vaginal breech

alliejoe · December 2013

I am 35Wed and the baby flipped breech

she was head down at 28w, so I stopped worrying and now I know I'm a little late in the game for her to move w/o assistance. My MW tried to move her yesterday with no luck. I'm doing inversions as I type this and have an appt with the chiropractor this afternoon.

I'm really hoping the natural stuff will get her to move, if not I'm open to an ECV. My MW deliver in the hospital and there are a few OBs who will deliver vaginal breech, but I'd have to take the chances to see who is on call when I go into labor. Anyone have experience with vaginal breech? Vaginal breech without an epidural? (Which sounds extra painful)

Any other tips/tricks or positive stories about late flipping babies anyone is willing to share? I really need some positivity

AmyRI · December 2013

At least you found out now... I didn't find out until I was in labor and 7cm dilated, ha.

Make sure your chiro is doing the Webster technique, not just a regular adjustment. That flipped my DD from transverse to vertex at 33/34 weeks after 2 adjustments. Turns out she flipped frank breech at 40w5d, but I'll just add that to the list of reasons I should have continued seeing the chiro instead of stopping because I didn't want to pay all the copays.

Honestly I would see one of the OBs that does breech births now. You should see if you're a good candidate for a vaginal breech birth and transfer all care if needed to guarantee that they'll show up to the hospital when you go into labor.

I was under the care of a midwife, and didn't know DD was breech until she checked me and I was 7+cm dilated. I got really, really, really (and 10 more reallys) lucky that the on call OB was trained in breech births. We weighed the options and he agreed I was a good candidate, so it was take a small risk either way: higher risk for me with a c/s or higher risk for baby with a vaginal delivery. We were comfortable trying the vaginal delivery.

I had a great experience. I did not need an epidural, and no one suggested I get it (even after I asked). They preferred it be a natural birth so I was completely in control during the pushing stage, which is the most risky. There was an anesthesiologist in the hallway and a 2nd team of doctors/nurses in the ER down the hall, so it's not to say that weren't taking precautions... they just believed I could do it and allowed me to birth the way I wanted to birth.

I was a good candidate because they thought she was about the same size as my DS had been (he was 8lbs, she was estimated 8-8.5), I had a fast labor and low pushing time (15 minutes), my pelvis was plenty roomy (thanks for that horribly painful internal in the middle of transition...), DD was frank breech with chin tucked and was tolerating labor just fine. She was born about an hour after the decision was made, and I pushed for 7 minutes according to the midwife.

I will say that I was more sore and had more hip pain postpartum than I did with DS, but no way to know if it was because she was a full pound bigger than DS, arrived more quickly, or was breech. Probably a combination of all of those things. My recovery was still much easier than a c/s would have been.

Link to the full birth story if you're interested (sorry for weird formatting in that post - it apparently didn't make the migration to the new format unscathed). https://forums.thebump.com/discussion/8740433/natural-breech-birth-story-very-long

alliejoe · December 2013

Thank you so much for sharing your birth story!

Thankfully I've been seeing a chiropractor the whole pregnancy and she fit me in for an extra appt.today. She was very confident that baby will flip. She said, in her experience, it's rare for someone whose had chiropractic the whole time to stay breech. Fingers crossed she's right.

There is no point in me switching my care over to the OBs b/c it would still be just luck of the draw for whoever was on call. I wish I had some control over that. The MWs and the OBs work out of the same office at a major hospital here, the MWs consult with the OB on call whenever necessary.

My MW and I didn't talk much about whether I was a good candiate for a breech birth. We sort of.left it at "lets try the chiropractic and inversions and discuss next week". But based on what you said I think I am (hopefully). My birth with my son was 5 hours from first ctx and I pushed for maybe 15minutes tops? It's sort of a blur. It was only a few pushes though.

Again, thanks so so much for sharing with me. I googled vaginal breech birth and anything I found was pretty much the antithesis of natural

I was pretty freaked out.

barnwife · December 2013

Well, when I was pregnant with A. she briefly flipped to breech late in the game. Thankfully, she flipped again on her own. However, I did ask my MW what happens if baby is breech. Her response was along the lines of "we treat that as a normal variation in the birthing process."

I would absolutely attempt a vaginal breech delivery with my MW if she thought I was a good candidate, or with her and an OB at the hospital or whatever.

MississippiCatfish · December 2013

My LO was breech all along until 37 weeks. ECV was unsuccessful. Next day, I went to the chiro, that night he flipped and stayed until my birth. Good luck - I hope chiro works for you, too!

rooftop · December 2013

My baby went breech at 34 weeks but flipped back after a week of me bent forward lol. I would hve attempted a breech though. I'm sending good vibes and hoping for good results for you! Let us know how it goes.

AmyRI · December 2013

I agree with @Tangerine01's suggestion of actually talking to the OBs trained in breech deliveries and ask if they would make an exception to show up for your labor. The OB I got just can't understand why more doctors won't attempt the vaginal birth. He admitted that he likes seeing "out of the ordinary" cases.

My experience was certainly nerve wracking, and it felt much more medicalized than my first. I remember the names of the 4 people in my room the first time, and i lost count of the number in my room the second time. Plus half the docs and nurses in the OR said hi before or after. It was different, and as an introvert quite overwhelming, but the result was a brightly lit, well celebrated, low-intervention drug-free birth.

Keep us updated!

starskristen79 · December 2013

Lurker here, but accupuncture is your friend. My first flipped at 32 weeks, then went head down at 37 weeks within 2 days after having accupuncture and moxibustion.

alliejoe · December 2013

@starskristen79 I was told that you can't do moxa after 35w. Maybe I need to call around to another practice? Hmmmm.

alliejoe · December 2013

I totally emphasize with your perspective. I'm willing to try an ECV between 37-38 weeks though. Obviously there is risk of prematurity issues if the ECV were to trigger premature labor. However, the likelihood of NICU time being needed at 37+ weeks is slim.

The main difference, from what I've been told by a couple of planned breech moms that I've been able to talk to, is with twins there is the possible need for extraction. With a planned breech birth many practitioners prefer the mom to birth w/o an episode b/c they are in control of the pushing, etc. And it is established that the baby is in whichever position before pushing starts versus with the second of twins the position often changes once baby A is born making an extraction necessary.

I am still hoping the baby will turn in her own and all of this will be a nonissue. My next appt is Thursday, so we shall see.

AmyRI · December 2013

bromios said:

My daughter was a breech extraction. My understanding, though, is that they will not do it without an epidural unless it were an emergency and they didn't have time to put one in. I have to tell you, even with an epidural, it was pretty unpleasant, so I would not push to do it without one! My little girl decided to kick the walls of the birth canal on the way out and it was freaky. That being said, the healing process isn't nearly as extensive as from a c-section (which also needs an epidural), so if there is a doctor who knows how to do a breech extraction, it's not a bad option. One thing I can tell you for sure: if any of the things you are trying to do to rotate your baby carry a risk of triggering preterm labor (term is now 39 weeks), you should just leave it alone, because you do not want to see the inside of a NICU if you can possibly avoid it (my babies were in there for 60 and 69 days respectively).

A breech extraction of a second twin is completely different from a vaginal breech birth of a singleton. And a frank breech baby cannot kick the birth canal, only a footling breech baby could do that, and I haven't heard of any docs that would allow a footling breech birth. I labored and pushed exactly like I did when I had my son who was vertex - the doctor did nothing but catch.

alliejoe · December 2013

MW managed to turn baby yesterday! Fingers crossed she stays that way!

wintersong · December 2013

Forgive my ignorance...still TTC my first...but is there a difference between a breech vaginal birth and a breech extraction, or is it just another way to say the same thing?

wintersong · December 2013

In an extraction, do they physically pull baby out? (necessitating an epidural?)

alliejoe · December 2013

In an extraction (as far as I know) the OB may reach in and help/pull the second baby into the birth canal. I guess it could be done without a epidural, but the couple of vaginal twin moms I know did it with an epi in a hospital just in case the need arose.

If I had needed to do a breech birth my MW basically said as long as things are progressing normally and at a healthy pace they let the baby deliver itself and just catch unless they need to intervene to help the baby come out safely.

AmyRI · December 2013

Yep, @alliejoe is right about extraction vs. regular birth. They are two wildly different things.

In an extraction, the first twin already opened the birth canal and stretched everything out through the entire normal labor and delivery process. Only after that is complete can a doctor put their arm up there and assist the second twin being born, or attempt to turn the second twin vertex, or whatever. Generally speaking the epidural is in place in case a c/s is needed for either twin, not only for the extraction.

In a vaginal breech birth, it's exactly how a normal birth goes. Footling breeches (like PP was talking about the extraction, which is feet first) are dangerous vaginal deliveries. Normally vaginal breech births are frank breech, meaning bum first and the baby's legs are going up along the torso and feet by the head. Labor and delivery are the same, only you see the bum come out first, then the body and legs flop out, and then the head is the last to be delivered. The doctor's only involvement is supporting the baby properly once it's out so that there's no strain on the neck when waiting for the head to be delivered.

HNRomance · January 2014

I'm glad someone else posted this since I was just going to ask the same question. My next appointment is thursday but my little guy was breech last I knew and I have a feeling he is transverse now. We still have lots of time but I watched a few videos and it seems like there isn't significant difference between the birth except for being careful during the pushing stage. However, my practice has little experience with vaginal breech and I would want to try if possible....anyone have experience convincing practice to allow vaginal breech? They can't MAKE me do c-section and I don't think they can kick me out once admitted.

alliejoe · January 2014

You still have plenty PLENTY of time for you baby to turn. My babe was vertex at 28w and turned breech when I posted this, it took 3 separate tries at 36-37+ weeks, but she's vertex again.

I was scheduled for a formal ECV in L&D on Christmas Eve, but the MW got her to flip a few days before at my regular appointment.

If you're worried, I'd start seeing a chiropractor who specializes in Webster Technique now. I think that helped a lot and if you're concerned ask your practice what they do if a baby is breech. Do they do ECVs? While I don't think they can make you do a c/s they can decide to terminate your care and refer you to some else if they don't feel that they could deliver you by breech. They would know the baby's position before labor unless he flipped last minute.

Even though I see very liberal MWs they won't/can't deliver breech babies. My care would have been transferred to an OB and I would have been scheduled for a c/s at 39w (although I provably could he pushed that to 40). They still would have attended the birth, but not as the care provider. (I guess as a nurse? I didn't ask) Since I have a "proven pelvis" and had an average size baby with number #1, I could have tried a breech vaginal delivery with 4 of the on call doctors, but it would have been some luck of the draw to that. I live in an incredibly pro natural birth area with a ton of options and there is only one OB who will induce a breech birth in this area.

We discussed a lot of the risk factors before we got the baby turned and I would have tried a breech for sure- but only b/c the MW felt I was a really strong candidate given my previous labor and delivery.

Seriously though, try not to fret yet. Your little guy can still flip all over the place for several more weeks. He's not even 3lbs yet. Be proactive and ask questions and seek chiropractic care... But something like 95% of babies will flip to vertex.

Good luck mama!

sschwege · January 2014

HNRomance said:

I'm glad someone else posted this since I was just going to ask the same question. My next appointment is thursday but my little guy was breech last I knew and I have a feeling he is transverse now. We still have lots of time but I watched a few videos and it seems like there isn't significant difference between the birth except for being careful during the pushing stage. However, my practice has little experience with vaginal breech and I would want to try if possible....anyone have experience convincing practice to allow vaginal breech? They can't MAKE me do c-section and I don't think they can kick me out once admitted.

You have plenty of time, I wouldn't give it a second thought at this point, truly!

Sadly breech deliveries are a dying art in this country, usually it's one of those things a doctor or MW has learned about in school, but may have very little first hand experience with it. You are right no one can make you have a c-section nor can they turn you away once you are in labor, but that being said do you really want your provider delivering your breech baby when their only experience with it is watching training videos?

I really don't think you are going to have to worry about any of this, but IMO your best bet would be to find a provider who is comfortable delivering a breech baby, tall order for sure but they are out there. I've heard some people have better luck if they can find someone who studied in another country. And of course this goes without saying, but do everything you can to help that baby turn on its own, Spinning Babies, Chiro, Acupuncture, etc.

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