We met in her first trimester and her words still echo in my head...
"My doctor is recommending a C-section if baby doesn't turn by my next visit?
I am considering asking about delivering breech. What do you know about breech birth?"
Well that's a great question. Here's the gist of what I know:
3-4% of babies are in a breech position at term.
There are 3 types of breech presentations:
Frank Breech - the most common type
Meaning: the baby's bottom faces the cervix and his legs are straight up, with feet near his/her head.
Footling/Incomplete Breech - the second most common type of breech
Meaning: one or both baby's feet are directly above the mother's cervix.
Complete Breech - the least likely breech position
Meaning: the baby is bottom first with his/her knees bent and one or both feet near his bottom.
Recognizing approximately 13,500+ Canadian babies present breech annually perhaps the following options could help turn some babies - there's no harm in trying...
Best at: 32+ weeks gestation
The Tilt - an inversion technique
The Webster Technique - a chiropractic adjustment
Best at: 37+ weeks gestation
Moxibustion - using heat to stimulate an acupuncture point
External cephalic version (ECV) - external rotation of the baby by an obstetrician
*consultation with your health care provider should be sought prior to the above*
Women should be offered a breech vaginal delivery, rather than a cesarean birth, according to the clinical practice guidelines set by the Society of Obstetricians and Gynaecologists of Canada (SOGC), No. 226, June 2009.
The basic labour selection criteria for Vaginal Delivery of Breech Presentation Guidelines states:
-an ultra sound showing the baby and position are optimal
-mother has no contraindications for successful vaginal birth
-baby's weight is estimated between is 2500 - 4000 grams (more on ultrasound estimates later!)
Knowing this, why do many women still report their physicians suggesting cesarean birth as the optimal choice for a breech baby?
Is their hospital not open to breech vaginal deliveries? Is planning a c-section better for the healthcare provider's schedule? Or is it the serious shortage of physicians willing to facilitate breech birth because their skill set is incomplete?
Regardless of the reason this is disheartening!
Autonomy and women-centered care demand that competent physicians emerge from university programs with the confidence and know-how to support breech vaginal birth. If this isn't possible, senior physicians should be mentoring the new doctors so they can develop the skills needed to support these women while birthing.
Furthermore, don't all doctors have an ethical responsibility to decrease our alarmingly high cesarean birth rate? Perhaps, supporting breech vaginal birth would be a beautiful place to begin...