Sunday, November 22, 2009

C-Section NOT Best for Breech Birth

By Carla Wintersgill
for The Globe and Mail 
posted with permission


Physicians should no longer automatically opt to perform a cesarean section in the case of a breech birth, according to new guidelines by the Society of Obstetricians and Gynecologists of Canada.
Released yesterday, the guidelines are a response to new evidence that shows many women are safely able to vaginally deliver babies who enter the birth canal with the buttocks or feet first. Normally, the infant descends head first.

“Our primary purpose is to offer choice to women,” said AndrĂ© Lalonde, executive vice-president of the SOGC.

“More women are feeling disappointed when there is no one who is trained to assist in breech vaginal delivery,” he adds.

Since 2000, C-sections have been the preferred method of delivery in breech births. Studies suggested that breached births were associated with an increased rate of complication when performed vaginally.
As a result, many medical schools have stopped training their physicians in breech vaginal delivery.
The problem now, according to Dr. Lalonde, is that there is a serious shortage of doctors to teach and perform these deliveries.

With the release of the new guidelines, the SOGC will launch a nationwide training program to ensure that doctors will be adequately prepared to offer vaginal breech births.

The new approach was prompted by a reassessment of earlier trials. It now appears that there is no difference in complication rates between vaginal and cesarean section deliveries in the case of breech births.

News of the change is a boon for the Ottawa-based Coalition for Breech Birth.

“We're really, really pleased,” said Robin Guy, co-founder of the coalition.

Ms. Guy started the group after the birth of her second child in the fall of 2006. Although she had given birth to her first child at home with a midwife, Ms. Guy delivered her daughter in the hospital because of the baby's breech position.

“I was cornered into an unneeded and unwanted C-section because the obstetrician that I had didn't have the experience to catch her,” said Ms. Guy.

The aim of the coalition is to ensure that women know what their options are when it comes to breech birth. Ms. Guy believes that many women don't realize that vaginal breech births are even possible.
“Educating women is our primary goal because it takes more than just a guideline change,” she said.
The SOGC stresses that because of complications that may arise, many breech deliveries will still require a cesarean section.

Breech presentations occur in 3-4 per cent of pregnant women who reach term. That translates to approximately 11,000 to 14,500 breech deliveries a year in Canada.

The new decision to offer vaginal breech birth aligns with the SOGC promotion of normal childbirth – spontaneous labour, followed by a delivery that is not assisted by forceps, vacuum or cesarean section. In December of 2008, the society release a policy statement that included its recommendation for a development of national practice guidelines on normal childbirth.

“The safest way to deliver has always been the natural way,” said Dr. Lalonde.

“Vaginal birth is the preferred method of having a baby because a C-section in itself has complications.”
Cesarean sections, in which incisions are made through a mother's abdomen and uterus to deliver the baby, can lead to increased chance of bleeding and infections and can cause further complications for pregnancies later on.

“There's the idea out there in the public sometimes that having a C-section today with modern anesthesia and modern hospitals is as safe as having a normal childbirth, but we don't think so,” said Dr. Lalonde.
“It is the general principle in medicine to not make having a cesarean section trivial.”

The SOGC believes that if a woman is well-prepared during pregnancy, she has the innate ability to deliver vaginally.

The national average for babies delivered via cesarean section in Canada is 25%. [The national average in the United States is 33%.] 

9 comments:

  1. Good to know! My son was breech for a few weeks and my dr was panicked. They said that I could NOT have a vaginal birth because it was not safe and the hospital "didn't like to do it." Thankfully, my son turned back around and I delivered him vaginally, but this is good information to be armed with for my next baby!

    ReplyDelete
  2. I wish I knew then what I know now. I was still intent on having a vaginal birth even after finding out my daughter was in the breech position. We tried everything to get her to turn, but to no avail. My doctor was adament that we have a c-section. I'm not sure if she is trained to deliver a breech baby, but she refused to none-the-less. I certainly felt bullied into something I didn't want. To this day I regret the way my daughter came into this world. Not only did I have a c-section, but they didn't even show her to me immediately after she was born. I felt like the whole thing was very surreal and happening outside myself. I hope they train doctors better and give them the education to be able to offer the option to other woman so they don't have the same experience I did.

    ReplyDelete
  3. I have had two breech babies, one footling and one with buttocks first, and due to my anatomy most likely will always have breech babies.

    I have no doubt that breech babies can be delivered by natural delivery, but many times the lack of pressure by the baby's head makes it so the body is not preparing as much for labor, with little or no dilation/effacement.

    All doctors should be trained in how to deliver breech, simply for the situation of a baby who was never detected breech, but the mother is in labor.

    ReplyDelete
  4. I was born breech, and my mom did it vaginally and without pain killers. When I became pregnant I found out at 38 weeks that she was breech. We were living in Wales, UK at the time. They did an unsuccessful EVS and then that doctor immediately wanted to schedule me for a c-section. We fought him off, and got the clearance from another doctor to try for a vaginal breech delivery. Unfortunately, when I was 11 days past my due date, my water broke, and 24 hours later I hadn't made any progress. Due to the risk of infection I went on to have a c-section. I'm alright with how it turned out, since I did my darndest, but I'm glad that this kind of policy is getting out there now. I'm hopefully for a VBAC, even if the next one ends up breech too. I just wonder if I could have gotten the same flexibility if I had been home in the States, or if I would have had no option but an immediate c-section, and if I'll even have the option of a VBAC with the next one.

    ReplyDelete
  5. Added this to my list of what I wish I'd known when... 3 out of 6 of my babies were breech. The first was a twin and there was no way a practicioner was going to deliver her breech (she was the presenting twin). 2nd breech baby was turned externally and then 3rd breech baby was c/s too, rupture from 4 previous c/s. I have always lamented the first one, wondering if it was truly necessary. Wish I'd known then.

    ReplyDelete
  6. I had a vaginal breech birth this past November. I found out baby was breech at about 38wks. I didn't want to schedule a c-section but also knew the chances of getting an experienced OB with breech delivery was going to be a slim. I opted to go into labor then make the decision at the time of what to do. When I went into labor it just so happened that one of few doctors that had the experience was on. He gave me to go ahead to try for a natural birth after checking baby's position, estimated weight. He also wanted me not to have an epidural so that when time came to push it would be effective (considering I had an epi with my first daughter and pushed for 2.5 hours, this made sense). Once my water broke a few hours later my baby pretty much delivered herself. I pushed twice and baby was born. It was an amazing experience. I was at a teaching hospital and the chief resident plus a handful of other resident doctors were able to see how breech babies are to be caught. I am so thankful that I had amazing midwives that told me there were options out there and I didn't HAVE TO have a c-section. I think it is so important that women have different options and that they get all the information then make a decision that is right for them. And now that this recommendation has been made in Canada, maybe the rest of the world with start training there doctors on how to deliver a breech presentation.

    ReplyDelete
  7. this recommendation came out just months after i had my first baby via c section because he was breach with the cord wrapped twice around his neck. i wish i could have tried for a vaginal but no one would do it. i recently had a beautiful HBAC and it was amazing. i didn't know what i missed with my first until i had my second! v

    ReplyDelete
  8. i wish i had known this. i live just outside of toronto, and because of a previous addiction to painkillers (i broke my foot twice in four months on the same spot) my methadone doc (methadone is part of an opiate replacement therapy) referred me to a hospital in toronto that specialized in methadone babies. anyways for those of u who have a problem with the methadone pregnancy, it was unplanned. well anyways, my son at 22weeks was breech but i was assured that he would turn. after 36 weeks because i was on methadone i was to have weekly ultrasounds. the night before my last ultrasound me and the father had sex and early the next morning i lost some fluid. it was found out at 36w+2d that my monster was still breech. well i had a csection. i didnt get to hold him right after as the freezing had started to wear off and i felt the staples when they were halfway done and they gave me 40mg of liquid ketamine which knocked me out. because of this i didnt get to hold him for a full day and a half. my mom saw him before i did. a week later the staples came out and that night i tore the incision open. then it got infected and the hole looked like it was black. i got on antibiotics and it finally closed like a week ago. my son was born on july 15, 2011. it is now sept 3. my next one is going to be delivered vbac if i can help it. my sister's friend was delivered breech 40 years ago and theres nothing wromg with her

    ReplyDelete
  9. Breech is on my list of things I'm truly afraid of, such as placenta praevia, as I will have my first home birth in June and I want *nothing* to get in the way of it.

    It seems to be a normal variation, like twin labour, that has been deemed 'too dangerous' in recent years. My father was born via a twin home birth back in 1931. I'm not afraid of a breech delivery, nor a twin birth, but I'm afraid of being told that I CAN'T do it.

    I'm being attended by two graduate midwives, not my first choice but out of necessity. Don't get me wrong, I'm absolutely committed to doing my bit for training in the profession, but I want to steer clear of the unnecessary panic that sometimes ensues when several inexperienced workers collaborate.

    My daughter sat in a breech position for much of the latter part of my pregnancy. She was also posterior, as my son was, as I had two anterior placentas and they tend to face them. I found rocking on all fours, something intuitively comfortable, especially helpful.

    ReplyDelete

LinkWithin

Related Posts with Thumbnails