Vaginal breech births are, in many countries, rare these days. Cesarean sections have become the “standard of care” for breech deliveries, and if a breech baby is delivered vaginally, it happens with a lot of careful monitoring. Some homebirth midwives will attend breech births, but many more will not. Those who are contemplating unassisted childbirth may wonder what to do if their baby turns out to be breech. What are the risks of a vaginal breech birth? Would you plan an unassisted birth for a breech baby?
The majority of babies settle into a vertex, head-down position the the weeks prior to birth. Women who are any good at palpating their uterus can feel their baby’s position themselves. Otherwise, ultrasound will be needed to determine the baby’s exact position with certainty (although a fetoscope can also be of help, as it allows parents to find out where the heart is located).
The few babies who are not head-down by the time they are ready to be born are breech. There are several different breech positions:
- Frank breech is seen as the least risky breech position. The baby’s bum is pointing toward the birth canal and the feet are near the baby’s head. The bum, thus, will be born first.
- Complete breech babies have their bums down, but their legs and feet also in that area.
- Footling breech means the feet and legs will be born first.
It has to be noted that breech babies can turn right before labor, or even while labor is already in progress.
Laura Shanley, a well-known figure in the “UC movement” (in inverted commas, because I don’t believe there is really any such thing – we are all just individuals), choose unassisted birth for a breech baby as well, and discusses it on her website. Breech has been discussed as “just a variation of normal” on discussion boards for women who are preparing for an unassisted birth.
And, in my country of residence, vaginal breech births are still common – I know several women who have delivered breech babies vaginally without much difficulty, and the one who asked for a c-section got turned down. The only difference in procedure for breech babies is that women who are giving birth to a breech don’t get their labors augmented with pitocin. That does not mean vaginal breech deliveries are safe – the hospitals suck badly in this part of the world, and risk (and death) is not something many hospitals care about very much. Vaginal breech births are cheaper than c-sections, that is why they do it.
Is breech birth really just a variation of normal, something that implies that the risks are no greater than a vertex birth? The answer is that breech births have a significantly higher risk of becoming very complicated (as in, dangerous). Before we take a look at those complications, it is also very interesting to see what the risk factors for breech are:
- The mother is a multipara or is carrying twins.
- There is too much or too little amniotic fluid in the uterus.
- The mother has a history of preterm labor.
- The mother’s uterus has an abnormal shape, like a bicornuate uterus.
- Growths such as fibroids are present.
- The baby has a birth defect.
The last is especially interesting. It has been suggested that babies who have birth defects may be in the breech position for that very reason. The baby is unable to turn vertex for some reason. Even the most mainstream sources note that most breech babies, including ones that were born vaginally, are perfectly healthy. So, what are the risks related to vaginal breech births?
Umbilical cord prolapse is always a serious complication. It involves the umbilical cord sipping out of the vagina before the baby is born (completely), resulting in the cord being compressed and oxygen supply being compromised. As you can see from the (attended) breech homebirth video embedded above, cord compression is almost inevitable with vaginal breech births. Because the baby’s oxygen supply is at risk, it is crucial that the baby’s head is born quickly after the body. In the video, it took five minutes for the head to be born. The baby was fine, but it shouldn’t have been much longer.
Head entrapment happens when a breech baby’s body is born fine, but the head will not come out. If this goes on for a while, the baby is at risk of dying or suffering brain damage, because the cord is no longer able to supply him or her with oxygen. Still, it is important in vaginal breech birth situations to avoid tugging on the body to get the head out, as this can obviously cause damage.
Unassisted breech birth?
All in all, I would personally not choose an unassisted homebirth for a breech baby, if I had reasonably safe (and in this case safer) alternatives available. I feel that fetal monitoring for a breech birth makes sense, especially during the stage where the body is out and the head is still waiting to be born.
Homebirth with a midwife may be an option, but consider how a midwife may be able to assist you. If the breech birth proceeds smoothly without complications, you will not need her. If head entrapment happens, or your baby is born not breathing or with other difficulties, a midwife will not be able to do much, if anything, more than you could yourself.
With all the risks combined, including the possibility of a baby with a birth defect, My personal conclusion is that vaginal breech delivery in a good hospital is the safest choice for breech births. Unfortunately, good hospitals are not available to everyone, and not all hospitals even offer the option to deliver a breech vaginally.
If you do choose UC
Women who are going to give birth unassisted to a breech should remember the old midwifery saying “keep your hands off the breech”. A water birth may support the baby’s body while the head emerges, and for a land birth your partner’s (if you have one) hands can support, but not pull on, the body.
The head should not be born more than ten minutes after the body, and ideally the head’s birth should occur sooner. Keep in mind that you may require medical care for your baby immediately following birth, and prepare for that possibility accordingly. At the same time, I don’t want to be alarmist. If you are having a planned unassisted breech birth, midwife-attended homebirth with a breech, or you find yourself giving birth precipitously to a breech baby without having planned for it, the chances are still very high that your baby will be born perfectly health
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