally at home four days later. It can be done!

    Anyway, keep up the good work, and I will be reading!

  7. I couldn’t agree more. It is ridiculous that doctor’s are not even taught the process anymore in medical school. I just wrote a post about how I am still processing my C-section 5 years ago- the ONLY reason being, was my baby was breech.
    http://amamasblog.com/2009/04/09/my-c-section-five-years-later/

    This trend needs to stop, and women need to at least be offered the choice of a vaginal birth when their baby is breech.

    I am going to add your blog to my blog roll.

    • nursingbirth Says:

      A Mama’s Blog: I will definitely check that story out!! Thanks for being a fan! I write for women like you!!!!

  8. I’m a doula and I recently had a breech client whose baby would not turn (after moxi, ECV, chiro, etc). She was a primip who went from ROM with menstrual crampiness to 10 cm in under 4 hours. Baby was frank. Given the speed of dilation, I think it could have been a completely uncomplicated hands-off birth. But she was told “don’t push” and rushed to the OR.

    So, so sad. No OB in our town is willing to do a vaginal breech. Other than going to another state or birthing unassisted, she was without choice.

    I hate it.

    • nursingbirth Says:

      InexplicableWays, your story frustrate and saddens me, as I am sure it does for you too!! So so sad indeed! No OB in our town is willing to do breech births and you have to travel at least 3 hours to find one that does. Shame! I feel your pain sister!

  9. Marissa Says:

    I can understand some docs not wanting to do ECV because it does have some risks, but some don’t even tell their patients how to encourage the baby to turn on their own. my little one turned on her own at 32 weeks, but it wasn’t until after I had a physical therapist realign my SI joint which had gotten stuck out of place a couple of months earlier. and I think she would have turned much sooner if my pelvis had been in alignment.

  10. PixieQueen Says:

    So glad you posted this! I had a surprise breech home waterbirth last month with my second. It was fantastic! I didn’t even tear! Like Dr. Alyssa, this is a topic I now feel very strongly about!


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