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My baby is breeched at 33 weeks

Posted by on Oct. 22, 2013 at 7:07 PM
  • 12 Replies
Should I be worried? I really don't want t a c section... :/
Is there anything I can do to help him move into position??
by on Oct. 22, 2013 at 7:07 PM
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Replies (1-10):
norahsmommy
by Silver Member on Oct. 22, 2013 at 7:09 PM
Supposedly www.spinningbabies.com has good tips. Babies can turn any time, even during labor. I wouldn't worry too much yet.
mommy2casidee
by Bronze Member on Oct. 22, 2013 at 7:09 PM
Chiropractor using the Webster technique and spinning babies.com
Posted on CafeMom Mobile
LilysMommy813
by Member on Oct. 22, 2013 at 7:36 PM
Totally normal, baby still has time to turn on its own
mileysmom331
by Member on Oct. 22, 2013 at 7:37 PM
That's about the time Ds turned
esox
by Bronze Member on Oct. 22, 2013 at 7:39 PM
There is still time for him to spin around. If it comes down to it, a c-section would not be the end of the world as long as you and the baby are both healthy and in one unbroken piece.
Raeann11
by Platinum Member on Oct. 22, 2013 at 8:59 PM

Here is some info for you to read. Breech Wisdom and Practical Hints

 and spinning babys

wolfybaby
by Member on Oct. 22, 2013 at 9:12 PM

you have plenty of time.

kajira
by Emma on Oct. 22, 2013 at 9:20 PM

I had a breech baby up until I pushed her out... head first.

She was breech and nothing I did convinced her to change, and I literally tried everything. Rocking, dancing, cat positions, paid for a specialist who does chiropractic care to come over to me and do that. ( I was on hospital bedrest.) 

Finally, I even tried an EVC (a version where your doctor manually flips the baby.)

Stubborn girl wouldn't turn. They wanted to do a c-section at 39 weeks. I refused. Planned on having a homebirth with a midwife and figured we'd take things one day at a time and go from there.

My midwife was prepared to do a vaginal breech delivery - with hospital on stand by in case of complications. She'd delivered breeches before and since mine wasn't a star gazer, or footling, was content to let nature take it's course and see what happened.

She flipped during labor and popped out head first at 39 1/2 weeks.

Do you know how many doctors open mom's up and find out the baby flipped head first? LOL

I would always, ALWAYS ask for a trial of labor before going straight to a c-section. The risk of a c-section and a vaginal breech birth are comparable for BOTH mom and baby - with the vaginal birth being safer for mom, but the risk to baby being the same as a c-section.

And c-sections have more of a risk in the bigger picture, plus recovery times than a breech delivery. Despite medical procedures being "standard" = c-section is major surgery and has huge complications and risks that can result in both maternal and fetal demise... with many other long-term complications that they don't warn you about... such as infection, healing problems, complications from surgery later, scar tissue, infertility problems, etc.

I would definitely do everything in my power to avoid a c-section, breech deliveries aren't that dangerous IF the doctor knows what they are doing - the problem is most doctors are worried about being sued... and hospital policies make it so c-section is automatic and standard because it's easier when it's normal routine, to not get sued... even if it's not better for mom OR baby.

kajira
by Emma on Oct. 22, 2013 at 9:23 PM

Most babies are born headfirst, but at the end of pregnancy, around 3% to 4% are found to be breech. Before 37 weeks of pregnancy, breech presentation is much more common - about 20% of babies at 28 weeks are breech, and 15% at 32 weeks. Before term, which is defined as 37 weeks, it doesn't matter if the baby is breech, as there is always a good chance that she will turn spontaneously. Some babies do turn by themselves after this time, but it is much less likely, and some preparations should be made to decide how delivery is going to take place. About 10% to 15% of breech babies are discovered for the first time late in labour!

Preterm Breech

Before 37 weeks, the only time that it does matter if the baby is breech is if labour begins. There are many factors that will be taken into account before advising on how to have your baby if this happens. Frequently, a caesarean section will be advised, particularly if your baby is between 27 and 30 weeks, but this is not always the case. Some obstetricians feel very strongly that a caesarean is always safer, others advise a vaginal delivery if there are no other problems.

It is generally accepted that the studies which have tried to find the safest delivery for the baby have been subject to much bias. The problems babies have when they are born early are very much related to prematurity, rather than the type of birth. Unfortunately, it is unlikely that an adequate study to discover the best type of delivery for a premature breech baby will ever be done.

If a planned early delivery is needed, for example because of preeclampsia, growth problems or another separate problem of pregnancy, then it is more likely that a caesarean section will be suggested rather than induction of labour with a preterm breech baby.

Term Breech

If a baby is found to be breech at 36 weeks, it is usual to refer to the hospital to discuss and plan the mode of delivery for a breech baby. A scan is done to check the following things:

Placenta position - a low lying placenta (praevia) can lead to breech presentation, and one third of women with a praevia do not have any bleeding, which would normally alert to this problem. Often the scan at around 18 to 20 weeks may have already ruled this out.

Baby and his position - now that ultrasound is so common at 18 to 20 weeks, it is extremely unusual to discover any abnormalities in the baby at this stage. The sonographer will check the amount of water around the baby, the exact position, and whether the baby has his neck extended looking upwards (stargazing). A weight estimation is also made.

Breech babies sit in one of three positions:

  • Extended or frank breech - hips flexed, with the thighs against the chest, and feet up by their ears.
  • Flexed breech - hips flexed with thighs against the chest, but knees also flexed with the calves against the back of the thigh and feet just above the bottom.
  • Footling breech - as above, but hips not flexed so much, and the feet lying below the bottom.

The options available to you for the birth will then be discussed. They include the following:

  • Normal breech delivery
  • Attempt at turning the baby (external cephalic version or ECV) then normal breech delivery if this is unsuccessful
  • ECV followed by caesarean section if unsuccessful
  • Elective caesarean section

Normal Breech Delivery

Until recently, there was not enough research to guide us on what is the safest way for a breech baby to be born. In 2000, the results of the Term Breech Study were reported. This study included 121 hospitals throughout 26 countries. Babies were randomly allocated to either planned breech delivery or planned caesarean section. The results revealed that planned caesrean section was safer for the baby than attempt at vaginal birth, with vaginal delivery resulting in a 1% increased risk of death and 2.4% increase in risk of serious problems in the early months after birth.

There has been a lot of back and forth analysis and re-analysis of the information provided to us by the Term Breech Study, including criticisms of the study design. Also, the findings of the Term Breech Study do not apply to twin pregnancies and if the second twin is breech, this does not rule out a normal birth.

Since 2000, there has been a significant fall in the number of vaginal breech births throughout the UK, Canada and the US. The result is that even if you do not agree with the findings of the research, or if you accept them and still want a normal breech birth, finding an obstetrician who has enough experience to offer breech delivery might be difficult. Not having an experienced obstetrician will mean that the risk for the baby will be greater than the findings of the Term Breech Study, as this was one of the study entry requirements.

Going for Breech

If you do choose to go for a breech delivery, the following 'rules' will normally be required:

  • The baby is not excessively small or large
  • Your pelvis is not judged as excessively small. Previously we used to do a pelvic x-ray to check the exact measurements of the pelvis. It has since been found, however, that this is unnecessarily limiting and a judgement based on previous births and/or pelvic examination is as useful. There is also a very small but definite increased risk of childhood cancers in babies exposed to this type of x-ray.
  • Baby is not a footling breech. Extended breech is the most favourable, but flexed breech is OK as long as the bottom moves down and engages into the pelvis. Footling breech babies don't fit so well onto the cervix, leading to a risk of the cord falling out during labour (cord prolapse).
  • Baby is not 'stargazing'.
  • Labour starts spontaneously.

When labour starts you come into hospital as usual. Some doctors advise an epidural for every woman having a breech birth, but this is not strictly necessary. There is some evidence that epidurals increase the risk of a caesarean section being needed during labour. Many women who have a breech birth choose this type of pain relief in any case.

Labour is never excessively long and continuous monitoring of the baby's heart rate is advised. When it comes to the actual birth, some doctors use forceps to control the delivery of the baby's head, others prefer to just assist it with their hands. An episiotomy (cut) is frequently needed for first-time mothers, but it really depends on how well the skin stretches, the progress at the time of delivery and the size of the baby.

A paediatrician will be present at the birth to check the baby over, but you will be able to have him with you straight after this. Congenital hip problems are more common in breech babies and this explains why some are breech in the first place. The paediatrician will examine your baby more fully before you go home.

External Cephalic Version

It is possible to manoeuvre the baby from breech to a head-first position. This is done after 37 weeks and the success rate is around 50%, though some doctors are successful as often as 70% of the time. It is useful in that it definitely reduces the number of breech and caesarean births. Around 2.5% of babies flip back to breech after a successful ECV.

The doctor places her hands on the womb, and guides the baby through a forward somersault - often the baby seems to get the idea and his kicking helps to complete the turn. Some doctors use a drug to help the womb relax, particularly for first-time mothers. It may be quite uncomfortable during the turn, but shouldn't be excessively painful. The baby's heartbeat is monitored before and after ECV.

It is a safe procedure for the baby, but on the rare occasion the baby becomes distressed a caesarean delivery will be necessary at that time. Because the baby is mature and facilities for surgery are close at hand, this rare occurrence is still not harmful for the baby.

If an ECV is unsuccessful, it is still possible to have a normal breech birth as discussed above.

Is There Anything I can do to Make Him Turn?

There has been a suggestion that spending 15 minutes every 2 hours of the waking day in the knee-chest position will help the baby to turn (Elkin's manoeuvre). Although the first report of this was very encouraging, subsequent studies have not found it to be useful. There is some evidence that hypnotherapy may be useful, though only one study has looked at this. Acupuncture has been suggested and the results of a more formal study are awaited.

Caesarean Section

There is no doubt that caesarean section is a safe operation, but it is not without problems, and this is why many doctors and midwives still feel that there is still a place for normal breech births - particularly if you have had a vaginal delivery before. A caesarean section means a stay in hospital of around 4 to 5 days, a more prolonged recovery, and implications for future pregnancies or operations. Overall, caesarean section is a relatively safe operation, but infections and above average blood loss are not uncommon. Scar tissue formed during the healing can lead to pain and make future operations more difficult.

For elective surgery you normally come into hospital either the night before the operation or the morning if it is to be done in the afternoon. Most often an epidural or spinal anaesthetic is advised. This involves a very small needle in the back, which numbs everything below the navel so you feel no pain. Most women feel a bit of tugging and pulling, but it should not be uncomfortable. This type of pain-relief is safer for you than being asleep (general anaesthetic). It also means that you can see your baby immediately, and usually hold him before the operation is finished. You will need to have a drip in your hand and a catheter in the bladder to ensure it is empty. Both of these will be removed the day after the operation.

Summary

Although vaginal breech birth is now less commonly offered, ECV is a useful option to help avoid the need for caesrean section. If you are keen for a breech delivery then it would be sensible to discuss this with your obstetrician or midwife who can advise on the availability of delivery staff who have appropriate experience.

kajira
by Emma on Oct. 22, 2013 at 9:30 PM

C-section not best option for breech birth

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.

MORE RELATED TO THIS STORY

"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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