Sunday, March 8, 2009

Breech vaginal birth is NOT an emergency

In my continuing crusade to shoot down OB myths, this week I am tackling breech vaginal birth. This post has taken a lot longer to write than I thought it would. At first I thought I was having trouble with the amount of information available about it, but that isn't the problem. The problem is that I can't really understand why breech vaginal birth is considered an emergency in the first place. Sure, I know that there are risks associated with breech vaginal birth, but I just can't shake the idea that babies are born breech all over the world with little fanfare or issue. Nevertheless, obstetricians continue to look for more and more excuses to avoid the topic entirely by just cutting the babies out. So, in the interest of being thorough, here is some food for thought.

According to this article, "Vaginal breech deliveries were previously the norm until 1959 when it was proposed that all breech presentations should be delivered abdominally to reduce perinatal morbidity and mortality." Typical of obstetric mentality, instead of looking at the cause of morbidity and mortality in the first place, they chose to focus on the correlative factor instead - that many babies who presented breech had a high rate of injury or death. But as far as I know, no one thought to ask if medications, managed, or instrumental delivery could have contributed to those injuries or deaths.

Fast forward to today, and more than 90% of all breech births in the U.S. are delivered by c-section. This has happened largely because of a study that was done in 2000 by Hannah, et al, that shows a higher rate of perinatal morbidity and mortality associated with breech vaginal birth, as compared to planned c-section. Consequently, the American College of Obstetrics and Gynecology (ACOG) has systematically condemned breech vaginal birth, and it is no longer offered as a choice to women today. Henci Goer does a good job here of explaining why the conclusions of that 2000 study are not valid.

However, the ACOG has a history of picking and choosing those studies that support its own position. They also prefer to ignore any studies not done in the United States, as those studies are often contrary to American obstetric practics. For example:

A study out of Sweden in 2003 in the European Journal of Obstetrics & Gynecology and Reproductive Biology showed no difference between elective cesarean vs. planned vaginal birth for term breech deliveries.

Another study actually published with the American Journal of Obstetrics and Gynecology in 2006 examined planned breech delivery in France and Belgium, and found no discernable difference in outcome with more than 8,000 breech patients studied.

A different study from France in 2002 and published in European Journal of Obstetrics & Gynecology and Reproductive Biology looked at more than 500 patients and found no difference in outcome.

The International Journal of Gynecology & Obstetrics published a study in 2004 from the United Emirates which found no clear difference in breech vaginal vs. cesarean, but did find more maternal morbidity associated with cesarean section.

The Malaysian Journal of Medical Sciences, published a study in 2007, which concluded, "Most of the perinatal mortality was due to IUD, congenital abnormality and prematurity and there
were no perinatal death related to mode of delivery or due to birth trauma."

and there have been other studies to support these findings.

Danell Swim writes in her article, A Breech of Trust

So I ask you, what are the United States hospitals doing wrong for their vaginal breech deliveries?

It is NOT that cesarean section is safer for breech deliveries in this nation, it is that vaginal breech is more dangerous in this country. US hospital policy and procedure are killing more breech babies than their European counterparts.

And to remedy the situation, it’s been recommended that nearly all babies in a breech presentation be delivered via cesarean section. This is despite the study published with the American Journal of Obstetrics and Gynecology that discovered that France and Belgium are able to safely deliver them vaginally, and safely.

So rather than teach our doctors how to safely deliver a breech baby, the ACOG's answer to the breech problem is to simply take them by c-section at term.

This article describes how best to safely deliver a breech baby. Included in the highlighted points are:

  • Spontaneous onset anytime after about the 37th week.
  • No augmentation if labour is slow or there is poor progress - caesarean section.
  • Mother encouraged to assume positions of choice during the first stage.
  • Fetal heart listened to frequently with a Pinard stethoscope or a hand held Doppler Sonic aid using ultrasound.
  • Food and drink encouraged, but remembering that women in strong progressing labour rarely want to eat.
  • Membranes not ruptured artificially.
  • Vaginal examinations restricted to avoid accidental rupturing of the membranes.
  • If, and when spontaneous rupture occurs conduct a vaginal examination as soon as possible.
  • Second stage by maternal propulsion and spontaneous expulsive efforts guided by the attendant if judged appropriate.
  • Mother encouraged to be in an all-fours position.
  • No routine episiotomy.
  • Third stage without chemical or mechanical assistance, usually managed according to woman's wishes.
Of that list, tell me how many of those are likely to occur in a medically managed birth in a US hospital today?

The most dangerous aspect of this trend is that American health care providers are losing, or have completely lost, the art of safely delivering breech babies. While some doctors may envision a 100% c-section rate for breech births, that will never be possible. The World Health Organization (WHO), in this publication about planned c-section for breech says,
It will be impossible to deliver all term breech pregnancies by caesarean section. The systematic review showed that 9% of women with breech presentation still have a vaginal breech delivery because the mother may insist on vaginal delivery, breech labour may be precipitate, or special situations such as the second fetus in twins. It is therefore imperative to continue providing expertise in vaginal breech delivery to all the intrapartum care providers.

This atmosphere of fear and foreboding surrounding breech births is leading women to choose dangerous options to avoid having a breech baby at all costs. The current recommendation is to attempt an external cephalic version (ECV), in which the care provider attempts to turn the baby from the outside into a head-down position. But ECV is not without risks. According to this publication:
The largest review which included 44 studies and 7377 patients found the most common complication of ECV to be transient fetal heart rate abnormalities (5.7%). The risk of placental abruption, emergency cesarean section, vaginal bleeding, and perinatal mortality were less than 1 percent combined. Because of the risk of alloimmunization, Rhogam is recommended for non-sensitised Rh negative women following ECV. There currently is not enough evidence from randomized controlled trials to assess complications of ECV.
In addition, in order to perform an ECV, tocolytics such as terbutaline, and epidural anesthesia are sometimes used. The risks of epidural anesthesia are well-documented. Risks of terbutaline to the baby include fetal tachycardia, hyperinsulinemia, hyperglycemia, myocardial and septal hypertrophy, myocardial ischemia. Terbutaline not only does not have FDA approval but the FDA disapproves of its use as a tocolytic.

ECV is only successful 50-60% of the time (various sources). When ECV is unsuccessful, the only other option is to schedule a planned c-section for some arbitrary date. The problem with this is that breech babies can and do turn, up to, and even during labor. So planning a c-section may be taking a baby even before it is ready to be born, and without giving it a chance to get itself into a favorable position.

It is clear to me that breech birth, while carrying some risk, is not unreasonably dangerous in itself. The danger lies in breech birth in a highly managed hospital setting. For this reason, I would suggest that if a woman plans to birth in the hospital in the U.S, and her baby is breech, she should plan to have c-section. In fact, if a woman is planning a hospital birth and her baby is breech, she probably won't have a choice about it. If she does not want to have a c-section, she should stay home. But she should know a c-section for breech is not necessary! In fact, I don't even believe any undue concern should be attributed to breech presentation, especially if one has a midwife who is experienced and skilled in delivering breech babies.

If you find yourself pregnant, approaching term, and your baby is breech, please try these suggestions for gently encouraging your baby to turn. If you want to avoid unnecessary surgery, start now looking for a midwife who is experienced in breech delivery. Don't schedule a c-section - allow baby all the time it needs to turn itself. You can visit to learn how to tell whether your baby is head-down. If it comes down to the wire, and you find yourself in labor with a breech baby, stay home until you can't resist pushing any longer, then call the EMTs to come take you and baby to the hospital after the fact. That may sound a little extreme to some of you, but unnecessary c-section is about as extreme as it gets.


Laura Hopper, Midwife said...

Great post - mind if I post it to my blog - giving you credit of course?

The only thing I don't agree with is calling the EMTs at the last minute. I don't think that is a great idea for a couple reasons...
1. In the event that baby is still not born when they get there, they may not handle the birth properly. I do think breeches should be born vaginally - as long as it is hands off. The EMTs here are taught to either make sure baby stays inside (once resulting in a death of baby) or baby comes out and they can be very scared and not handle it properly.
2. Going to the hospital after the fact will cause your baby to be treated as he/she were infected because it was born outside of the hospital. I have known and heard of many stories of moms and babies being separated after transporting to the hospital after an unintentional homebirth.
My opinion of course, is to find a skilled, hands off attendant to attend you at home - or go UC.

Emily said...

Sure post away!

ITA with you about calling the EMTs, which is why I said about

1) after the fact, so the EMTs don't end up screwing up the pushing phase, and

2) while I personally think UC is the safest way to birth breech in our current OB climate, I have to be realistic that 99% of my readers would never even consider it. So I split the difference and hope that some may at least consider waiting to call for assistance after the baby is born.

If I can stop just one more unnecessarean I will be happy.

alisaterry said...

That's what pissed me off about last week's episode of Lost. The mom's baby is breech so they declare a horrible emergency and bring an O/B out of hiding to do the c-section.

I also love how she's not in labor and then all of the sudden she has one contraction and suddenly the baby is COMING RIGHT NOW! Aaaaaaah!


Birthkeeper said...

Alisaterry - LOL!! *ALL* of the birth scenes since the beginning of Lost have driven me nuts. My husband now just says "Don't even go there, just watch the show", before I can say anything. Hahaha.

Great post Em, as usual!! It drives me nuts that people believe that breech babies necessitate a cesarean. :( We must be the only country in the world who has incapable women. :-/

Tanya said...

Oh yeah I was yelling at the TV during LOST too! My DF just looks at me and says "It's ok honey. I know. Let it go" lol. He thinks I'm crazy. Did we ever see that chick (can't remember her name) breastfeeding? I don't remember seeing it and I always thought "Shes on a deserted island and isn't breastfeeding?" I guess she got "lucky" and found formula along with all that peanut butter they found lol

Vicki said...

LOST bothered me too..I didn't mind Claire's birth, but I tried hard to just shut up and watch the show w/o getting too pissed this last birth.

Thanks for putting this information together, Emily.

Melodie said...

Just wanted to say "Wow! What a fabulous post!' So thorough and educational and well written. I have always thought it was pretty crappy that women have "no Choice" when it comes to a breech presentation. If Ina May Gaskin can deliver a breech baby then why can't an OB?
Thanks Emily!

Faelyn Audrey said...

Great Post! I had to giggle at a couple parts.

1. Waiting and letting baby get into a more favorable position for birth. I did the inversion to turn my breech babe and did so successfully at 34 weeks. Fast forward to June 10th, due date. Little Faelyn decides to turn breech that morning. Little Faelyn decides to introduce herself that night. Seems Breech WAS her more favorable position for birth!

2. Calling the EMTs. Well... We were trying to be on our way to the hospital for my Midwife to delivery and never made it there. My husband caught Faye under her arm pits as she came out. He just held her so that she didn't hit the floor. We got her all cleaned up, suctioned out, and wrapped up tightly but called the EMTs because we were not educated on cord cutting (and her cord was pretty short, only came up to my lap) and I couldn't move. I delivered her in the bathroom standing up and sat down on the toilet after she was born and couldn't go anywhere from there.

That went good though. They clamped her cord and cut it and checked her out. I could not carry her out to the ambulance.. I tried to pick up the diaper bag to bring along to the hospital, but they wouldn't let me carry that either... haha. They wanted to bring the gurney down stairs to get me, but I'm stubborn and wanted to walk up the stairs myself. Faye and I rode together and I nursed her in the ambulance. They did all their "hospital stuff" in the same room as me. She was just right next to my bed. We were never separated. They treated her and myself as though we delivered there.

The most entertaining parts about her birth were:
1. Me wanting a home birth, but not wanting an UC or to delivery in my in-laws house (which I did both).
2. Me asking hubby if he would want to catch her at the hospital when she was born and him not wanting to because he would be afraid of dropping her.

The saddest part: This is my second birth, so I know that my body is more "used to" this than my first time...

Baby #1 - Born 4 weeks early in the hospital. 6lbs even. They made me give birth on my back. I tore TWICE.

Baby #2 - Born on due date at 7lbs even and Breech. I gave birth standing up and I did not tear at all.

Anyways. Sorry that was so long! Thanks so much for posting!

Emily said...

Faelyn - great story! For what it's worth, there is no "education" needed to cut the cord. You just...cut it. We had a UC at home, waited about 2-3 hours, then DH cut the cord himself, after we tied it off with a bit of ribbon.

SandraRh said...

Faelyn, I too had my DD in my bathroom...LOL...though we meant to have a Midwife there. She didn't make it in time. I caught her myself. I was great! Unintentional as it was if we ever have another it will be another UC.

Faelyn Audrey said...

Emily - I wish it were something I had really known more about because skipping the hospital all together would have been so much better! I'm half way between a very medicalized view and a crunchy view, it's hard to shake what you learned and were exposed to (100%), so having her unexpectedly at home shook my confidence for months after she was born that she was OK. I was terribly worried about Pneumonia LOL

I would still love to have a home birth (and besides going to the hospital after wards, it was the better of my two births), but I still do not think I am ready for UC. However, when we have another, I'm sure I could learn a lot more about everything and be much more comfortable with it.

paige said...

i'm 34 weeks pregnant with my 7th baby & this little one is firmly breech. i have been scouring the internet for stories of vaginal breech - & have found the information you included in your post to be totally accurate. i'm in Canada & in my province, provincial health care *just* started covering homebirths/midwives last april. i was so excited to sign up with a midwife rather than an ob this time - only to find that midwives aren't allowed to attend a breech birth??!! i'm floored. What's the point of a midwife if they're shackled & not allowed to "birth outside the box" so to speak. Routinely here, they send you for an u/s at 36 weeks to see if babe has turned & if baby hasn't, then they sign you over to an ob to try a version (not an option for me with my anterior placenta - & i'm not sure it's what i would want anyway...) i'm frustrated right now... & i'm sorry for using your awesome blog to pour out my frustrations, but i like your suggestions. i will probably go for the 36 week u/s & if babe is frank or complete breech, i'm gonna stand my ground for a natural vaginal birth (if *only* my dh wasn't so against u/c - that would be a wonderful route...)

Dawn said...

This is my second pregnancy. First one was breech, and doctor didn't give me a choice in the matter. Since I was also young (19) I thought that the c-section was the only way. Now I am pregnant with my second, and again this baby is head up. My husband and I have talked about what I should do, since I know more now, and my doctor has refused service to me because I will NOT do another c-section unless medically necessary! I have heard there is a risk of the baby's head getting stuck and dying, but last time I had a c-section, I had a severe infection from it. I admit, I'm still scared on what to do, suck it up and have a safe pregnancy. or try to fight hard for this baby to be delivered naturally! I've tried many things to turn this baby, as well as my first, and nothing.. I even regularly go to a chiropractor for help, and still nothing.
And unfortunately, here in Canada, finding a midwife is hard. Unless I know someone that had a midwife, I won't find one. because doctors won't give out that information.
Anyways, thank you for this blog!

Bob in Dallas said...

My sister just delivered a breech baby vaginally yesterday. It has severe brain damage from lack of oxygen. For weeks she's known the baby was breech and for weeks she's been trying every witchcraft thing she's found on the web to turn the baby. Midwives told her to jump in the pool several times and the baby would turn. Burn your little toe with these herbs and the baby will turn. But don't trust the doctors. They don't know what they're doing. In the end she followed the midwives and now she had a dying baby. She's 43 and this was her first. She suffered horrible bleeding and won't be able to try again. Say your prayers for the baby. Say them for my sister.

Emily said...

Bob, I'm terribly sorry to hear about your sister's unfortunate outcome. Most recent medical information says that hypoxia most likely occurs prior to delivery. I will continue to keep your family in my prayers, but it unlikely that the method of delivery caused the baby's injury.

Laura said...

Thank you for writing on breech deliveries. My little girl was an undetected complete breech, and I was having a home water birth with a midwife. Luckily my midwife had experience delivering breech babies overseas. She realized halfway through that what we thought was a hand was really a foot. I declined her offer to transport to the hospital, and after seven hours of labor, I had a perfect baby girl. No complications, apgars were 7 and 9, and I had only one tiny tear. I am so glad she was undetected, as midwives are not allowed to deliver breech babies at home, and the OB would have insisted on a caesarean. Ignorance is bliss.

Jill said...

wow this was awesome! I've been researching so much about pregnancy in america. How ingnorant doctors are regarding breach births. They aren't even taught it in school. I had a very negative experience with my 1st, too many stitches to count from being cut, holding my legs down flat, my epidural falling out, no coaching or good jobs from the staff. I felt like an assembly line. my dr telling me to shut up. This all happened in 2009 AMERICA!

I have a right mind to give birth at home with my future 2nd child. the only good thing that happened was my son was born with pneumothorax and I was in a hospital that could save his life.

I live in Chicago area, and I'm researching experienced midwives NOW. I'm not even pregnant yet.

my friend is expecting and went to some midwives in my area. she had normal tests done, and they failed to inform her of an infection. she was notified 4 weeks later via snail mail! they never called her or told her of this. she needed to be on meds immediately, and this slack in the midwife's office could have cost her not only her baby's life, but her own. she's went back to her regular doctor after she told those women off.

so, i'm very scared by not only the hospital - but by midwives not knowing what they're doing.

I have a right mind to fly to europe for my next child. They seem to know what they're doing over there. I should move to norway, lol.

*Lyss* said...

I am 41 weeks pregnant today and my baby is complete breech. We've tried *everything* for a few weeks now. (except an ECV, not comfortable with that). Baby still hasn't turned. Our midwife is not licensed to deliver a breech baby and the doctors here won't. So unless our baby turns at the last minute our only options are unassisted breech birth or c-section. I dread a c-section and don't want my baby to enter the world that way. I also don't feel comfortable unassisted breech. So overwhelmed and not sure what to do yet. I wish there were more options and experience with breech births in our country. Feels like my hands are tied!

Emily said...

Lyss - you're right, your hands are pretty tied. I have so much sympathy for women all over this country who are faced with your exact situation, whether because of breech, VBAC, twins, etc. It's a question I can't answer for you. For me, personally, an unnecessary c-section, with all its risks, both present and future, is much scarier than an unassisted breech birth. But then, I am/was prepared to UC.

Certainly waiting until labor begins is a good idea no matter which path you take, because sometimes baby do wait to turn, and that is the thing that triggers labor. Also, if you wait until labor begins, you can be sure it was the baby who signaled your body that it was ready to be born, so you don't have to worry about baby coming too early.

As far as the actual labor goes, you have a few, slightly different choices:

- As soon as labor begins, you can proceed to a hospital and explain the situation and ask for a c-section.

- You can labor until you feel "pushy," then either drive to the hospital or call the EMTs, so medical people will be on hand for the second stage (which is the part most people fear when going unassisted). But be warned: I have heard stories of women coming to the hospital with a breech baby crowning, and they have pushed the baby back up and gave her a c-section anyway. It's generally a good idea to wait until the baby's out to be around medical professionals, in the case of breech.

- Labor and have baby unassisted at home, then go to the hospital afterwards.

Whichever you choose, as I wrote in my post, hospital vaginal birth for breech can be dangerous because of the doctors' and nurses' tendency to be "grabby," which often causes birth injury to breech babies. (BTW, birth injury to breech babies can also occur in c/s). So I wouldn't suggest attempting a full labor and vaginal delivery in the hospital, personally. You'll either have to go in for surgery, or do most or all of it yourself at home.

((hugs)) Good luck.

p.s. If you are interested in more information about unassisted birth, I would be happy to give you some websites to visit and put you in contact with people who have also UCed, including myself. One of my friends, in particular, just had an intended unassisted breech birth about 6 months ago.

Anonymous said...

So I just wanted to add my story too. I am due to have my 2nd in about a week and she too is breech. She was head down till about a week and ahalf ago when she decided to go head up. My two yr old was also a breech baby, but she was breech the last two mo of my pregnancy. We tried Everything to get her to turn, even the version, with no luck and I had to have her by c-section. We have been doing all the stuff to get this LO to turn as well, and so far no go - she's still head up.

But the big difference this time is that the hospital now does breech deliveries (one of 6 hospitals in the US that will actually do them without it being an emergency). And believe me I was so happy to hear that I would not have to have an automatic c-section.

The good thing about this is that they will only do them if you pass several different "tests" first. Pelvis has to be within a certain range, size of baby's head, babys' weight and height, as well as being in a specific breech position and not having any other major health issues. To me it's great that they do this, because from what we were told and what I have read, the major causes for trouble in breech deliveries are due to the fact that the mom's pelvis is too small, baby is too big, head won't fit through, or cord prolapse due to being a footling breech.

I must say reading all the terrible things that can happen to baby, it's very scary. So I think it's a great idea for the doctors not only to be trained in doing breech deliveries but also to have these parameters set up so it can be the best outcome for baby and mom.

The physician we talked to (who has done a lot of these, some as emergencies) said I look really good for having a successful breech delivery (I passed all the "tests") so now it's just waiting on baby to arrive. I'm excited and nervous all at the same time, but glad the option is out there for me. Just wish more hospitals and doctors would give this option to other moms who are pregnant with breech baby's!

Emily said...

Anonymous - I can't say I'm terribly encouraged by your comment. While I'm glad you doctor is at least allowing the trial of breech labor, it's too bad that they've narrowed the parameters so much that only a small percentage of women with breech babies will still be "allowed" to birth them vaginally.

As for your assessment about the risks of breech, I would encourage you to re-read my post, and do more research, and you will see the studies I posted, as well as others, have found no increased risk to breech vaginal delivery, per se.

Good luck, and happy birthing!

VoiceOfReason said...

This is a great post& I just wanted to tell you about my experience.
Pregnant with my 3rd child in 11 years, I found out my son was breech around the 34-35 week mark when the ultrasound tech told me in a grave voice that "the poor little thing is breech, you'll need a section." I was very upset, as I had my first two not only vaginally, but without drugs. Fast forward. 11 days before my due date, we were scheduled to drive an hour away to try the version to turn him. We were supposed to call the hospital at 5 to see if my bed was available. Well...he didn't want to wait. My water broke at 4:15. Having been through labor twice before, I didn't rush to wake my husband up even though my previous labors/births went VERY fast (my first was 7 hrs 41 minutes from the first contraction,my 2nd was about 2 hours from when my water broke & woke me up). Well, by 5 am I had called the doctor & woken up DH & the other 2 kids for the trip to the hospital. We got turned around twice trying to find the hospital (we hadn't made our practice run yet) and I was starting to panic, not to mention in a bit of pain, lol. So...we got to the hospital at 5:52am. They brought a gurney downstairs to get me and while my husband was parking the car & getting a nurse to sit with the kids, I was transported up to the 3rd floor & into a room. The doctor checked really quick and realized he was breech & said we'd have to deliver vaginally. I said,"Are you sure? They said I couldn't do it vaginally." (I was worried since doctors are usually so quick to jump to c-section for breeches) He looked me right in the eye and said, "The difference is, I have 30 years experience." Since they had already said my husband couldn't be in the room if it meant bringing the other two kids (11 & 5 & we literally had no one to watch them), I was upset, but when the doctor said that, I calmed right down and told myself to just do it. Machete James was delivered breech, vaginally & with no drugs at 6am. I delivered him only 8 minutes after getting to the hospital and only an hour and 45 minutes after my water broke. Although his 1 minute apgar was low (very common in breech vaginal deliveries), he perked right up. He is now 7 weeks old, has been mostly sleeping trough the night since the first week, eating like a beast & growing like a weed. He is a happy & content baby & I could not feel more blessed. It was as if he knew my heart & knew that I didn't want the c-section,so he, the fates & the crappy freeways in our city all conspired to be sure I would have my drug-free delivery, breech or not. It IS possible, I did it on April 14th of this year.

Anonymous said...

Thank you so much for your research and post. I'm a first time mom in the making and am terrified of breech births. I have a very low immune system so the idea of getting cut open for a c section truly terrifies me whether I'll be able to heal properly (and timely) afterward. My baby was head down for the majority of my pregnancy, but decided to flip to transverse three weeks ago. I'm now 36 weeks along and baby is measuring just under 8 lbs (I know it's just a guess on the weight). I've used ice packs and the inverted positions to lay to try to flip her. I have an ultrasound with a very sweet doctor tomorrow. But, she's very young. I'm hoping she will encourage me to at least TRY vaginal delivery. I'm hoping that once we go into labor, baby will flip at that point.

I just can't do a c section. I just can't. Last year I had to go to the ER because a few days before I had cut my leg shaving. The cut got so infected I had to go to the ER. I can only imagine how difficult it's going to be to heal from a "gutting". Not only that, but the increased risks to my baby for entering the world via c section. I just can't stand the thought of it.

Anonymous said...

I would like to share my story and actually ask if this could truly happen. 2nd baby. Went to hospital for planned induction. Doctor broke water and was clear. Got the epidural and then realized the baby defecated. They then checked me and said that she turned breech during labor. Is that even possible? My doctor stated that since I progressed so fast (10cm in less than 3 hours that he has done several breech deliveries but that it was up to me). (like I knew what was best). Anyway..... We delivered in ER she was not breathing but ended up okay. Her vaginal area was totally black (no exaggeration) and may have had to stitch her bottom due to the pressure. Anyway. She is 6 months now but I can not stop asking myself if she really could have turned at the last minute and was that the safest route. ???

Emily said...

Anon - thanks for your comment. As I stated in the post, it's very possible for babies to turn during labor. In fact, having an epidural, having your water broken, and lying down on your back can force a baby turn into a different position than head-down, and can wedge them in against the pelvic bone like that. It's entirely possible that your baby would have come out head first if you simply waited to go into labor after the baby was well engaged and coming out.

Her bottom being black could be due to a number of things, including effects of the epidural, or forced pushing, or even your pushing position.

She clearly turned out fine, and as I pointed out in this post, breech babies generally do come out fine, if left alone. If you find yourself with a breech baby in the future, come back and read this post again and you can get some really good information.

Anonymous said...

At 38 wks preganant with my fourth, i went in for a routine check-up and was told my baby was footling breech. My OB told me to be at the hospital at 5AM the next morning to try and turn him and induce or they'd deliver by section. I was horrified and said absolutley not! My prior three births had been extremely fast and uncomplicated so the idea that I would need a section was unheard of to me. But my OB used a scare tactic and told me that my baby's head could get stuck and he could die. She gave me some drug to stop contractions because I was already dialeted to 3 and sent me home. I remember laying in bed terrified that my labor would start and my baby's hips would get broken along with multiple other things my imagination could think up. In the end, he wouldn't turn and I ended up with a section. I hated it! I felt like a piece of meat strapped to a table. I could see my reflection in the lights above and felt completely out of control and humilated. After my son's birth I studied and studied and realized that I had been a perfect candidate for a vaginal breech birth considering the fact that my previous births had been so easy and uneventful. When I asked my Dr why I hadn't been able to deliver him vaginally, she told me that insurance completely tied her hands and that she'd never had training in vaginal breech births. So, it had had nothing to do with whether or not it was safe or if I was capable. My condfidence in the medical establishment went out the window and I became determined to educate myself. To make a long story short, I haven't stopped studying since then and have gone on to have two VBACs, my last a UC. I have worked as a midwife's assistant and am planning to become one when my kids are older. I am currently pregnant with my 7th and am preparing myself for a homebirth, breech or not. So my mission now is viewing and reading as much as I can about breech birth and how to handle it. Any book recommendations would be appreciated. I keep feeling the need to focus on this topic and be prepared.

Emily said...

Anon - thanks for your comment, and congrats on your VBACs! As far as books go, I don't know off-hand of any books on breech birth specifically, although I know Sheila Kitzinger often deals with breech birth naturally in her books.

Anonymous said...

I came across this website while looking for breech birth stories the other night and I really enjoyed reading the different articles! My husband and I have been practicing many similar things on our own such as attachment parenting, co-sleeping, being very careful about vaccinating, natural living etc... We come from a very "medical" background and we've had to study things for ourselves and kind of "go against the grain" when making decisions for our family. With the views that surround us, we sometimes wonder if we've just gone off the deep end. It was very refreshing and encouraging to find these views shared here. Thanks for your blog!:)

From the previous anonymous

gallipot said...

Good post. My son was born via precipitous footling breech vaginal delivery at 27 weeks. He had very low Apgar scores and massively bruised legs due to the method of delivery, but thankfully, the footling breech presentation caused no other complications. I honestly don't know whether planned breech vaginal delivery is an option at my hospital, but I believe it should be an option at all hospitals because of emergency cases like mine, where experience with breech vaginal delivery is needed.

Anonymous said...

I just had my first baby at a free standing birth center with a midwife. She had been head down the whole pregnancy and flipped a couple days before birth. The midwife didn't realize she had turned until the baby was presenting. Because of the laws in our area the midwife's assistant had to call 911. My midwife had me change position and push by the time the medics got there everything was out but the head! Within seconds of the medics arriving the head came out. Thankfully the just stood back and let the midwife do her job. My daughter is fine and so am I. She was 6lbs 12oz and I didn't even tear or anything! Thank the Lord we didn't know til the last minute because I wouldn't have wanted to have not been able to have the midwife and I'm too informed to go to the hospital and let them give me a c-section! Baby didn't breathe for 90 seconds after birth so I'm glad midwife was there.

boxermom said...

Love your post. I'm currently 41 weeks + 1 day, planning a home birth, and baby has been persistently breech for several weeks now. I've tried everything from hand stands in the swimming pool to acupressure to chiropractic, pelvic tilts, pulsatilla, lying inverted, and ECV. My midwife is still trying to work with me but she's getting nervous and I have an appt later today with her and another midwife (more experienced in breech births) where they will decide whether it's still safe to have a home birth. She's threatening me with a c-section and I just loathe the idea of having to be sliced open! I've never had surgery for anything before and I certainly don't want my baby cut out of me! I'm so frustrated at the moment! I wish he would just flip over so I wouldn't have to stress about it. I just emailed your article to my midwife. I just don't feel like this is an emergency and don't think that surgery is necessary!

Rahime said...

I realize this is an old post, but just wanted to add a quick comment. I was able to vaginally deliver a breech baby in a hospital. 3/5 of the OB/GYNs at the hospital did breech births, and when the person on call the day I delivered wasn't one of those three, one of them came in and delivered walked the other dr. through the process. So, SOME hospitals in the US are encouraging and teaching this skill. Yes, we also had to fall under their precautionary "requirements," of pelvic diameter and estimated fetal weight (which was over-estimated by almost a pound, BTW), but it's a step in the right direction, I think. I had planned a homebirth, but our midwife wasn't comfortable doing a breech delivery and hubby didn't want to go the UC route, so I was thrilled to find a hospital where I wouldn't have to have my baby surgically.

Breech Birth said...

I am writing to tell you about Breech Birth Australia and New Zealand (BBANZ) and to request that you provide a link to our website on your page>

I formed BBANZ in 2011 after a successful vaginal breech birth. I was very disappointed in the lack of support for vaginal breech and feel that there is a real need for women facing the 'breech situation' to make contact with other women who have been through the same thing, for moral support.

We have a very active Facebook group (, with over 100 members, about half of whom are mothers of breech babies and half are midwives with an interest in breech (a couple are both!). We also have a website (, although it is still incomplete.

We don't seek to provide medical advice but we have lots of support and information to share with other women who are distressed after finding out their baby is breech. We also help provide links to care-providers who might be able to provide a second opinion on whether a vaginal birth is a good option. Plenty of our members have had caesareans for breech too - we are supportive of all breech mums and their choices.

We are also involved in various initiatives to improve options for vaginal breech birth, including the Coalition for Breech Birth conference in Washington in November (, a conference in Sydney this November ( and we are in the process of organising workshops in Melbourne after the Sydney conference with three international experts in vaginal breech. The speakers will talk about the latest evidence on vaginal breech birth taken from a recent Frankfurt-based study, as well as the techniques of upright hands-off vaginal breech birth.

It would be great if you could mention our support group on your webpage.

Another Emily said...

I loved reading this article and the comments that followed. I am, unfortunately, finding myself in the position that I am scheduled for a c-section for the delivery of my 4th and 5th children. I live in CA and have Kaiser for insurance coverage, to give you a bit of background. I am pregnant with twins. My previous 3 deliveries have been unmedicated vaginal deliveries attended by midwives in a hospital setting (as is required by my insurance). When I found out I was pregnant with twins, literally the only thing I was concerned about was having a c-section. After many appointments with my OB (they won't let me see midwives for a twin pregnancy) where I left in tears, he and I had a "come to Jesus" talk. He told me that of any of his patients I was a prime candidate for a vaginal delivery and I shouldn't be worried - the caveat being that Baby A had to be vertex, Baby B could be delivered breech. Now, at 37w3d, my Baby A is still presenting frank breech and my hopes of another unmedicated vaginal delivery are starting to diminish. My OB even had me meet with a High Risk OB to discuss vaginal delivery with Baby A presenting breech, and though (according to everyone) I am a good candidate for that (as I have delivered a 10lb7oz child) it is too "unconventional" and they are not comfortable doing it. I just want to cry!!! Too bad I can't get on a plane and fly to Europe...and the husband is not at all comfortable with "accidentally" having a UC at home for our twins.

Thanks for listening to my pity party!

Anonymous said...

Thank you for this. I am in the same boat at 37 weeks now. I know I have the right to refuse a c-section but then I have to put up with doctors and nurses that are not skilled at delivering breech. I think it is sad that laws force skilled midwives to abandon their clients under these circumstances. I think I would be better off alone than in a hospital with an untrained doctor poking and prodding at me and my baby. This is my 4th baby...the last one was posterior with a very stubborn lip...I birthed her at home...a butt first baby does not scare me one bit!!

Chelle Girl said...

Hi lovely ladies. My breechling is now 10 yrs old. In the end I succumbed to a c-section with her because the Term Breech Trial had just been released and I could not find a care provider willing to catch her vaginally in a hands off way. It wasn't informed choice. I WAS informed, but it wasn't a choice.

I wanted to let you know there is an organization called the Coalition for Breech Birth, seeking to expand breech skills in North America. They are having a conference this November in Washington DC. I know this is an old post, but I am hoping anyone seeing this can share the information around, especially with care providers, though consumers are most welcome as well. Here is the link

Emily said...

Thank you Chelle Girl for that link. I will post to Facebook.