If you have been recently told that your baby is presenting by the breech, you are likely to be feeling upset and confused. You may have read that breech is a 'variation of normal' and that vaginal breech birth is both possible and safe. Yet, your care-providers are unlikely to offering vaginal birth as an option to you. Why the contradiction?
Download our Decision Making for Breech Births INFOSHEET
1. Do not panic!
We will support you as you navigate 'the system' and consider your options. Please join our Facebook group.
2. Do nothing
Depending how many weeks pregnant you are, you may decide just to wait for your baby to turn. The majority of babies turn spontaneous pre-term.
3. Non-medicalised turning
Alternatively, there are various non-medical turning techniques you can try. You can read more on Spinning Babies.
4. Research your options and discuss them with your care-provider
Check out our Breech Birth Resources and Evidence on Breech Birth pages.
5. Look for a care-provider who will support you in whatever option you choose
Many maternity care-providers do not support vaginal breech birth and will advise a planned caesarean section at 38 or 39 weeks if your baby does not turn. This is partly because most obstetricians and midwives do not possess skills in vaginal breech birth and so they are unable to offer this option safely.
However, depending on various maternal and foetal factors, vaginal breech birth is not necessarily any riskier than caesarean section, particularly with the support of an experienced attendant. You might therefore approach a doctor or midwife with skills in vaginal breech birth (and who therefore is less likely to be biased in favour of caesarean section) and ask for their advice on whether you would be a good candidate for a 'trial of labour'.
There is a list of Australian care-providers known to support vaginal breech birth on Belly Belly's website. We also have a wide network of connections that may help you so please get in touch via Facebook.
Even if you do ultimately decide upon a caesarean birth, it is still helpful to research your options first. Then you know you have made a fully informed choice.
6. Consultations about vaginal versus caesarean birth
When you are discussing your birth options with your care-provider, or getting a second opinion, it helps to think about what questions you might ask in advance. Write them down and take them with you. Here are some ideas:
7. External Cephalic Version (ECV)
If non-medical techniques don't work, at about 37 weeks you should be offered ECV. This is where a doctor attempts to turn the baby manually by placing their hands on your abdomen. You do not have to undergo ECV. However, for many women, this is their best option to avoid a planned caesarean section. If you have found a care-provider who will support you in a vaginal breech birth, you may decide not to under go ECV. You can read more about ECV here.
8. Look forward to the birth
Depending where you live, your options may include:
You will need a very supportive partner or birth-attendant to help if you are planning to negotiate once in labour.
Whatever birth you end up with, we hope that you are treated respectfully, given full information and empowered to make your own choice for you and your baby.
Happy mothering - please send us a photo of your breech baby!
Download our Decision Making for Breech Births INFOSHEET
1. Do not panic!
We will support you as you navigate 'the system' and consider your options. Please join our Facebook group.
2. Do nothing
Depending how many weeks pregnant you are, you may decide just to wait for your baby to turn. The majority of babies turn spontaneous pre-term.
3. Non-medicalised turning
Alternatively, there are various non-medical turning techniques you can try. You can read more on Spinning Babies.
4. Research your options and discuss them with your care-provider
Check out our Breech Birth Resources and Evidence on Breech Birth pages.
5. Look for a care-provider who will support you in whatever option you choose
Many maternity care-providers do not support vaginal breech birth and will advise a planned caesarean section at 38 or 39 weeks if your baby does not turn. This is partly because most obstetricians and midwives do not possess skills in vaginal breech birth and so they are unable to offer this option safely.
However, depending on various maternal and foetal factors, vaginal breech birth is not necessarily any riskier than caesarean section, particularly with the support of an experienced attendant. You might therefore approach a doctor or midwife with skills in vaginal breech birth (and who therefore is less likely to be biased in favour of caesarean section) and ask for their advice on whether you would be a good candidate for a 'trial of labour'.
There is a list of Australian care-providers known to support vaginal breech birth on Belly Belly's website. We also have a wide network of connections that may help you so please get in touch via Facebook.
Even if you do ultimately decide upon a caesarean birth, it is still helpful to research your options first. Then you know you have made a fully informed choice.
6. Consultations about vaginal versus caesarean birth
When you are discussing your birth options with your care-provider, or getting a second opinion, it helps to think about what questions you might ask in advance. Write them down and take them with you. Here are some ideas:
- Ask about the risks of both caesarean birth and vaginal birth in absolute terms rather than relative terms. Ask for figures. Make sure you cover both risks to you, risks to your baby and risks for future pregnancies. Given the current climate on vaginal breech birth, it is surprising how low the risks of vaginal breech birth are in absolute terms (for good candidates) and how high the risks of caesarean birth are in absolute terms, especially when you take future pregnancies into account.
- If you are told about the term breech trial, raise the issue that the trial has been criticised for its methodology and conclusions (see Evidence on Breech Birth) and ask about the other studies which showed good results for vaginal breech birth when properly managed. If your care-provider considers the term breech trial to be the 'last word' on vaginal breech, you should seek a second opinion.
- If your care-provider recommends a caesarean section only, ask why. Then ask whether they could recommend somebody else for a second opinion.
- If your care-provider recommends a caesarean section, ask whether this could take place after you go into labour. If your body has the opportunity to labour, your chances of a successful vaginal birth next time are increased. There are also benefits to the baby both of experiencing labour and of being born when they are ready. This option is more likely to be available in a larger hospital where anaesthetists are available 24/7.
- Ask how many breeches have they delivered. What difficulties have they encountered and how were they resolved?
- Ask what proportion of attempted vaginal breech births succeed and what proportion proceed to caesarean section. Care-providers experienced in vaginal breech birth sometimes have a successful vaginal birth rate of up to 75% (which is higher than the vaginal birth rate for head down babies in many hospitals).
- Ask what position your baby is in (frank breech, complete breech, footling breech) and whether that makes a difference to your options.
- Ask how they typically "manage" each breech presentation. How long do they wait before touching the baby, if at all? In what circumstances would they assist the delivery?
- What happens if your primary caregiver (who has breech experience) is unavailable?
- At what point would they induce an overdue breech baby (if at all)?
- If they are supportive of a trial of labour, under what circumstances and indications during labour would they recommend a caesarean section and how is that likely to work?
7. External Cephalic Version (ECV)
If non-medical techniques don't work, at about 37 weeks you should be offered ECV. This is where a doctor attempts to turn the baby manually by placing their hands on your abdomen. You do not have to undergo ECV. However, for many women, this is their best option to avoid a planned caesarean section. If you have found a care-provider who will support you in a vaginal breech birth, you may decide not to under go ECV. You can read more about ECV here.
8. Look forward to the birth
Depending where you live, your options may include:
- find an obstetrician or midwife to support you in a planned vaginal breech birth;
- choose a planned caesarean section at 38-39 weeks;
- choose a planned caesarean section but wait until you go into labour spontaneously (this option may be more likely to be available to you in a larger hospital as smaller hospitals often rely on skeleton staff in evenings and weekends);
- call around all the local hospitals once you go into labour to see if anybody has the skills to support a vaginal breech birth and then decide where to go;
- arrive at your local hospital in labour, ask whether anybody has the skills to support a vaginal breech birth and if not agree to a caesarean section in labour;
- arrive at your local hospital in labour and refuse a caesarean birth (but be advised that vaginal breech birth has been shown to be safer when a skilled attendant is present).
You will need a very supportive partner or birth-attendant to help if you are planning to negotiate once in labour.
Whatever birth you end up with, we hope that you are treated respectfully, given full information and empowered to make your own choice for you and your baby.
Happy mothering - please send us a photo of your breech baby!