http://www.theglobeandmail.com/life/health/c-section-not-best-option-for-breech-birth/article1186104/
C-section not best option for breech birth
The Society of Obstetricians and Gynecologists of Canada will launch program to teach physicians breech vaginal delivery
Physicians should no longer automatically opt to perform a cesarean section in the case of a breech birth, according to new guidelines by the Society of Obstetricians and Gynecologists of Canada.
Released yesterday, the guidelines are a response to new evidence that shows many women are safely able to vaginally deliver babies who enter the birth canal with the buttocks or feet first. Normally, the infant descends head first.
“Our primary purpose is to offer choice to women,” said André Lalonde, executive vice-president of the SOGC.
“More women are feeling disappointed when there is no one who is trained to assist in breech vaginal delivery,” he adds.
Since 2000, C-sections have been the preferred method of delivery in breech births. Studies suggested that breached births were associated with an increased rate of complication when performed vaginally.
As a result, many medical schools have stopped training their physicians in breech vaginal delivery.
The problem now, according to Dr. Lalonde, is that there is a serious shortage of doctors to teach and perform these deliveries.
With the release of the new guidelines, the SOGC will launch a nationwide training program to ensure that doctors will be adequately prepared to offer vaginal breech births .
The new approach was prompted by a reassessment of earlier trials. It now appears that there is no difference in complication rates between vaginal and cesarean section deliveries in the case of breech births.
News of the change is a boon for the Ottawa-based Coalition for Breech Birth.
“We're really, really pleased,” said Robin Guy, co-founder of the coalition.
Ms. Guy started the group after the birth of her second child in the fall of 2006. Although she had given birth to her first child at home with a midwife, Ms. Guy delivered her daughter in the hospital because of the baby's breech position.
“I was cornered into an unneeded and unwanted C-section because the obstetrician that I had didn't have the experience to catch her,” said Ms. Guy.
The aim of the coalition is to ensure that women know what their options are when it comes to breech birth. Ms. Guy believes that many women don't realize that vaginal breech births are even possible.
“Educating women is our primary goal because it takes more than just a guideline change,” she said.
The SOGC stresses that because of complications that may arise, many breech deliveries will still require a cesarean section.
Breech presentations occur in 3-4 per cent of pregnant women who reach term. That translates to approximately 11,000 to 14,500 breech deliveries a year in Canada.
The new decision to offer vaginal breech birth aligns with the SOGC promotion of normal childbirth – spontaneous labour, followed by a delivery that is not assisted by forceps, vacuum or cesarean section. In December of 2008, the society release a policy statement that included its recommendation for a development of national practice guidelines on normal childbirth.
“The safest way to deliver has always been the natural way,” said Dr. Lalonde.
“Vaginal birth is the preferred method of having a baby because a C-section in itself has complications.”
Cesarean sections, in which incisions are made through a mother's abdomen and uterus to deliver the baby, can lead to increased chance of bleeding and infections and can cause further complications for pregnancies later on.
“There's the idea out there in the public sometimes that having a C-section today with modern anesthesia and modern hospitals is as safe as having a normal childbirth, but we don't think so,” said Dr. Lalonde.
“It is the general principle in medicine to not make having a cesarean section trivial.”
The SOGC believes that if a woman is well-prepared during pregnancy, she has the innate ability to deliver vaginally.
The national average for babies delivered via cesarean section in Canada is 25 per cent.
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My last son didn't turn until the very end of pregnancy. My doc started telling me that he was breech and I was going to have a C-Section. I said, "No, I won't. I have a very large pelvis, this is my 4th delivery, and my babies are not big. I can deliver a breech baby just fine." She said, "Oh yes you will!" I walked out of her office and changed doctors during my third trimester. I had my medical records transferred to a new doc. The first doc called me and asked my why I had transferred out of her office and I said, "Because I won't be having a C-Section." ...end of conversation....
In some cases it is not the best option though. My son was wedged under my ribs, head on one side feet on the other bottom down in my pelvis. I had high blood pressure. We decided to do a c section because of the stress risks to my health. It was a good thing we did because they couldn't see that the cord was around my son's neck on the ultrasound. Had I tried to deliver vaginally he would have been strangled before anything could be done. I had no complications, my son was wide awake and alert. He nursed liked a champ. My incision was almost closed when I left the hospital 3 days later. I was driving and moving like normal 5 days after having him. If needed I would do it again in a heartbeat.
I'm all for a vaginal delivery, when the circumstances are optimal. But when there is any question about the mother's or baby's safety, I would do what the trained professionals feel is in the best interest for us.
Good for you! I wish I heard more stories like that!!
Quoting myfoursonsks:
My last son didn't turn until the very end of pregnancy. My doc started telling me that he was breech and I was going to have a C-Section. I said, "No, I won't. I have a very large pelvis, this is my 4th delivery, and my babies are not big. I can deliver a breech baby just fine." She said, "Oh yes you will!" I walked out of her office and changed doctors during my third trimester. I had my medical records transferred to a new doc. The first doc called me and asked my why I had transferred out of her office and I said, "Because I won't be having a C-Section." ...end of conversation....
Not that it may be your case, but in the vast majority of cases, a cord around the neck is not an emergency, and happens in almost 2/3 of births.
http://jeremyscorner-grifter.blogspot.com/2009/02/cord-around-neck-is-not-emergency.html
Edit : Also, this study was published by trained professionals, the equivalent of ACOG in the US. Sadly not always do medical professionals suggest or do what is best for moms.
Quoting EtiesMommy:
In some cases it is not the best option though. My son was wedged under my ribs, head on one side feet on the other bottom down in my pelvis. I had high blood pressure. We decided to do a c section because of the stress risks to my health. It was a good thing we did because they couldn't see that the cord was around my son's neck on the ultrasound. Had I tried to deliver vaginally he would have been strangled before anything could be done. I had no complications, my son was wide awake and alert. He nursed liked a champ. My incision was almost closed when I left the hospital 3 days later. I was driving and moving like normal 5 days after having him. If needed I would do it again in a heartbeat.
I'm all for a vaginal delivery, when the circumstances are optimal. But when there is any question about the mother's or baby's safety, I would do what the trained professionals feel is in the best interest for us.
Good for you!
My tiny 4' 10" grandmother delivered 2 babies "ass backwards" Lol.
Quoting myfoursonsks:
My last son didn't turn until the very end of pregnancy. My doc started telling me that he was breech and I was going to have a C-Section. I said, "No, I won't. I have a very large pelvis, this is my 4th delivery, and my babies are not big. I can deliver a breech baby just fine." She said, "Oh yes you will!" I walked out of her office and changed doctors during my third trimester. I had my medical records transferred to a new doc. The first doc called me and asked my why I had transferred out of her office and I said, "Because I won't be having a C-Section." ...end of conversation....
Quoting Paesana82:
I wish they would train docs in breech deliveries here too.
Dont they do that?
I dont know but from my understanding sectio is far more common in the US than it is where I am.
We dont do a sectio on routine only if its medically motivated. Which means that a breech delivery can be done vaginally or that its OK to have a vbac.
It all depends on the circumstances surrounding the woman and the foetus.
My first son was breech but I had to have a sectio since my pelvis is not big enough for a breech delivery. They tried to turn him the right way but my bp was way to high so we had to stop and later that day my water brooke and I had a sectio.
What we do first of all is to find out if her pelvis is OK for a breech birth and if not we try to turn the foetus head first.
If that doesnt work it will end with a planned sectio.
Women have been made to feel so inadequate in giving birth. Every time they turn around, they are being told what they can't do, what will go wrong, and taught that the natural process is not best. It is sad. They are fed such a load of BS. It isn't their fault they trust their doctors. We are taught to do that. But, many women do not see the childbirth industry as being the multi-billion dollar industry it is. Money is the main concern. If doctors really cared about the women, they would be making better choices and not causing the US to have one of the highest fetal/infant mortality rates and one of the highest maternal mortality rates out of all developed Nations of the world. We are even worse than most undeveloped nations. People really need to step back and think about what is going on.
Quoting isra1986:
Good for you!
My tiny 4' 10" grandmother delivered 2 babies "ass backwards" Lol.Quoting myfoursonsks:
My last son didn't turn until the very end of pregnancy. My doc started telling me that he was breech and I was going to have a C-Section. I said, "No, I won't. I have a very large pelvis, this is my 4th delivery, and my babies are not big. I can deliver a breech baby just fine." She said, "Oh yes you will!" I walked out of her office and changed doctors during my third trimester. I had my medical records transferred to a new doc. The first doc called me and asked my why I had transferred out of her office and I said, "Because I won't be having a C-Section." ...end of conversation....
BRAVO! If I said that in this group, I would be hung out to dry, but that is the bottom line, the dollar!!!!
A friend of mine was told after her first child she could NEVER give birth because her pelvis was just too small, well she had a baby in April, vaginally, AT HOME, and she was over 9 pounds. She just wrote her OB/GYN a letter which I loved.
http://journeytohomebirth-hbac.blogspot.com/2009/11/finally-sent-letter-to-my-obgyn.html
Quoting myfoursonsks:
Women have been made to feel so inadequate in giving birth. Every time they turn around, they are being told what they can't do, what will go wrong, and taught that the natural process is not best. It is sad. They are fed such a load of BS. It isn't their fault they trust their doctors. We are taught to do that. But, many women do not see the childbirth industry as being the multi-billion dollar industry it is. Money is the main concern. If doctors really cared about the women, they would be making better choices and not causing the US to have one of the highest fetal/infant mortality rates and one of the highest maternal mortality rates out of all developed Nations of the world. We are even worse than most undeveloped nations. People really need to step back and think about what is going on.
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- CTRedSoxMom
on Nov. 24, 2009 at 4:53 PM