Monday, November 2, 2009

Why should a breech baby mean an automatic c-section?

I feel very strongly something is wrong with this practice of automatic c-sections when the baby is breech. After all, merely a generation ago breech births were considered almost routine. I know many people who were born breech. I do realize there are more risks to a breech birth, but why does it automatically have to be a c-section?

I suspect that at least a part of it is because the doctors making the decision about the delivery are thinking short-term. They don't really know their patient, and they certainly won't have to meet her in a year or two, when the risks and complications from the (perhaps unnecessary) c-section present themselves when she is pregnant again. If this time she truly is in need of a c-section, performing two of those makes it highly unlikely for her to have a natural delivery in the future.

I think it's a point of grave concern that these days, as my doctor told me, young doctors are not even taught how to deliver breech births, and rely entirely on c-sections. This means short-changing women who could deliver a breech baby with no complications if only they were given a chance.

Read this article; it seems that in some countries, the medical community is starting to become more open-minded towards this issue. I hope Israel follows.

Also take a look at this article about a campaign to stop unnecessary inductions.

33 comments:

justme27 said...

There's a very good book out there called "Ina May's Guide to Childbirth" by Ina May Gaskin.

Have you seen the movie, The Business of Being Born? It's very informative. :)

Gothelittle Rose said...

In my case, I think the doctor did best with the ECV (turning the baby in the womb) when my daughter was breech at 36wks. Then the midwife used pitocin to strengthen my labor, which I hated at the time.

I've since found out, though, that the baby was born at 8lb 13oz (over the weight for breech vaginal delivery) and she was born with the cord around her neck (but suffered no damage thanks to an accelerated labor/delivery)...

I'm very, very glad I didn't have to have a C-section.

I do admit, though, that the pitocin with my second and my first having to have been induced (my water broke on its own and labor wasn't strong) has kind of dampened my confidence in my ability to give birth on my own. That, and pitocin labors are dreadful! But all the same, I know modern medicine has done a lot for both my deliveries and I've got two healthy children for it.

Heather said...

I don't know how the law works in Israel, but here in the States, many docs opt for a C-section due to fear of being sued. I would assume that the doctors have more confidence in their ability to perform a common operation than in their ability to manipulate a baby in the womb.

Front Porch Society said...

I have an excellent doctor-patient relationship with my doctor. And most people that I know who are pregnant usually do too here. The same doctor you see every checkup is the same doctor that is there in the delivery room. So they tend to know their patients.

I know I can't ever medically have kids, but if I could....there would be no natural delivery for me. My bone structure is such that it is not shaped correctly or large enough to allow a baby to be delivered - I would have to have a C-section.

But I do know that some of my friends who had C-sections said it was harder to get off the baby weight vs when they had a normal delivery. That would be interesting to find out why that is.

A Joyful Chaos said...

My second child was breech and thankfully I had a really good midwife who told me what to do to get the baby in the right position. Uncomfortable yes, but at least I could do it alone and I didn't have to have a C-section.

Rachel said...

Well, I've been blessed to have three vaginal births, but my last delivery (twins) ended up being a csection, in spite of them both being head down (one of them rolled over onto the others cord, and there massive heart decels during contractions). Given that they gave me an epidural and effectively strapped me down into an "on my back position", changing positions to see if that helped, wasn't an option...

And now, I am in the "great" state of Oklahoma--where babies being delivered by mothers with one csec (regardless of reason) are, a good 90+% are required to be born by another csection, simply because there is no hospital around that will deliver them VBAC. State law doesn't permit it, except under certain circumstances. And while I know I can deliver vaginally, and would have done it with the twins, I won't be permitted to do so, if I go to my local hospital. Frankly, a homebirth sounds good, but I am almost on the outer-limit driving distance-wise for the midwives who do homebirths. I am hoping that when, if, we are blessed again, I will be able to convince one of them to drive down here. Because otherwise? I'm stuck either delivering at home unassisted, or going to a hospital and going under the knife FOR NO REASON--other than that I was blessed to have twins, who needed surgical delivery...

I am angry, very angry. But I have fast deliveries, once I go into labor. So driving to another state is not an option. Shoot, driving to the hospitals that *will* deliver VBACs, are too far away, too. I don't want to deliver on an interstate emergency lane!

I'm angry, but I am praying for change.

Anonymous said...

A lot of women and babies used to routinely die during labor and delivery. As a woman, I am thankful for the availability of c-sections.

Mrs W said...

Anna, with the baby I just birthed...I was in the hospital at my midwifes suggestion even though I wanted a home birth. I was within 15 minutes of my c-section for my breech 10 lb baby. However, right before they took me down the hall to get my medicine, the doctor did another ultrasound. The baby had turned (this was after the midwife manually turning him at 39 weeks).

After I left the hospital, my baby went breech again. He kept flipping right up until a few hours before he was born. But I delivered a 10 lb baby who had been breech until over 40 weeks at home in a birthing pool. It was wonderful.

Kacie said...

That's the problem -- very few health care professionals have done natural breech deliveries. So if you wanted to do a natural one, it would be difficult to find someone with reasonable experience.

I'm pro natural birth, and had one with my son. If a future child of mine is breech and can't be turned, I'd probably opt for the c-section, but that's just a personal choice.

I hope it doesn't come to that!

Genipher said...

I think it's sad that doctors aren't trained to handle breech births. From the few breech homebirth stories I've read on the web, it seems all it takes is patience, timing, and quick hands to get the baby out.
I also think the hospitals prey on our fears. The underlining idea on breech births is that if you DON'T have a c-section, you or the baby will die. sigh.
I've been blessed to have 3 normal, homebirths. If I WERE to have a breech, I'm confidant that my knowledgeable midwife would be able to help me with the birth.

Samara said...

Anna, I could not agree more. While I love the possibilities provided by modern medicine, automatic csections for the delivery of all footling breech babies is not a wise policy.

One of my friends who is a paramedic has delivered many babies over the course of her career. She insists that breech births are common and that the only thing that she has to do is put her hand in once the baby starts to emerge, to make sure that its chin is down toward its chest. That's it, that's all. If the chin is not down, its neck could be pulled injuriously or fatally during delivery. She said it's never been an emergency for her to deliver a footling breech this way, you just have to know what you're doing.

Ways of Zion said...

completely off topic but a modesty in Israel question. No short sleevs? 3/4 lenght is ok? um and open toed sandel ok or not? don't want to cause offence especially while we travel through the Shomron!

Thanks!

Mrs. Anna T said...

Ways of Zion,

That really depends on where you are going. In Jerusalem, it's better to opt for a long skirt and at least 3\4 sleeves, while in the Shomron you can even wear pants and short sleeves in most places without attracting any attention. Sandals should be OK but it's getting colder so I doubt you'll need them.

Ways of Zion said...

Thanks! I wear a long skirt everyday anyways....only own 1 pair of pants for when it is -40C outside...but most of my t-shirts are just that, not 3.4 lenght. I do have a couple though and will pack them...

too cool for sandles oh dear! maybe I'd better repack some of the kids clothing....

The Stay at Home Wifey said...

I am glad that when my mum delivered me c-sections were still seen as a last resort and rare in Scotland at the time. I was lying double breech, even after labour started. The doctors actually turned me 3 times, only for me to turn back to where I was comfortable. Finally my mum refused to let them turn me again, but just before it was too late I turned by myself. I was a 10lb baby delivered naturally with no pain medication.

I wonder sometimes how many babies would actually turn by themselves if only the doctors would stop being so eager to use surgery.

I am currently 11weeks pregnant, and I will be homebirthing our little one. The thought of going into a hospital here in Florida terrifies me, especially when this part of Florida has a 70%+ c-section rate on ALL deliveries.

I am so thankful for those who choose to become home birth midwives, so I can choose to birth the way God designed it.

Mrs. Anna T said...

"here in the States, many docs opt for a C-section due to fear of being sued."

Same here.

Mommy-moto said...

I have wondered the same thing myself: I also wonder why if a mother goes in for an induction, she is bound to the bed, not even aloud to get up to use the toilet.
Here in America, many colleges only have a paragraph in a text book on breech deliveries. The useful tool of the c-section has become an abused crutch.
I delivered my son via c-section. It may have been necessary, but it may have also been avoided if I had been aloud to walk and move after the doctor ruptured the water membrane.
I America, a big part of why so many unnecessary, yet potentially necessary, procedures are being done is so no legal charges are brought up against the doctor. They tread of egg shells every day, in hopes that if they don't do what someone wants (wants, not needs) that they'll get sued.

Michelle Potter said...

Samara,

I wonder if you meant to say "footling breech" or just "breech"? Vaginal birth with a footling breech baby is actually very dangerous -- much moreso than any other form of breech. When a baby is footling breech (feet first), there is nothing blocking the cervical opening and the cord may prelapse -- that is the cord may fall out and become pinched, which cuts off oxygen and blood to the baby. A head-down baby's head blocks the cervical opening and prevents this; a frank or complete breech baby's bottom does the same.

My third child was born footling breech. She was head down the night before I went into labor, but turned in the middle of the night! I woke up in the morning when my water broke, labor started immediately, and by the time I even realized what was going on she was born up to her naval -- feet first. I never even consciously pushed!

I'm a big supporter of normal birth, even for breech babies. I had an unnecessary c-section with my first child, and fought tooth-and-nail to avoid it with the next four. (My fifth child ended up needing a c-section, but only after all other options were exhausted.) And I believe that my footling breech baby was born exactly as God intended, since the circumstances of her birth led me to believe that had we even attempted to go to the hospital she'd have been born, and probably died, on the way. But I would not say that intentionally delivering a footling breech baby vaginally is wise or safe. Even ICAN (International Cesarean Awareness Network - ican-online.org) suggests that a c-section is the best option for a footling breech baby.

Anonymous, it is true that many more women used to die in childbirth than do now, but that is mainly due to our improved understanding of sanitation. When women first began having babies in hospitals, those women were MORE likely to die in childbirth than women who birthed at home. The reason for that was that doctors did not yet understand germs, and would go from one patient to another -- even from a corpse in the morgue to a woman in labor -- without washing their hands. The discovery of germs and proper sanitation technique has been one of the greatest boons of the modern age.

It is also true that c-sections can be wonderful, life-saving surgeries that give mothers and babies a chance they would never have otherwise. However, the World Health Organization has determined that the optimal rate of c-section for a developed country is between 10% and 15%. Any less than 10% and women are being denied life-saving surgery, any more than 15% and women are undergoing risky surgery with no benefits. The current c-section rate in the U.S. is 31.8%, suggesting that at least HALF of all c-sections in the United States are unnecessary.

Anonymous said...

I totally agree with you that c-sections should not be mandatory. However, sometimes the baby can't be turned and it doesn't end well. My friend's brother can
't walk because of a bad breech birth. His mother would have liked the option for a c-section. It wasn't one for her. So it maybe isn't 100% bad.

Miss Kelsye said...

Breech births can be delivered without the help of a c-section. One thing to keep in mind is that the shoulders of a baby is the widest point so you do have a chance of the shoulders getting stuck behind the pubic bones. The worst way to deliver a baby is in the missionary ( delivering on your back) position (breech or not). Yep, the most common way to deliver a baby in a hospital is actually harder on you and the baby and can be dangerous. For a breech presentation you would either need to be on you hands and knees or in a squatting position. The hands and knees is the ideal position because your pubic bones are open to their widest point. If you have a experienced midwife she might try to manually turn the baby or wait and see if the baby will turn by itself before you get to far dilated. Many healthy babies have been born breech. Some Doctors might opt for a c-section if either they are: new to the field or they are becoming impatient. That is why it is very important to get your doctors vaginal births to c-section ratios before birth. Most doctors will be willing to share this information with you.

Have a very blessed day,
Kelsye

Shannan said...

i was born breech, my mother delivered naturally. it was a rough birth, but she laughs when she talks about it... 'oh, she had to be difficult from the start... came out mooning the doctor, what a troublemaker!' ;-)

but seriously, her doc pushed for natural, too bad they still don't

Jo said...

In Australia I think it is all about being sued and increasing the cost of insurance for doctors. C-sections are on the rise, with many women opting for it so they can have the baby on the "right" day.

As to home-birthing, the government is making it so difficult for midwives to practice that it is becoming too expensive for some families to chose.

Betsy said...

Regarding the increase in c-sections, I'd encourage you to find the book "Complications" by Atul Gawande (I think it was "Complications", it might have been "Better" by the same author). There is a chapter that describes the transition from a highly trained use of forceps to the c-section. Doctors used to be trained in, I believe, 30 or so different methods of turning and "adjusting" the baby with the use of forceps, but because those techniques were so difficult to teach they transitioned to just using the "easy way out" of the one-size-fits-all c-section. Fascinating stuff, especially from the perspective of a surgeon. I think inductions and c-sections can be a great blessing to some women, but I do agree that they are greatly overused for often ridiculous reasons.

Mrs. Reverend Doctor said...

My homebirth midwife will deliver a breach baby to a woman at home as long as shes already had a sucessful vaginal delivery. Otherwise to the hospital you go.

Michelle Potter said...

I'm sorry, I made a mistake in my previous comment. The World Health Organization says that the c-section rate should not be less than 5% -- not 10% as I stated before -- and should not be more than 15%.

Andrea said...

Anna,

Canadian doctors are starting to come round in lots of ways, not just with breech deliveries. Midwifery is becoming a regulated and recognised practice in many provinces, which is causing the rest of the provinces to lobby all the harder for the same recognition. I am pleased and hopeful to think that if/when it is my turn to prepare for the birth of my children, these new changes will have become firmly and safely entrenched in our medical system.

Anonymous said...

I've not had to deliver a breech, but my fifth was a C-section. Something was wrong, I "knew" it. It was FIVE loops of cord around her neck. Recovery from a C-section is HARD! And the weight doesn't come off as easily. No one should be subject to a C-section because a doctor is afraid of being sued, or is just plain uneducated.

My brother was a breech baby, a "spontaneous unassisted breech delivery" right there in the hospital hallway (on a gurney), while the professionals tried to decide what to do. He turned out just fine.

Mrs. Anna T said...

Ladies, thank you all for your wonderful comments. Michelle, thanks for giving the WHO statistics. I knew a large percentage of C-sections s being performed unnecessarily, though I didn't know the numbers.

Michelle said...

I read a recent article where a woman was refused insurance because she had had a previous c-section. To get insurance, she would have been forced to be sterilized.
The health system here is very screwed up!

Elena Michalev said...

I was born breech (in Russia, in 1985), and I was almost 9 lbs (4 kg!). My mom asked them for a C-section, but the doctors said "No, you should be fine", and they were right... so here I am... :)
Here in USA, if a baby is breech, they tell you "You MUST have a c-section", they don't even want to give you a choice. Obviously nobody can force it on you, but they will try to pressure you into a c-section.

Anonymous said...

You should tread very carefully in this. I know it is common practice on blogs to question medical practices, but there is a higher rate of adverse outcomes associated with vaginal breech births.

There is absolutely no shame in a woman having a c-section, if that's what her doctor recommends (and hopefully she has a good relationship with him/her and trusts their judgement).

Anonymous said...

I agree about treading carefully.

I had an unmedicated attempt at a delivery of a baby in an abnormal position. The cord prolapsed during the pushing phase and we were rushed into emergency surgery to save both our lives. We are both here due to a c-section.

I suffered permanent damage due to the attempt at regular delivery. I was not informed he was in an abnormal position until after the birth (he was bottom down and subsequent doctors said the attempt never should have been made). My entire pelvic floor was damaged, ligaments torn and stretched to the point that I was incontinent and suffering from a severe uterine and bladder prolapse at age 32, after my second child, a planned c-section. I required a two hour surgery to correct the damage, after doctors said I was so badly damaged, I could never have another child. The surgery included a complete hysterectomy and repair to my damaged bladder. The nerves to my bladder have been permanently damaged and I need to take medication daily for the rest of my life to help regulate it. I will also likely require future surgery for prolapses and of course, I can't have any more children, though I would have liked to. All the damage was attributed by several experts to the attempt at a normal delivery. I would much rather have had planned c-sections with several children than go through what I did. There is a valid reason for some c-sections and it adds insult to injury when mothers who have good deliveries question the "need" for them.

CappuccinoLife said...

I think you are right, that this trend is a result of short-sighted thinking.

Actually, with any scenario, c-section would be my last choice, an absolute emergency. That is because a c-section would put me and future children at higher and higher risk each time I had a child. Many people don't understand and feel a section is "no big deal" because they will be permanently finishing their family after two or three children anyway.

Questioning the rates of c-section and their necessity in certain situations is not questioning the individual choices of women who have had them. :/

In spite of our high rates of surgical childbirth, America has dismal morbidity and mortality rates when it comes to birth. There *is* something wrong with this picture. That doesn't mean that every woman who has had a c-section has had one for the wrong reasons, and it is unfortunate when people take serious offense over a generalized discussion. :(

Of course there is no shame in taking action to save your baby! If that is what is needed, hop up on that operating table and tell them to hurry up and help your baby out. It is *great* that we have the ability to do that. It is not so great that women are pressured or manipulated into things they do not need, for reasons of liability or because of a doctor's own personal biases or his lack of education.