Question: "Can I have a VBAC if my baby
is breech?"
-response by Gretchen
Humphries
Ah breech, one of the first things I decided
to learn everything I could about :-) That's what
happens when you get cut for it...
Well, in and of itself, breech shouldn't be considered
a contraindication to a VBAC -- there is
no increased rupture risk (UR is the ONLY risk
specific to VBAC and even now, with cytotec, we
are losing our exclusive rights to UR as our special
"risk factor") so there's no reason
to deny a VBAC based on breech. Now, as to whether
you believe breech is a contraindication to a
VAGINAL birth (VBAC or no) is another question.
There was just a thread on breech birth and the
research thereon on the RMA
list. I love it when those midwives talk about
breech, because there are some women on that list
who KNOW how to attend a breech birth. One of
them, who works with the Amish, has attended 52
breech births. No fatalities or significant morbidity
related to breech (obviously, something like birth
defects wouldn't factor into the safety of the
breech). Other midwives with similar numbers have
similar stats.
The truth about breech is that it is quite safe
to have a vaginal breech birth (VBAC or no) if
you are attended by someone who knows what they
are doing (or NOT doing, as the case may be --
mostly, breech babies need to be left alone).
And yes, while its a bit more controversial among
some, breech babies can be and are born unassisted.
What is NOT safe is having someone who is inexperienced
(most OBs these days), scared (most OBs these
days) or trained to be interventive (most OBs
these days) attending a vaginal breech birth.
Serious damage or even death can and DOES occur
when breech babies are fiddled with inappropriately.
If all you have is access to your garden variety
OB, then a cesarean might just be safer for your
baby.
Now, you'll hear about head entrapment, particularly
with footlings. Or cord prolapse. Both of these
are much more likely to happen with preemies (who
are often breech and footling to boot), and unlikely
to happen in a term breech (even if footling).
But most breech babies aren't footling (at term)
so its really not an issue most of the time.
For me, with access to a number of very good
and very experienced midwives, there's no way
I'd plan an otherwise uncomplicated breech birth
in a hospital, much less as a c/s. As a VBAC,
if you are living in a state where midwives are
"legal", ie regulated or licenced, you
are probably up a creek -- because most states
that regulate midwifery prohibit planned breech
births at home. (Many of the also prohibit multiples
and many of them prohibit homebirth after cesarean
as well. That's why I'm opposed to legalizing
midwifery, as it is done these days.) You'd need
to find a midwife who isn't licensed (this is
why some midwives refuse licensure -- they don't
want the state telling them who they can attend)
or fly someone in, or find a midwife who is willing
to risk her license.
As far as "low fluid" and "compressed
cord" -- if they were really all that worried
about that particular scenario, then they wouldn't
be AROMing women right and left [breaking the
bag of waters with a hook]. And the more you
read about assessing amniotic fluid levels (aka
AFI), the more you realize that it ain't an exact
science. And back before we thought we knew how
to assess AFI, babies- breech or otherwise- were
NOT dying in numbers of cord accidents attributable
to low fluid. Its just a really effective way
to scare a very pregnant mom and get her to consent
to whatever procedure you want to do now, rather
than later, in my opinion.
Two really good places to read up about breech
birth:
For interesting reading about assessing amniotic
fluid, go here.
And know that MUCH weirder things have happened
than a breech baby turning after 38 weeks.
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