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They Say: C-Section Not Best Route for Breech Birth

By Madeline Holler |

breechChanging guidelines with regard to breech births has Canadian obstetricians and gynecologists scrambling to train doctors to deliver breech babies vaginally.

The Society of Obstetricians and Gynecologists of Canada issued new guidelines this week calling for doctors to no longer automatically schedule moms for c-sections of their baby is positioned to enter the birth canal buttocks or feet first. They say a reassessment of earlier trials shows that babies and mothers do not suffer worse outcomes in vaginal breech births than those who opt for c-sections.

So, they decided, it’s a matter of the mother’s preference.

Problem is, most medical schools stopped training docs to deliver breech babies vaginally and there’s a tremendous shortage of those who can. So the SOGC is launching a nationwide training program.

The professional group points out that women carrying breech babies won’t be denied c-sections. Rather, there had been plenty of demand for vaginal breech deliveries but not enough trained doctors to attend them.

I wonder if American doctors are paying attention.

Anybody deliver a breech baby vaginally? Would you do it again? Anybody have a doctor tell them no?

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About Madeline Holler

madeline-holler

Madeline Holler

Madeline Holler is a writer, journalist, and blogger. She has written for Babble since the site launched in 2006. Her writing has appeared in various other publications both online and in print, including Salon and True/Slant (now Forbes). A native of the Midwest, Madeline lives, writes, and parents in Southern California, where she's raising two daughters and a son. Read bio and latest posts → Read Madeline's latest posts →

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21 thoughts on “They Say: C-Section Not Best Route for Breech Birth

  1. Cali Mom says:

    Quick question – does anyone have a link to the new evidence they are talking about. I am just wondering, since doctors have not performed vaginal, breech births in so long, how can there be new evidence that they are safe.

    In any case, I think it is good to give women the choice, as long as the family does not sue in case something goes wrong because of whatever choice they make. I used to work with doctors, and you would be amazed what people will sue for.

  2. Ali says:

    I thought the main reason a c-section was called for in the case of breech deliveries was the danger of the baby suffocating or suffering brain damage. So now is it okay for that to happen so a woman can choose her dream delivery?

  3. ChiLaura says:

    Cali Mom, good question re: where is the new evidence come from? I’d be curious, too.

    This news is relatively amazing. I’ll be really interested to see what happens in the future.

  4. Shana says:

    Well Ali, obviously this is a sign that these babies are not being born with brain damage or dead from lack of oxygen just so the woman can have her dream birth. Several midwives I talked to when trying to find the right one for me admitted to performing breech births (of course, a majority said that they would much rather transfer a woman to a hospital). There are a lot of risks that come with cesareans. They save many women and babies from death or injury, but why have surgery if it is not even necessary?

  5. mbaker says:

    In many cases it’s possible for trained doctors, midwives or chiropractors to safely turn a breech baby before you deliver. Unfortunately, a lot of obs don’t know how to do it and go straight for the c-section. My son was breech until the end and my midwife had made plans to either have an expert chiropractor or her and her partner midwife try to turn the baby.

  6. Cali Mom says:

    mbaker – good point about doing that procedure to turn the baby. OB’s usually try to perform this procedure also. (At least here in the Bay Area.) I am assuming that the article is talking about those babies who cannot be turned, and have to be delivered butt- or feet-first.

  7. PlumbLucky says:

    No personal experience but we were told that the hospital at which we delivered, no doctor would permit a vaginal breech nor a VBAC. My guess is that these two types of deliveries are possibly considered insurance red flags? (Speaking as an American, not a Canadian. I know nothing of how malpractice/insurance works there. I have heard from my friend, who is a high risk OB, what she pays for her insurance premiums though, and it is not cheap.)

  8. Zanne says:

    My sister-in-law delivered her breech baby at home, in a quick and smooth delivery with no complications.
    While there is some risk of asphyxiation in the birth canal, much of the risk can be ameliorated through upright labor positions, and a water birth (air contact on the skin prompts the baby to try to breathe; if the baby is still submerged as long as the head is still inside the mother, it will not try to breathe, and thus will not suffocate). And apparently, there is now research demonstrating that the risk is not so great as people have believed! I am very glad to see that, and excited that Canada is willing to change its policies.

  9. Sheri says:

    My mom gave birth to three children. The first one was breech. She said it was her worst birth ever. And her second child was hydrocephalic with an abnormally large head. Both of those children died. My oldest brother died at 1 year 1 month and one day due to infection from having his fontenels reopened. The second one died from complications from the hydrocephilis.
    Anyway, I don’t think I’d want to chance it, but I didn’t find my c-section procedures or recoveries to be any worse than my completely natural vaginal birth.

  10. My daughter was a breech home birth, and it was smooth and easy. Obviously that’s just one account, but with attendants who know how to deliver breeches safely, I’d prefer it over the risks of surgery.

  11. jenny feldman says:

    This is very encouraging. I hope US doctors are listening.

  12. Morgan says:

    Wow, I don’t know if I would be okay with having a vaginal delivery if my babies had been breach. I’ve had 4 c-sections and wish I could have delivered naturally. If my baby were breach, I’m not sure I would take a risk of delivering vaginally.

  13. Corinne says:

    I know I’m adding this in late but my son was born in April and he was breech. I pushed for close to 3 hours without making any progress. I don’t think it would have been physically possible for me to deliver him vaginally. It may have been easier if we had known he was breech but he flipped himself sometime between my last appointment (a thursday) and when he was born (the next monday).

  14. amy says:

    I was pregnant with my twin girls some 12 years ago. Baby A delivered just fine vaginally after 2.5 hours of labor. Her sister (breech) came 9 minutes later. The first 5 of those min were excruciating with the doctor manually rotating her, hand in my womb! Born vaginally, both healthy :) The 5 min or so was painful but within half hour of delivering I was in the shower feeling fine. By that evening I was bopping down the halls feeling better than I had in MONTHS! I would do it again in a heartbeat. Have never had a C-section but understand recovery can be rather painful.

    Side note, I was told an epidural would not be available as I was not a high risk pregnancy. What?! Twins, one breech is not high risk?! Didn’t need it blessedly.

  15. Jonathan Schrier says:

    My son was boring breech vaginally. We didn’t know he was breech. The nurse was making my wife push and saw three time black come out. another nurse came in and was saying what are you doing making her push that not his head. The where running around to find out what to do the doctor came in and said it was to late it has to born vaginally. It was painful to watch and now my son might have brain damage for it

  16. Jonathan Schrier says:

    My son was boring breech vaginally. We didn’t know he was breech. The nurse was making my wife push and saw three time black come out. another nurse came in and was saying what are you doing making her push that not his head. They where running around to find out what to do the doctor came in and said it was to late it has to born vaginally. It was painful to watch and now my son might have brain damage for it

  17. Penn Girl says:

    My dad is a retired OBGYN and delivered hundreds of breech babies vaginally. I think they all (or almost all) had perfectly healthy outcomes, but parents and doctors don’t really like to take any risks when it comes to delivering babies. Well, really, they would rather deal with the highly likely risks associated with c-section, which can be serious but are usually very treatable, versus the much smaller risk of brain damage or death due to asphyxiation in the birth canal, which is a much more remote but also much more devistating if it occurs. I think rational minds can differ on whether that is the better course of medicine, but that’s why it’s done.
    Oh, and yes, my dad and his fellow retirees do bemoan that breech deliveries, use of foreceps, etc. is a “lost art,” usually while they are at the nineteenth hole…Very cliched.

  18. Jenna Rose says:

    Cali Mom–There was a study in 2000 called the Term Breech Trial. It was a randomized controlled trial that attempted to compare the safety and outcomes of vaginal versus cesarian delivery for breech. It was a trial that was coordinated out of Toronto, Ontario Canada but it was carried out in many countries all over the world. Half way through the study the researchers believed that they were seeing worse outcomes with vaginal breech deliveries and decided to stop the study all together. The problem was that they study was poorly constructed from the beginning and there were many inconsistencies and problems. They had a wide range of practitioners with a wide range of skills and training (some of them had no training what ever in normal birth or breech deliveries) as well as a wide range of access to technology and surgical backup. Unfortunately, based on this ONE poorly designed and poorly conducted study, doctors all over the world abruptly stopped catching breech babies. Doctors and midwives who had caught breech babies safely for many years were bullied into stopping the practice. The idea that it was reasonable to stop training practitioners to catch breech babies was irresponsible and foolish since there will always be surprise breeches no matter how many ultra sounds we have. There will also be surprise twins (even with ultra sound) and often one twin is breech. The widespread loss of this skill is an abdication of responsibility on the part of the medical community and has placed both mothers and babies in danger. Even though the decision to stop catching breech babies was made based on ONE study, it has taken ten years of response to the Term Breech Trial and ten years of subsequent studies to reverse the hasty and alarmist response to the Term Breech Trial. We now have more than ten years of well-designed studies that show clearly that for Frank and Complete breeches, a vaginal delivery is significantly safer for both mother and baby and furthermore, it always was safer. One bad study has caused thousands of women to be subjected to unnecessary and dangerous open abdominal surgery. C-sections carry 4 times the risk of maternal mortality (death) and morbidity (sickness) than any type of vaginal delivery (including breech) and C-sections are 8 times more dangerous for mothers (risk of death or serious illness) compared to a normal vaginal delivery (spontaneous and head first). There is almost no situation where C-section is not more dangerous fora healthy pregnant woman and her baby than a normal vaginal birth. Certainly not in the case of a term breech baby. C-sections are called for in cases of placenta previa (when the placenta completely covers the cervix) or occasionally if a woman has serious complications (in other words, she is actually a sick woman and not merely a pregnant woman.) Pregnancy is not an illness and performing surgeries on healthy people (like most pregnant women) only causes them to become sick and should be avoided at all costs.

  19. Jenna Rose says:

    P.S. I’m a student midwife in Toronto, Ontario Canada, home of the infamous Term Breech Trial. The SOGC compared to its American equivalent, ACOG has recognized that midwifery care is the most appropriate care for the majority of healthy pregnant women (in accordance with the World Health Organization’s recommendations) and has supported the integration of midwifery care into our provincial health care systems. In Ontario, midwives are now attending 10% of all births and the number of midwives in the province is set to double (from 500 to almost 1000 provincially) in less than five years. Midwives in Canada study for four years in a university program dedicated to midwifery (we do not do any nursing studies). We spend three semesters doing course work at a university and then spend three years in clinical training. Canadian midwives are autonomous primary care providers on par with family doctors and attend births in both home and hospital. In Ontario, the rate of C-section among midwifery clients (over 10,000 women last year) is 15% (the rate recommended by the WHO). The section rate in the US nationally hit 37% last year.

  20. Sarah L says:

    Thanks for your awesome assesment, Penn Girl. The whole point of the article is that having a vaginal breech is NOT necessarily riskier than a c-section. Everyone who keeps saying “I’m not sure I would risk a vaginal breech” has missed the point and show how indoctrinated we are to the idea that surgery is safe and vaginas are scary. Secondly, there are still doctors catching breech babies, so we do indeed have data about vaginal breech births. Unfortunately, those doctors are few and far between, and it’s an insurance issue, not a safety issue. My third baby was breech until nearly 39 weeks gestation. We were in contact with a doctor in Colorado who was willing to attend a vaginal breech, which I really appreciated. Thankfully, she turned and we didn’t have to deal with it. However, if I had been following the normal OB practice of scheduling a c-section 2 weeks before due date, she would have been a cesarean delivery simply because she wouldn’t have had time to turn! Vaginal breech deliveries aren’t always the best option. There are some criteria which can help doctors screen out breech births which may be more dangerous as vaginal deliveries – whether you have had a vaginal delivery before, estimated size of the baby, ease of prior deliveries, and most importantly, the position of baby (there are several different kinds of breech positions). However, for moms who do fit into the “low risk” category with a breech baby, why should the be forced to have a surgery?

    Obviously NO ONE wants a dead or brain damaged baby just to get mom’s “dream delivery.” How would that be a dream delivery if you go home without your baby? The science tells us that there are dangers to surgical deliveries – significant dangers, in fact – and that the indoctrination that breech births are deadly is not based on facts. Hurling insults and belittling people who challenge the status quo does no good, and just causes you to look foolish.

  21. Karen K says:

    I read this article and shuddered….my sister just gave birth to a baby boy via breech vaginal delivery. He got stuck in the birth canal and was deprived of oxygen for 9 minutes, and he is globally brain dead. All of his vitals are functioning, but he needs to be fed via feeding tube….and as we speak, they are at his bedside waiting for him to pass as they’ve had to remove the tube. I understand that women want a positive birth experience and think cesaerean sections are risky, but this was a birth in a hospital with doctors who’ve delivered hundreds of breech babies. Why gamble?? They should be home with their newborn right now….instead, they are watching his body die. It’s devastating. :(

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