Breech deaths are vanishing; why would anyone want to bring them back?

Sad mother missing her daughter

The folks at VBACFacts are shocked, shocked that breech vaginal birth is discouraged.

It’s time to summon all that passion you have for patient autonomy and take some action!

Let’s support Dr. Annette Fineberg and flood this hospital with letters!

The following is copied from a fellow birth advocate in California:

“I’m so sad right now. Like in tears.

Dr. Annette Fineberg at Sutter Davis is being pressured to stop supporting vaginal breeches. She’s by far our best option around.

She’s asking for our help collecting stories to convince the administrators to continue to allow her to openly offer this option. This is huge! …

Dr. Fineberg is one of very few OBs within driving distance of the Bay Area skilled in breech birth. She’s also the only ‘local’ OB breech expert who actively supports/encourages people with breech babies to birth in non-lithotomy positions and labor in the tub prior to stage two — and she is the only one who doesn’t pressure them to get epidurals.

According to Dr. Fineberg:

The death rate from vaginal breech is more than 1000% higher than the death rate from SIDS.

I am getting a lot of pressure to stop attending breech and despite my best efforts to get privileges at a tertiary care hospital with neonatology, it is not happening.

Why is Dr.Fineberg being “pressured”? Because breech deaths are vanishing and no one wants to bring them back.

What’s the death rate from vaginal breech. It is approximately 6/1000. That sounds like a small number, too small to be concerning, right? Not exactly. The death rate from vaginal breech is more than 1000% higher than the death rate from SIDS. It doesn’t sound like a trivial risk of death when you put it like that, does it?

We have spent literally millions of dollars trying to change the habits of parents and caregivers in order to prevent SIDS deaths. We’ve heavily promoted a regimen of putting babies to sleep on their backs even though that does not happen in nature, leads to poorer quality sleep, and has created an epidemic (200,000 cases per year) of tiny babies wearing tiny helmets to correct iatrogenic plagiocephaly (flat head syndrome).

We think that’s entirely appropriate in order to prevent deaths from SIDS that occur at the rate of 0.54/1000 babies. Doesn’t it make sense that we would want to prevent the much greater (6/1000) risk of death from breech birth?

There’s even greater urgency for hospitals and malpractice insurers to prevent death from breech birth. When a baby dies fo SIDS because a parent or caregiver put the baby to sleep face down, there may be recriminations but there is generally no one to be sued. In contrast when a baby dies as a result of attempted breech birth, there’s always someone or several someones with deep pockets (including neonatologists and others who had nothing to do with the decision) who can be sued.

While parents might not sue for a baby who dies, they will almost certainly sue for a baby who sustains severe brain damage because the costs of caring for such children are astronomical. No matter how much the mother avers that she understands the risk, no matter how many consent forms she signs, she will insist in her lawsuit that she didn’t understand that it could happen to her baby and she certainly didn’t understand the aftermath of caring for a severely disabled child. When hospitals prohibit breech vaginal births, they aren’t merely protecting babies; they are protecting themselves and their staff.

Does a mother have a right to have a breech vaginal birth? Of course she does, just like she has the right to lay her baby face down to sleep. Neither is illegal and both are fully within the purview of autonomous adults. But that doesn’t mean she has a right to force hospitals and doctors to attend her while she attempts that breech vaginal birth just like it doesn’t mean that she has the right to force daycare centers to put her baby to sleep facedown.

If you met a mother who proudly told you that she ignores the “back to sleep” recommendation because the risk of SIDS is tiny, would you be impressed? Would you consider her a brave, transgressive proponent of maternal autonomy or would you be horrified that she was willing to risk her baby’s life? I suspect that most people would be horrified.

So why would anyone be impressed with a mother who wished to to expose her baby to a 1000% times greater risk of death at vaginal birth? Breech deaths are vanishing; why would anyone want to bring them back?

  • Annette Fineberg

    With proper patient selection and labor management, the death rate for a term Singleton breech is 1 in 500 compared to 1 in 1000 for a term vertex baby who labors. The rate is 1 in 2000 for a baby born by scheduled cs at 39 weeks. This is according to multiple studies and the Canadian, British and American published guidelines. Vaginal breech is not for everyone and I certainly dont push women in either direction. But it is safer in the hospital so. I’ve done about 100 Singleton breeches and many more second twins at this point without problems. Of course many more than that by cesarean. I’ve been following the OB literature for 25 years and delivering babies that whole time. Not just criticizing on the sidelines as a non practicing doctor.

    • Amy Tuteur, MD

      In other words, the death rate for singleton term breech is 2/1000, term vertex 1/1000, and 0.5/1000 for scheduled C-section. Therefore, the death rate for vaginal breech is 300% HIGHER when delivered vaginally compared to C-section. That’s not trivial. And that doesn’t even count brain injuries.

      Imagine for a moment that epidural led to a 300% increase in neonatal death; would anyone be recommending epidurals? How about if scheduled C-sections led to a 300% increase in neonatal death? Would anyone be scheduling C-sections?

      Is it any wonder then that hospitals and malpractice insurers don’t want to be financially responsible for a procedure that has a death rate 300% higher than the standard of care? How willing to attend vaginal breech births would you be if you personally were responsible for the multimillion dollar verdicts that will inevitably result? No very willing, I imagine. Because you know as well as know, based on your own statistics, it is only a matter of time before one of the breech babies you decide to deliver vaginally will die. At that point you will need all the malpractice insurance that you can afford.

      How lovely for you that you are still practicing, but that doesn’t entitle you to risk millions of dollars of other people’s money because you don’t find a 300% risk of death meaningful.

      • Annette Fineberg

        You need to compare it to vaginal birth of vertex not scheduled cs at 39 weeks. Some of the risk is due to issues with the baby that is breech. Some of the benefit to that first baby is passed of as risk to the next baby with a scarred uterus. It’s not as simple as you are making it. Again it’s up to the mom not me
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        • Amy Tuteur, MD

          If the only options are breech vaginal birth or C-section, those are the two that should be compared if a mother is trying to choose between them.

  • Gæst

    Okay, the picture on this is cracking me up, because the size of the shoe that woman is holding is HUGE if the child died during childbirth!

    • mabelcruet

      Maybe it was fetal macrosomia combined with a breech-a bigger baby with a bigger bum is bound to get into trouble.

    • Charybdis

      She went post-dates on her delivery. 40+78 weeks.

  • jane

    Sutter Davis has no business delivery high risk births like breech! it’s a teeny, 48-bed hospital. The closest NICU is UC Davis hospital in Sacramento, a 30 minute drive away.

  • Anonymous

    Because gathering stories and anecdotes sways the medical community. Would being the only doctor that used ether still get the same response?

  • CSN0116
  • I wonder just how many breech births Dr. Fineberg has done, and whether they were primip or multip breeches.

    Breech isn’t common. In the roughly 40 years I was delivering babies, I only had four women who were suitable candidates for a vaginal breech birth by a midwife (in an OR, with a full OB and pediatric team present as well, btw). In the early years of my career (the 70s) I did assist at a small number of multip breech deliveries performed by OBs, who generally used Piper forceps for the aftercoming head. By the 80s, C/S was already the method of choice even for multips, always for primips. It was obvious to everyone that a C/S was less traumatic for both mother and baby.

  • Kim

    A neonatal mortality rate of six in 1,000 seems incredibly high. Where does the figure come from? (This Norwegian study suggests 0.9 in 1,000 – three times as high as the rate for babies born with cephalic presentation: http://bmjopen.bmj.com/content/7/4/e014979)

    • CSN0116

      I’m curious too because I’d love to quote it!

      • Kim

        I’ve found a systematic review from 2015 that says: “The risk for perinatal mortality was 1 in 300 for planned vaginal breech deliveries, or about a 4.6-fold heighted risk compared with a perinatal mortality risk of 1 in 2000 for planned cesarean deliveries.”

  • Petticoat Philosopher

    The only argument I can make in favor of OBs doing stuff like this is harm reduction–however, that’s not in insignificant argument. I’d rather a woman have some less-safe option in a hospital with actual trained medical professionals than eschew real medical professionals altogether and give birth at home with an unqualified CPM (or worse) especially if it’s a breech birth. I honestly don’t know how hospitals and responsible birth centers should handle this. We now live in a world where they have to compete with the natural birth industry whether they like it or not, especially in places like the Bay Area. And it’s going to be that way until we find an effective way to fight the propaganda that a C-section or an epidural is the Worst Thing Ever.* That is a potential argument for making some compromises but I don’t know how many or how far is too far. I don’t envy anyone the task of having to figure it out.

    *I fear that the only thing that will ultimately turn the tide is enough women finding out that, actually, a dead baby is The Worst Thing Ever.

  • Sue

    Imagine the general surgeon still offering open elective cholecystectomy (Gall Bladder removal), while everyone else does almost all cases laparascopically:

    “I’m really sorry to tell my open-surgery-preferring patients that (Teaching Hospital) has threatened to revoke my privileges if I won’t do the majority of cases laparascopically, even though I’m one of the best performers around at open cholecystectomy.”

    Too bad that open surgery incurs a bigger wound, more pain, longer hospital stay, greater risk of thrombo-embolic disease…

    • Helen

      But as I’ve been told that I have an extra lobe on my liver and that means I would need the open cholecystectomy, I would hope that there are still some surgeons trained to do the latter.

      • mabelcruet

        When I had mine done (via laparoscopic chole) the surgeon warned me that there was a risk of having to convert it to an open chole during the surgery if the need arose-I can’t remember the actual figure, but it was mentioned as part of the standard consent procedure so presumably it happens from time to time, which means they still need to do them.

        I miss my gallstones-I don’t miss the vomiting and nausea and pain, and then the obstructive jaundice, and subsequent nightmare itching, but I miss the being unable to eat and losing loads of weight without even trying, it was great.

        • Helen

          I have a memory of standing in the grocery store and showing my petite, 115 pound, 14 year old daughter how to find potato chips with the least amount of fat. I was sure that I looked like a friggin’ nutty mother who was training her child in the ways of anorexia. The truth is that we were trying to find food that she could eat without pain and vomiting. It took over a month after her full-blown gall bladder attack before she was able to say goodbye to it, and in that month she lost about ten pounds — which is a lot when you start at 115.

          She did not have gall stones. She had a too long, too narrow bile duct, and her continuous stomach problems had been blown off as psychosomatic. Everything I know about gall bladder surgery came from her surgery.

          I have a different sort of stomach issues, and it includes gallbladder-like issues. SOD. But when I asked about the possibility of gall bladder surgery, the doctor pointed out the liver issue and said that I should make every effort to avoid such surgery because it would have to be full open.

  • Anon

    “Breech expert” – the words chill me because there really is no such thing. To be an expert you’d have to have done tons of VBBs and no-one does because its too dangerous. You know who the “breech expert” was around the Australian birth junkie groups circa 2009? yeah I don’t even need to say it but apparently breech expert means 3 breech deaths under your watch (that are known of). Breech expert in these groups means person who has sat there and watched a breech baby fall out but has NO idea what to do if they don’t just fall out. There are some big tertiary hospitals offering VBB only to very good candidates – small baby, tried pelvis, spontaneous labour before EDD, OR ready to go. Even then, its still a risk. Midwife I had for my homebirth loss was happy to do a breech delivery at home. She’d seen two (one in hospital, one surprised breech in a birth centre) so she was comfy with that. Pro-tip, surprise breech is usually code for the midwife knows but doesn’t want to get in trouble.

    • Allie

      My thought was if she were really a breech “expert,” she wouldn’t be championing at vaginal breech births.

      • Sue

        Exactly this: a “breech expert” is someone who has managed a large number of cases, and holds expertise and demonstrated results in minimising risk.

    • Anna

      Dr Steve Bisits probably deserves the title of “breech expert” in Australia. Hes also well known for ECV. I just wish he was a bit more aware that his practice is exploited by NCB crew saying that because he does low risk breech in hospital that means high risk breech at home is equally safe.

  • desiree

    I just want to say hello all, i havent posted on here in years, but i still binge-read six months of posts occasionally and still love the blog. 🙂

    • MainlyMom

      Ok, I changed my name. Part of why I came out of hiding is that I need advice or just to vent to people that understand. It’s been years since I was actively involved in the skeptical birth movement (any raptors left here?). I divorced three years ago, and now I’m dating a really wonderful guy. The only thing I sometimes get hung up on is that all three of his kids were born at home with a CPM. 2 almost died. Second birth was surprise premature twins (no hospital transfer). No vaccines. Goats milk. You name the woo, they did it. Now the kids are caught up on shots (high school and college), but he thinks all’s well that ends well. Sometimes it just drives me batty that he could have been a part of such horrid parenting. He’s slowly coming around to reason and logic, but not all that quickly. And every time I find out something new about the way he and his ex raised babies, I want to shake him. Anyone else been in similar shoes and have advice for me and my patience?

      • Allie

        I haven’t been in similar shoes, but I will say the fact that he is “slowly coming around to reason and logic” is a promising sign. I’m sure it’s easy to think “all’s well that end’s well” when your kids are in high school/college. It was obviously a long time ago, and it doesn’t sound like he’s suggesting anyone else should do what he did. If he’s otherwise a wonderful guy, I wouldn’t be too worried.

      • Empress of the Iguana People

        This specific issue never was an issue with my guy, since he was blinded by his mom catching rubella when she was expecting him, but yes, there a lot of reason and logic things we’ve had to work on. He’s not to good with the logic thing, lol. Boy sincerely believed I had a -literal- cast iron stomach.

      • attitude devant

        Unfortunately I have nothing helpful. As long as you’re not reproducing together, you could just put it down to youthful idiocy?

        Oh, and rawr!

  • PeggySue

    You mean… Spinning Babies doesn’t work? …Blinkblink…

    Can’t help it, the devil makes me do these things sometimes.

    • amazonmom

      We have CNM recommending moxibustion and spinning babies all the time. Makes me so mad

      • Empress of the Iguana People

        I had spinning babies today. Because apparently “Happy Birthday” must be sung while twirling, lol. (Not that the 19mo was actually singing, more like randomly chanting “happy”)

      • I’ll never forget my midwifery tutor disparaging ECV by noting that if a breech turns easily into a vertex presentation, it’s likely to turn back. I’ve had considerable experience with women who were encouraged by their OBs to go for ECV, only to wind up with super-emergency C/Ss.

        • amazonmom

          That’s why the option is available at my job but not so many use it. Most patients hear that the chance of success is low and you might need an emergent section and say nope to the idea.

  • Casual Verbosity

    Here’s what I don’t understand. Correct me if I’m wrong, but my understanding of the reason C-sections are recommended for high-risk presentations is that they transfer most of the risk from the party least able to handle it (the baby) to the party most able to handle it (the mother). Thus, all other things being equal (though they rarely are), a C-section poses greater risks to the mother than a straightforward vaginal birth. Since the NCB crowd seem to think that motherhood is measured by sacrifice, should not a maternal request C-section be considered the holy grail of sacrificial mothering, as the mother is taking on the majority of the risk in the birth?

    • BeatriceC

      Now you’re trying to use logic. Stop doing that. /s

      • Casual Verbosity

        Argh! Sorry! It’s this terrible habit I picked up from not being completely dense.

    • swbarnes2

      Because it’s not really about outcomes, it’s about vanity. Poor people, people who haven’t “researched”, get C-sections, so you can’t boast about them.

      • Charybdis

        I boast about my CS. Best way to have a baby, IMHO.

        I also sing the praises of formula and baby in his crib in his room from day 1, and I hated babywearing.

        Clearly I’m a beastly mother and Have Been Doing It All Wrong All This Time and don’t even have the decency to be embarrassed/ashamed of any of it.

        • oscar

          I loved my three elective CSs – so calm, so gentle, so safe, and a healthy and happy me and babe at the end of each. And the rest too. I too am a Beastly Mother, and not in the slightest bothered by it!

        • StephanieA

          We must be similar terrible mothers 😉 I have no problem talking about how wonderful formula is, and we do not co-sleep unless we’re desperate (we’ve done it but its not our sleep arrangement of choice and its not a regular thing by any means). Oldest slept in a swing for 6 months, youngest was in a bassinet then a crib at 6 months. I didn’t ‘wear’ either of them because I found it hindering and it hurt my back. Somehow my boys are happy and attached to me- no idea how.

          • Petticoat Philosopher

            I have a few parent friends who did/do do co-sleeping and, risks aside, now that some of their kids are getting older, I’m starting to wonder how exactly you stop co-sleeping. Some of them are early school-age and, though they have their own beds, they still end up in their parents bed pretty regularly. And really, from their point of view, why shouldn’t they? That’s normal for them.

            My sister and I (both born in the late 80s to parents who were mildly crunchy then but would be eaten alive by today’s crunchy parents) ended up in our parents bed for particularly bad thunderstorms or nightmares, which is common enough among small children, but we always understood that this was an unusual circumstance. Sleeping in our own beds in a separate room was our normal. It was all we’d ever known. But transitioning to sleeping by yourself when you’ve never had to do so is probably pretty hard if you’re a little kid. Even adapting from a crib to a “big kid bed” can be difficult for children, how much harder to adapt to sleeping without your parents when you’ve been doing that forever? My friends have tried to phase out co-sleeping but actually making the transition stick has proven elusive and they’re starting to get sick of it. But what do you do? Just go cold turkey? Tell your 5 or 6-year-old that they’re just permanently barred? I get why that’s difficult too. Seems much easier to just avoid the situation altogether. Kids who sleep in cribs and beds bond just fine with their parents. It seems like this is a downside of co-sleeping that people talk about a lot less.

            I mean, eventually, the kids will get old enough to find the whole idea embarrassing and babyish but one of the kids in question is 8 and still hasn’t quite gotten there yet. Do mom and dad just have to wait until the kids have hit puberty to have time to themselves in bed again? That seems…unappealing. (To them, as well.)

            Also, is it just me or does nobody get babysitters anymore? It seems like people just do absolutely everything with their kids. I like kids, I like my friends’ kids, and I understand that when you’re friends with parents, their kids are part of the package. But, good Lord, has the concept of an adult party or dinner outing without children just disappeared? Babysitting is a wonderful institution, folks! I loved having babysitters as a kid because it was novel and then, later on, when I got to high school, I made bank baby-sitting for other people’s kids. There is no downside! (Except that it’s not free, but neither is paying for dinners out for kids).

            Man, if I have my own, I feel like I’ll be considered a negligent monster…

          • mostlyclueless

            Something magical happens during the third year of life (ie, after the second birthday): Children become capable of communicating, and even being pretty darn reasonable sometimes.

            When mine were tiny babies, they did not tolerate sleeping alone at night. I tried everything, I promise. But they sobbed and screamed like they were terrified. So I slept with them until they were old enough to be reasoned with: “Daddy and I will be in our bed, and if you need us you can come get us. Otherwise, stay in your bed until the sun comes up. You can have a flashlight, a book, a toy, and a doll.”

            nb, I don’t think this is the only way or the right way or anything else. Just pointing out that bedsharing with a little one doesn’t need to be a permanent state, or a traumatic transition.

          • Petticoat Philosopher

            Oh yeah, I’m sure it just depends on the kid. Your technique doesn’t seem to have worked so well for some of my friends, though I think part of it is that some of them might feel reluctant to even set that kind of boundary, when there’s such an expectation of constant contact with children now, especially for mothers. (I have noticed that the dads seem to feel much more comfortable expressing that they’re less than thrilled to have their much-older-than-2-year-olds in bed with them all the time. I don’t think the mothers always feel entirely like they have the right to feel that way.)

            But I do think that a lot of parents who do co-sleeping as a first choice and not a last resort don’t seem to consider the possibility that an exit strategy might be difficult. Because that’a definitely proving to be a reality for some of them.

          • mostlyclueless

            You are right, my strategy to get them sleeping alone won’t work for everyone. Admittedly, I have been fortunate to have children who are extremely reasonable people.

            /mombrag 🙂

          • Busbus

            From both my own experience and what I’ve read over the course of the years I spent on Babycenter’s attachment parenting board, it seems that the second huge downside to co-sleeping is that a huge number of parents seem to end up with kids who are terrible sleepers – nurse semi-constantly at night if they are still nursing, wake up repeatedly every night until they are preschoolers, won’t fall asleep unless one of the parents lays down with them, and so on. That’s why we decided not to repeat this experiment with our second child. He ultimately started sleeping through the night before or oldest did! This new baby (I’m 37 weeks pregnant) will go straight to the bassinet in our room and to her crib in her own room as soon as that seems feasible.

          • Chi

            Babysitters are amazing.

            My husband and I are fortunate in that our 3 year old goes to bed at a relatively early time (usually between 6 and 7pm) so if we want to go out after that, we just have to make sure there’s some sort of reasonable adult in the house who knows what to do if she happens to wake up for whatever reason.

            And if we ever need more time than an evening, we have willing grandparents who are more than happy to have the little one over for sleepovers whilst we get some adult time.

            Yeah I’m probably a negligent monster too. *eyeroll*

          • I’m one of those grandparents . In fact, I’m babysitting this evening so my daughter and son-in-law can have a quiet evening together at a good restaurant. Three kids under 7 means the parents don’t get much privacy.

          • StephanieA

            I completely agree, telling your 6 year old they can’t sleep with you anymore when it’s all they know has to be really difficult. My cousin slept with my aunt til she was 12- she finally asked to move into her own room (I’ll add that my aunt and uncle are divorced now). I also have tons of friends and acquaintances who have never left their kids overnight. I get it if you don’t have anyone reliable to help, but just, wow. I left my oldest for two weeks when he was one, left both boys again for two weeks when they were 3 and 1. We regularly go on shorter trips too. The result is, my husband and I get to enjoy kid free vacations and my kids have lots of family that adore them and they look forward to spending time with. They also spend one night a week at my grandma’s, which is mid-week break for us. I completely understand that I’m lucky for all the family we have willing to help.

          • FormerPhysicist

            I’m like your friends, and hate that the 8-year-old regularly ends up in our bed. But we co-slept out of desperation – she’s always been a terrible sleeper.

          • I think it’s that babysitting is expensive, and there’s so many horror stories of babysitters abusing the kids in the news (even though it’s pretty rare) that parents don’t trust anyone to do it.

          • mostlyclueless

            The cost is the major impediment for us. We live in expensiveland where babysitters run a good $20/hr. I love my friends but I’m not going to pay $80 to hang out with them in the evening. We can get together with my kids during the day or my husband or I will go solo.

          • The Bofa on the Sofa

            When the kids were little, they always slept in their own beds. When they got older, even if they did need comfort in sleeping (like for thunderstorms), we went and slept in their room. They never have the expectation of sleeping in our bed.

            In fact, the only time either of them might sleep in our bed is when the other one is gone with either his mother or me. So if it’s just two in the house, we say sure, come sleep in our room.

          • moto_librarian

            Welcome to my world. I wound up co-sleeping because it was the only damned way to get any sleep, and I went back to work when my sons were infants. They are now 8 and 5, and prefer sleeping in my bed. My older one will at least sometimes start out the night in his own room, but the younger refuses. Yes, I should just gut it out and deal with the few rough nights to get them adjusted, but that’s easier said than done.

            Also, I am now appalled that I let the kids bedshare as babies. It was dangerous, and we were lucky. I would not do that again.

          • momofone

            Babysitting is awesome! We’ve only really used a babysitter in the past year or so (my son is 10), but we all love it.

        • momofone

          C-section s the only way I would ever want to have a baby.

          • Daleth

            Seriously, me too. I AM SO GLAD my babies decided to become identical twins, for a million reasons but chronologically the first reason is because it meant I got risked out of the hospital-based midwife-run birthing center I’d chosen, so instead of heading blindly into a medication-free vaginal birth (because that’s what you do, right? It’s what my mom did, my hippy friends…), I had to stop and think about the options.

            Which, for me, meant I had to go on PubMed and look up studies on mono-di twins, to see what was actually safest for them. And I learned things. Like, until then I’d never even heard of shoulder dystocia.

            And then I discovered the book “Choosing Cesarean: A Natural Birth Plan” (here it is, can’t recommend it highly enough: https://www.amazon.com/Choosing-Cesarean-Natural-Birth-Plan/dp/1616145110). That started me thinking about what was safest for me, and most compatible with my preferences. I didn’t even know what a third- or fourth-degree tear WAS before reading this. I didn’t know that prolapse was strongly correlated to vaginal birth–that got me talking to my mom, and it turned out she and my grandmother both had prolapse. Which I DID NOT WANT omg no.

            So yeah. If we had more kids I would schedule my c-section as soon as the positive pregnancy test came back. I don’t even have zero interest in attempting a VBAC–I have significantly negative interest. Nevah evah!

          • the wingless one

            SAME!! I was recently at a dinner with three other moms, all of which had frightening & painful birth experiences (two of them had 4th degree tears). I sat there all smug telling them how awesome the c/s & recovery was & how if we do have another I’ll be scheduling the c/s right away! If I ever end up with a vaginal birth something will have gone horribly wrong.

          • Daleth

            I was already wanting a CS for the safety of my twins (all the studies I saw indicated the risk to them was lower that way), and then when I googled “fourth-degree tear” I was like, OMG, SCHEDULE THE CS NOW!!!!

        • You are absolutely disgusting, and BTW, I did almost the exact same thing with my three (now happy, healthy, and successful adults in spite of their Terrible Upbringing)

    • The Bofa on the Sofa

      Didn’t you know? C-sections are violent and traumatic attacks on mothers, and are adverse interventions that are important to avoid in themselves, and that’s why they are the easy way out for mothers who are too posh to push.

      • Casual Verbosity

        I just can’t get my head around the contradiction of that viewpoint. On the one hand C-sections are traumatic interventions that should be avoided at all costs, but on the other hand when a woman chooses to have a C-section she’s taking the easy way out. Surely the only way this can make sense to people is because the only thing underpinning their beliefs about C-sections is their belief that natural birth is superior. Therefore their beliefs about C-sections shift according to the argument they wish to pursue. If a woman is considering having a C-section they argue that it’s so traumatic and that a vaginal birth is much easier to recover from. But if the woman has already had the C-section and liked it, then she took the easy way out and she can’t possibly be a proper mother because she didn’t suffer through a “real” birth. It makes me dizzy trying to get it straight.

        • The Bofa on the Sofa

          Yrs, you it correct. It doesn’t make any sense.

    • amazonmom

      I had no interest in stunt birthing so I was a terrible mom and asked for a second section ! Best decision I ever made

    • Tigger_the_Wing

      Had scans shown any sign of spina bifida in any of my babies, I would have insisted on an elective CS, to reduce the risk of paralysis. A mild form of it runs in my husband’s family, so mild that my father-in-law wasn’t diagnosed until his forties. One of my sons was diagnosed at 12.

    • Anna

      They don’t believe there is any risk to the baby. They do believe there is a lot of risk to the baby from a c-section – the microbiome!!!! obesity, lower IQ, diabetes, allergies – these things are in the media almost weekly. The average reader, and indeed most reporters can’t discern that the sources are rubbish. The midwifery and NCB groups will post every single article that is negative about c-section and every single article or piece of research that even appears to be positive about breech – including photos montages of breech babies born at home. There were photos circulated on FB about a year or so ago of a flat, blue, baby after a home VBB with a CPM in the US. The comments were all gushing “so beautiful” “this is how it should be”.

      • Casual Verbosity

        And therein lies the problem we’re trying to combat. If people don’t believe in the real and immediate risks of vaginal breech births, then the vague and delayed “risks” of caesareans are likely to be more convincing.

        That story about the blue HBAC baby is awful. The worst part is that it’s likely those same people would use the infirmity of the baby’s appearance as a condemnation of intervention if it had been born in a hospital. Yet at home it’s beautiful.

    • guest

      My first was a VBB (I was deep in the woo at the time) in a hospital with an OB my homebirth midwife recommended. No epidural and the anesthesiologist would have to be called in if there was a problem. We got very lucky and all went well. I was leaning toward C-section and the doctor told me breech delivery either way was risky and that long term outcomes were similar. It was when my son cried nonstop for 2 days after birth because he was so bruised that I realized it was all a load of crap and I wished I had gone with a C-section. I’m not sure that mothers are always informed that the risk is being transferred to the baby and what all that means. If I had been given the SIDS comparison, there is not a chance in hell that I would have done a VBB. Even just listing out the minor injuries like bruising the baby is likely to have would probably sway some mothers.

  • CSN0116

    Ugh, I watch mo-di twin moms try this shit all the time: “It’s cool. As long as Baby A is head down, doc can go on up for Baby B.” (I can only imagine what a breech extraction does to a vagina)

    They are literally that dismissive about it.

    They don’t clearly understand the risks, despite being under OB care. I have seen this result in CP, emergency cesarean after the birth of Baby A, shoulder dislocation, palsy, hemorrhage, and death. The last thing you want with a _shared placenta_ is a delayed or compromised birth of the second baby… who is relying on that placenta’s function (that’s just waiting to detach) until she is born.

    These women fail left and right, but keep on trying. Insanity.

    • Sullivan ThePoop

      In my SIL’s case baby B was too big for a safe vaginal birth.

    • Mel

      My mom had an emergency total breech extraction of my twin sister after I was born.

      Mom’s OB was frantically trying to get an open operating room for Mom because she had progressed from 4cm to fully dilated in a very short period of time. I was vertex; my twin was transverse. I popped out on my own at the beginning of a contraction; I was also beet-colored which is a sign of TTTS.

      The OB swore and said “We’ve gotta get Baby B out now” An anesthesiologist shoved a mask over my mom’s face and told her to breathe as deeply as she could. Mom said she was as high as a kite in seconds. The OB got the two biggest guys in the room and showed one intern/resident/whomever where to push Rachel’s feet down and the other where to push Rachel’s head up. The L&D nurses grabbed and pinned Mom’s legs in the stirrups so she couldn’t kick while my dad held my mom’s shoulders down. He said “Go” and reached into Mom to sweep for Rachel’s feet. Mom said it was the worst three minutes of her life – and that was with the best inhaled drugs she’d ever had.

      She didn’t have much vaginal damage – but she’s had multiple pelvic floor repairs.

      • PeggySue

        Seriously scary. So glad everyone survived.

      • amazonmom

        Oh your poor mom. Did Rachel do ok?

        • Mel

          Yup. Rach was born grey – but mainly because I had all her blood. We were at 29 weeks gestation so I was hospitalized for 6 weeks; Rach had a more complicated preemie-hood and was in for four months. She’s fine – profoundly deaf – married with a toddler and a job she loves.

          • amazonmom

            Lovely to hear- I love my little TTTS patients

          • mabelcruet

            Me too-i get the placentas to look at. We inject them with different coloured inks (a vein and artery in both sides) and that shows you where all the vascular anastomoses are, it’s fascinating.

      • Tigger_the_Wing

        Poor woman – what a terrible, terrible experience.

        • Mel

          She said it was miserable – but since it saved Rachel’s life she’d do it again.

          • Tigger_the_Wing

            Indeed, I can imagine – and I was lucky enough that my breech boys managed to get their feet and hips out by themselves. As mothers, we willingly go through hell so that our babies don’t have to.

            In a coincidence, both my breech boys are visiting today – they’re going to the cinema this evening to watch the new Star Wars film with their Dad. One lives in England, so (apart from Skype) we only see him a couple of times a year. It’s lovely to have him and his lovely wife staying with us for a few days!

      • CSN0116

        I am scared shitless just reading what your mom went through!

        And sounds like you guys had TAPS, or twin anemia-polycythemia sequence, which wasn’t formally recognized until 2008. It’s TTTS’s deadly little cousin. https://uploads.disquscdn.com/images/af7ae103350771663aad8945301f354c1337a75c8eec3f5d7ea2a61aa62e525b.jpg

      • Sue

        This is what it means to make life-saving decisions to deal with the emergency at hand and be prepared to take action, AND be held to account for the results.

        This is also what it means to understand the reasons for the intervention, and prioritise the outcome.

        • Anna

          I’m smashing the like button but its not working.

    • PeggySue

      That’s totally, totally terrifying.

    • StephanieA

      I recently cared for a twin mother who birthed Twin A vaginally and Twin B, despite being head down as well, wouldn’t come. She had to have a C section for B. The babies were fine, but I can’t imagine the recovery from a vaginal AND a c section delivery at the same time!

      • CSN0116

        Worst birthing scenario everrrr.

        • StephanieA

          Seriously. Had to be a rough recovery. But I’m sure it will make a good story down the road because the twins ended up with different birthdays due to B taking so long!

    • Daleth

      Omfg. I am a mo-di twin mom. My doctors (MFMs) tried repeatedly to talk me into attempting a vaginal birth even though Baby B was breech or transverse at every ultrasound but one. I read up on the procedure and statistics for attempting to turn breech Baby B’s and everything about it sounded horrifying and dangerous to both me and B. Are those twin moms you know just in denial? How does this seem like a good idea to them?

      In my case the docs finally, after repeated insistence from me, scheduled the c-section and then at the start of week 36 Baby B turned vertex. The head of MFM once AGAIN tried to pressure me: “Are you sure you want a c-section,” blah blah blah. YES GODDAMN IT I AM SURE, that’s why we’ve had this conversation fourteen times–and if he can turn at the start of week 36 he could turn again, so SHUT UP and respect my choices for a change!

      Sorry, vent over.

    • You’re right, you don’t want to know what a breech extraction does to a vagina.

    • Heidi

      Who would want to have to recover and experience the cons from both a vaginal birth AND a C-section? Insanity indeed!

      • Daleth

        Exactly. And about 1 in every 20 mono-di twin moms who attempts a vaginal birth ends up having to recover from both kinds of birth. That’s on top of the 40-45% who end up needing an emergency CS while in labor before either baby comes out.

        That’s part of the reason I kept telling my doctors, “Look, let’s just schedule a c-section and skip all that.”

        • Tigger_the_Wing

          I had to look up ‘mono-di twins’ because I had never heard the term. Fascinating! I was told at their birth that my twins had one big placenta between them, and separate sacs, and for the first few days there was even talk about them being identical, despite the size difference – but, aside from their race and their shared blood group, they are as unalike as any twins could be without being opposite sexes.

          • mabelcruet

            When it comes to twin placentas-a monochorionic twin pair are always monozygous (‘identical’), but a dichorionic twin pair may be dizygous or monozygous. About 80% of dichorionic twins are dizygous (fraternal ‘non identical’ twins) but if you have same sex dichorionic twins then is a chance they may be monozygous, even if they’ve got separate discs. It all comes down to how early on after conception that the conceptus divides. If division is within a day or two, you’ll end up with two separate embryos with separate placentas, but if it happens a couple days later, you get one big placental disc. If division is delayed longer (to 10 days after conception) then there’s a risk of conjoined twins.

            In practice, it’s generally easy to tell if the placenta is dichorionic or monochorionic by eyeballing it, but if the twins are same sex and the placenta is dichorionic, you can’t say definitively that the twins are identical or not without doing additional testing.

          • Who?

            Does it matter-apart from curiosity value-whether or not they are identical?

          • Gæst

            Not that I’ve ever heard of. Most of the twin parents in my online group don’t bother to get their tested. (I had di-di b/g twins, so it wasn’t necessary for me).

          • mabelcruet

            Not really, once you’re past the pregnancy and delivery stage, that’s the most dangerous aspect of being a twin. In monozygous twins I think there is a slightly increased risk of leukaemia in the co-twin if one twin develops it. But it would be nice to know what type of twins they are because how could you do all those experiments on them? Seeing if one of them can feel pain when the other one breaks their arm, or if they can mind-read the Zener cards

          • Daleth

            Yeah, apparently it can sometimes be hard to distinguish between two adjacent placentas that share a border and a single shared placenta (which always means identical twins).

            If an embryo splits into identical twins after the placental cells get attached to the uterine wall and the placenta starts growing–all of which happens within like the first 5-9 days after conception–then you get two babies and one placenta: mono-di twins (or if the splitting happens a day or three later, mono-mono, which is incredibly high risk because they share a sac so their umbilical cords can get tangled in each other).

            But an embryo can split into identicals before it implants in the uterine wall, and in that case you get two placentas, or di-di twins. About 30% of identicals are di-di, as are 100% of fraternals, but when fraternals implant close enough that their placentas touch, it can be hard to be sure it’s two separate placentas. Early scanning (<10 weeks) is best for making that distinction because at that early point the placentas are small enough that they're not touching yet, so you can clearly see there are two of them.

      • KeeperOfTheBooks

        Sigh.
        A nice-but-nutty relative of DH’s falls neatly into that category. Had twins, and deliberately had the first via VB so that she would “know if there was anything wrong” with twin B, born via CS. Because, of course, CSs are the cause of all sorts of horrors, and twins are always exactly alike in temperament/abilities/mental and physical health, right…?
        Like I said, very nice woman, but not infrequently nuttier than the average fruitcake.

  • amazonmom

    It’s my daughter’s ninth birthday today. She had flipped breech at term and almost certainly would have died, or suffered permanent devastating injury if she had been a vaginal breech attempt due the particulars of how she was positioned. My OB was convinced that cord compression or prolapse would have killed my baby if labor or rupture of membranes would have happened before the section.

    Instead of being sacrificed so vaginal breech could be in the skill set my daughter and I experienced a calm pleasant c section before labor onset at 40 weeks 5 days. I will forever be grateful for my OB asking me to come in for a last visit before my induction. Finding the breech and intervening in time gave me the gift of a healthy child.

    • StephanieJR

      Great story. Tell her happy birthday from me.

    • Mariana

      My second baby was in transverse lie st 38 weeks. He would flip and go back to transverse. Since I had already had a csection with my first, my ob offered to schedule a csection for 39 weeks. He was born butt first from a csection, a plump healthy baby. I can’t even imagine why anyone would risk having the baby push a little hand first (that’s the position my baby was) and end up with a true emergency.

      • amazonmom

        They don’t actually believe the emergencies happen. That or some of my coworkers are so used to being able to save the babies that come in the door they don’t think about consequences. We’ve gotten so good at preventing bad outcomes that people don’t realize how we got here.

        • mabelcruet

          ‘They don’t actually believe the emergencies happen’

          And that’s why homebirth fanatics always say ‘but the hospital is only a few minutes away so its perfectly safe’. They have 1) no idea what the risks are and 2) don’t believe there are risks anyway which is why they have a touching faith that the hospital will sort out the entire mess when things goes tits-up.

          • amazonmom

            Or they complain about everything we do talking how evil we are for separating them and not bringing their child with PPHN in to breastfeed in their room… to the point where the CEO calls and asks what’s going on

          • Sue

            The anti-scientists always have to find a fall-back position that justifies their pre-conceived beliefs, no matter how bizarre.

            That’s why anti-vaxers who have children who were apparently “damaged” before they even got a vaccination have to blame the Vitamin K. While paradoxically treating everything with massive doses of VitC.

          • kilda

            or the vaccines the baby’s mother got as a child.

        • Who?

          I think they think the emergencies are caused by the ‘interventions’ ie everything was fine until you put that monitor on me/ran the epidural/whatever. And that nothing can go wrong if you just let things flow. I feel like they have never been in a traffic jam on the way to an important appointment, or had the dishwasher overflow, let alone been in an accident or had a major illness. As we know, things go wrong all the time.

          A friend’s daughter has just come back from an east African country, doing a month as a medical student in a big regional hospital. She saw a birth where a lack of monitoring led to a very bad outcome for the baby. Labour was going really well but inside things were evidently not so good, and the baby was born in a very bad state and didn’t do at all well after. Monitoring would have shown up a problem with the heart rate, and they could have done a cs-she said they do a lot of them-but because they didn’t know the baby was in trouble, they couldn’t help.

          • Azuran

            Of course it’s the interventions. My baby was a perfect average 50th percentile when my water broke. But the pitocin and the epidural made her grow all the way to the 85th percentile and her head couldn’t fit in my pelvis.

            Everything would have been fine if I had went the natural way.

        • Tara Coombs Lohman

          They think emergencies happen to women who didn’t take care of themselves–who didn’t eat all organic food, who got vaccinated, who didn’t do hot yoga every day up until delivery. They think if they just “hold their mouth right” they can prevent any and all emergencies. If all goes well for them they can be smug, “That’s because my weight was perfect and I only ate organic vegetables and fruits.” And if something terrible does happen, they are blindsided and then have no one to talk to about it. And the other emergency deniers can comfort themselves that of course it happened because they must have done SOMETHING wrong even if they don’t admit it.

      • Transverse lie, with or without a prolapsed arm is NOT deliverable vaginally. Period.

        • usuallylurking

          I was transverse with a prolapsed arm and was delivered vaginally.

          But only after the OB performed an internal podalic version. I was second of a pair of twins.

          I get rather salty about people who are blasé about vaginal twin delivery, especially breech deliveries for Baby B. That was me, and the stats aren’t reassuring. I think my parents made a reasonable choice, but the risk calculus has changed quite a bit in the thirty years since I was born.

    • Tigger_the_Wing

      Happy Birthday, amazondaughter!

  • kilda

    it’s so tiresome listening to them yet again saying “whyyyyyyyy won’t you help us do something dangerous? It’s not faaaaaaiiiiiiiiiiiiir.”

  • kilda

    you know, if you can’t get privileges at a tertiary care hospital, there’s probably a reason. That really should raise some red flags about a dr.

    • The Bofa on the Sofa

      coughdangerouswhackocough

    • Mel

      It’s for the safety of the crazy OB. At some point, there would be an “intervention” staged by the older NICU nurses and RT’s that involved baseball bats and chains…..

  • namaste

    Obviously these NCBers need to listen to the immortal words of the Great Philosopher Mick Jagger* “You can’t always get what you want. But if you try, sometimes, you might find you get what you need.”

    *snark, in case that was in any way unclear.

  • ally

    Could anyone in the know enlighten me on the safety of external version( turning the baby around)? This is a possible solution to the breech problem, but OB’s do not seem to recommend it very often (I had 2 breech babies and 2 cesareans, version was never mentioned). Is that simply because versions aren’t safe, or because they aren’t convenient for the OB?

    • Helen

      If the baby is not engaged in the pelvis and not tangled in a cord, external version might work. My SIL had an external version with her second because at the time of labor, he was transverse. Frank breeches, butt first, can engage in the pelvis in that position, and thus can’t be turned. Also, external versions can be very painful for the mother.

      • kilda

        aren’t babies sometimes in the wrong position due to cord issues, like a short or tangled cord? in that case forcing them to turn could be very harmful.

        • Helen

          Tangled in the cord is very much a contraindication.

      • Pcogale

        One of my friends had an easy successful ECV of her third baby. No idea why he thought being bum down was preferred but he never turned back and she went on to have an NVB… like the other two. The midwives thought I had a breech for baby number 3. I don’t ever remember her turning but when there was a question around 28-30 weeks a more senior midwife had a feel and said definitely head. I think the kid had a hard butt – I don’t remember any large movements of her turning so was probably always cephalic. Certainly she came out head first. I did google breech births and was slightly horrified. After I had the kid (on the postnatal ward) I was telling the midwife how I would’ve had a C/S if the kid was breech and she asked, “Why?” I wasn’t expecting that. Also what I see is that most ECV’s attempted on primips are unsuccessful but tend to be successful on multi’s.

        • Tigger_the_Wing

          My second kept somersaulting and rupturing the membranes, even though I was on bed rest in the antenatal ward for ten days. The afternoon before he was born, a month early, the OB and her team came round, examined my bump, and declared him to be nicely head-engaged.

          In the middle of the night, he somersaulted again, and I went into labour. I told the midwife in charge that he had turned round, and she refused to believe me because of the doctor’s note. She even did an internal exam and claimed to be able to feel his nose. I dread to think what she was feeling, because he came out feet first.

        • Helen

          I knew someone who said that she was scheduled for a csection — which she did not want if at all possible — and she asked the hospital to check, right before the operation, to see if the baby was still breech. Overnight the little girl had flipped and engaged in the pelvis. The operation was canceled and she went ahead with an uncomplicated vaginal delivery.

          Quite a few birth attendants have been fooled by “just a feel,” and even the location of the heartbeat has a failure rate. I think the best thing to do is an ultrasound before any cuts are made.

    • FormerPhysicist

      I know nothing about them, medically. I do know that both of my friends that tried them had to have it done in the OR, and did end up needing an emergency c/s right then and there. And it was very painful.

      • Kristi Berry Pedler

        I do versions. My success rate is around 55%. After giving informed consent, it’s pretty rare for a pt to choose it.

        Personally, I prefer LTCS – easier on me. Versions cause my shoulder bursitis to flare. My office manager wants to forbid me to do them because of my shoulder.

    • crazy mama, PhD

      I had an external version for breech, although my baby refused to turn and so we went straight to a non-emergency C-section. It HURT, even with a low-dose epidural in place. It wasn’t done by my regular OB, but by an MFM—perhaps one reason why versions are rare is that most places don’t have a specialist with the required skills?

    • mabelcruet

      I don’t think I’ve ever met an obstetrician who scheduled something for their own convenience. Sections and ECVs are scheduled according to patient safety, taking into account staffing levels, availability of operative theatres, anaesthesia, beds in the special care baby unit and so on. It makes far more sense to schedule something for mid afternoon, for example, when all of this is in place, than it does to carry out a section in the middle of the night as an emergency.

      • fiftyfifty1

        Yeah, if you have a personality that is much concerned with your personal convenience, being an OB is the very LAST specialty you would choose.

    • Tigger_the_Wing

      I had an external version with my second twin, when he turned sideways after his much bigger brother was born – there was no way he could come out sideways, and the epidural had only numbed one side, so they wanted to avoid a CS if at all possible. It wasn’t comfortable, even with half the pain, and he would only turn so he was head up, and was born feet first.

      If both twins hadn’t been head-down at the start of labour, I would have had a CS (probably under a general anæsthetic) and been perfectly happy with that.

      Note: The reason why my babies found it so easy to turn, the reason I kept getting premature rupture of membranes in my pregnancies, and the reason the epidural didn’t work properly (also the reason why local anæsthetics don’t work for dental treatment) was finally discovered five years ago, when my then-GP in Australia realised I had all the signs of Ehlers-Danlos Syndrome, which was confirmed by a rheumatologist when I came home to Ireland.

      • Sullivan ThePoop

        My SIL second twin was also kind of 1/2 sideways and had both feet up against his body. His brother was head down, but 30% smaller. She had a C-section

    • The Bofa on the Sofa

      This is a possible solution to the breech problem, but OB’s do not seem to recommend it very often

      Our OB offered, but with the caveats:
      1) Her success rate is only about 1/6
      2) It can be very painful

      My wife had no interest.

      We had a friend who tried it. Her report was that it hurt. And it didn’t work.

      I don’t know how much of an issue safety is, but the reason OBs don’t do much about it is because it’s usually a waste of time and inflicts pain for no benefit.

      • Sarah

        Isn’t there also a small increase in the rate of EMCS after this procedure? I had a friend who was offered it in the UK for her breech baby and that’s part of the reason she declined and went straight to ELCS.

        • The Bofa on the Sofa

          Maybe. It might depend on when, I suppose

        • Daleth

          There’s a risk of placental abruption and cord accidents. But I guess if vaginal birth is your holy grail, those risks are somehow worth it??!?! Or else people think that those bad outcomes only happen to other people.

          • Sarah

            Yes I suppose those would potentially contribute to higher EMCS risk, as they’d be noticed afterwards. I like to think I played my part in my friend’s choice, I showed her my own section scar! She was leaning that way anyway but she said it didn’t look too bad.

    • amazonmom

      I was offered a version attempt. Under the conditions I had my OB said I had a 10 percent chance of the version working and a 50 percent chance baby would revert to breech before she could get labor going well enough to give me a vaginal delivery. She wanted to give me that option if trying for a vaginal birth meant a lot to me. she even asked me if I was sure I wanted to proceed with c section while we were in the OR giving me one last chance at version before surgery began. The OR crew even told me not to worry about inconveniencing them if I wanted version. It wasn’t appealing to me so section it was.

    • maidmarian555

      I looked into ECV when I was pregnant with #1 (they thought he might be transverse) and there were risks. I forget the actual numbers though (or where exactly I found them). My friend had (a successful) one at the same hospital and the OB told her that only 50% of expectant mothers meet their criteria for a safe version attempt, and of those only 50% have a successful procedure (the NHS website claims a 50% success rate and doesn’t mention that some mothers are risked out to begin with). I remember thinking it sounded like a lot of hassle and unnecessary risk when one could just have a c-section instead (although I knew we were only planning on having 2 children and no more so that, obviously, had an impact on my opinion of the procedure and whether I would consider it). It appears to be fairly standard practice here (in the UK) my daughter was breech and when it was confirmed at 37wks via ultrasound I was offered a consult for ECV if I wanted one (I already had a c-section booked so declined).

    • Seattle Mom

      I had an unsuccessful external version 15 years ago, which was recommended by the doctor. I was in the operating room with an epidural, and they went straight to the C-section afterwards. They observed their progress with an ultrasound machine, I guess so they wouldn’t make any dumb moves with the cord. Even with the epidural it still hurt, but maybe not as much as it would have? It felt like the worst Indian sunburn you could imagine. (the feeling of their skin repeatedly rubbing on my sensitive tummy skin)

    • StephanieA

      We have one doctor who will do them. He is very skilled, but they just don’t always work, and they’re very painful from what I’ve heard. I know of two of my colleagues who tried the ECV, it didn’t work for either of them.

    • cookiebaker

      I had a successful external version done on my 2nd. I was 24 at the time and believed natural childbirth was important. I was seeing a CNM and was having a hospital birth. I was devastated to find out he was breech at 36 weeks. They offered me a c-section or trying the version and I opted for the version. I had my appendix removed 5 years earlier and the surgical recovery sucked (large incision), so I really didn’t want surgery again, if I could help it. The version was done by an OB in the hospital. It was uncomfortable, but not painful and I had to be monitored for hours afterward. Fortunately, he stayed head down and 4 weeks later was a perfect birth (as measured by NCB advocates): spontaneous onset, short, productive natural labor, 10 minutes of pushing, healthy baby, no tearing, breastfeeding champ. I thought it would be cooler than it was, but all I remember was feeling irritated at how much labor and pushing had hurt.

      In retrospect, it scares me to know what could have gone wrong. I’m glad it worked because I went on to have 4 more kids and that would have been a lot of surgery.

      • You were very lucky. I’ve seen the “popularity” of ECV go back and forth several times during my professional life (also VBACs). Right now, in Israel at least, it seems to be offered mostly to religious women who are likely to want big families and so not have C/Ss if possible. But since premature separation of the placenta is one risk, if a woman is planning on only having at most 3 or 4 children, it seems much safer just to have a C/S.

  • The Bofa on the Sofa

    Aside from the mortality….

    my mother-in-law had two vaginal breech births (my wife says she is the only one who came out right). Neither of the babies died, so that must mean it’s all good, right?

    Not at all. My MIL basically describes it as among the worst experiences of her life. It was painful and caused a lot of damage to her (I think the Poise company profits will take a major hit when she dies). She was the one who made my wife fear breech births and even vaginal birth overall, and my wife was relieved when our first was breech so she could have a c-section and not have to go through L&D.

    It’s bad enough that the mortality rate is high, but there is also the high rates of the other complications that come with breech birth.

    I have no experience, but according to my MIL, vaginal breech births suck.

    Note she had them 50 years ago, when doctors should have been skilled at them (because they all had to do them back then), so don’t blame the doctor.

    • Tigger_the_Wing

      I agree with your MIL. I’ve also had two. They suck, they can be extremely painful, and there is the terrifying possibility that the baby will be brain damaged or die.

      • The Bofa on the Sofa

        They suck, they can be extremely painful, and there is the terrifying possibility that the baby will be brain damaged or die.

        But other than that, they are just peachy!

        • Tigger_the_Wing

          Indeed. 😛

          If your goal in getting pregnant is to get a lot of attention, and to crown it by having a Perfect Birth Experience (according to the rules of the woo crowd), then the baby is just an unavoidable inconvenience, a mere side-effect to the Mum’s ‘All About Me’ show.

          To the rest of us non-sociopaths, the goal in getting pregnant is to have a child, and pregnancy and birth are the unavoidable inconveniences to be endured as safely as possible; which means taking all the measures necessary to get Mum and Baby through with minimal trauma and risks.

          • BeatriceC

            Unless you’re me, and the goal is to have older kids and teenagers. Then pregnancy, birth, and infancy/early childhood are unavoidable steps in the goal. Well, unless one adopts a teen, which I may well do as soon as mine are out of high school. And don’t get me wrong. I love and adore my kids, and did so even when they were babies, but I’m just not all that fond of the work involved in caring for kids in the baby and toddler stages of life.

          • Roadstergal

            My dad once told me something similar – that the baby/toddler was something to get through, and he really got into us when we were old enough to have conversations. That makes a lot of sense to me!

          • Tigger_the_Wing

            I actually love children in all the stages of childhood, although I don’t like some of the drawbacks that come with being the parent at each stage!

            Besides my own five, and living with some of my grandchildren, I’ve also fostered teens; I think that they are wonderful, which is just as well because, by the time my youngest grandson leaves his teens, I’ll have spent over thirty years of my life living with at least one, and up to four, teens in the house.

          • swbarnes2

            Mine is at the age when she can say “Mommy, you are my cuddlebug”, “I like you”, and “I love you”. Soooo much better than the blobby baby stage.

          • BeatriceC

            Just wait until she starts using logic and reasoning skills. The results are often times hilarious.

          • swbarnes2

            Well, she knows she is not a droid, because she has no batteries.

          • Amazed

            My dad is ecstatic when Amazing Niece goes to him with the first paper she can lay her hands upon and demand, Write Mommy! (Actually, it’s more like thinking that she writes Mommy but whatever.) She recognizes many letters and points them out in different words, saying, “Grandpa!” (My dad’s letter), “Masha!” (Masha and the Bear) and so on. At the same time, he finds it hilarious when she says yes at being asked the tousle-head question. Yes, AN is tousle-head. Yes, Auntie is a tousle-head. (Both true.) Yes, Grandpa is a tousle-head (a female one, if you please, because I use the gendered form. Emphatically NOT true!). He’s so happy at each pointer that she moves towards being a reasonable conversationalist and he refuses to be discouraged just because he doesn’t know if she has any idea what she’s talking about!

          • kilda

            hey, I managed to avoid those stages! My kids were 9 and 10 when I adopted them.

          • BeatriceC

            You’re my kind of people. 🙂

            But for real. I taught 7th grade and not little kids for a reason. I once spent 90 minutes covering a 2nd grade classroom in an emergency situation (severe sub shortage crisis…even the lunch ladies were babysitting classes just to get an adult in the room), and it was the worst 90 minutes of my entire teaching career. I truly enjoy teenagers. I don’t like some of the attitude, but I find the teen issues much easier to deal with than toddler and baby issues.

          • kilda

            thanks. 🙂 It’s pretty funny when people assume I have experience raising babies just because I have kids. Or when I get asked things like “how old was your daughter when she walked?” (or slept through the night, or learned to read, etc). And i have to answer “I have no idea.” 🙂

          • BeatriceC

            You could have fun with that though, if the kids are okay with it. Totally different concept, but my sons and I used to secretly compete to see how outlandish our explanations of “what’s wrong with your kid” could be before people realized I wasn’t telling the truth. (Youngest uses a wheelchair a good chunk of the time, and oldest has the same bone disease, but not as severe)

          • Helen

            Yeah, me too.

          • PeggySue

            My brother thought he wouldn’t have any interest in his grands until they were old enough to “do things with.” But when the daughter who lived closest to him was pregnant, I kept telling him he’d turn to mush if she had a baby girl. He insisted that he just was “not a baby person.” The day of the C-section birth, he sent me so many photos my computer crashed, and when I finally got to see the photos, the very last one was of him holding his new baby granddaughter. He had her snuggled up close and they were staring deeply into each other’s eyes. I swear he didn’t know there was anyone else ON THE PLANET. I called him to offer felicitations and told him he looked pretty impressed with his little granddaughter, and he said, well, you know, I’m not a Baby Person, but THIS baby… She is UNUSUALLY beautiful and alert, don’t you think? And isn’t her face GORGEOUS? And her hair? And did you see how cute her little hands are, and her TINY EARS, MY GOD? He has been in her corner since the moment he saw her, every age, every challenge. It’s really been wonderful to watch.

          • StephanieJR

            Aww!

          • Allie

            “Every baby is the sweetest and the best.” ~ Marilla Cuthbert, Anne of Green Gables : )

        • kilda

          and empowering. you forgot empowering.

          • mabelcruet

            And bragging rights. You forgot points for sanctimommy bragging rights.

    • Heidi

      My mother was born breech in 1960. She was born blue. I kind of think if my grandmother wasn’t a fast laborer and she always went into labor a few weeks shy of 40, I wouldn’t exist. I can only imagine how scary the situation was.

  • mabelcruet

    I’m booked to go on a study day next week entitled ‘Controversies in Obstetrics’. I’m not an obstetrician, but I get involved when the outcomes are very, very bad. There’s sessions on breech birth and why are we so scared of it, fetal growth measurement and why it’s over rated, standalone midwife units and how underused they are despite being so safe and other such topics. The organisers say it’s meant to generate discussion, personally I think it’ll generate a few arguments.

    • Roadstergal

      Are the UK midwives scared of it? With all of the HBAC and the like they do, do they actually get the breech thing? (Honest question)

      • mabelcruet

        No, I think breech are generally attended by obstetricians, but UK midwives or obs staff will know better than me if there are regulations about it. Because it’s NHS, there’s no real financial drive for a midwife to try and hold onto cases, and they and the obstetricians get paid regardless of how many or how few operative deliveries they do, so there’s no evidence that obstetricians pressuring women into sections purely for financial reasons (I’ve seen that argument used before now).

        I’ve been involved in one case of a baby who was being delivered at a standalone midwife led unit who turned out to be an unexpected breech (the baby had been documented the whole way through as being cephalic, right up to the moment the testicles appeared) . Mum got blue lighted to the nearest obstetric unit but the baby died. That led to a number of policy changes in that unit eventually.

        • swbarnes2

          So were those midwives incompetent, lying, or unlucky?

          • mabelcruet

            No idea. The mother had only one scan (the routine anomaly scan at 20 weeks) and after that she was entirely midwife led care so there was no independent assessment other than what was documented. All the documentation was saying baby was cephalic. I don’t know if baby was genuinely cephalic and flipped at some point, or if the midwives were unable to tell the difference. Personally I think perhaps there’s an issue of ‘follow my leader’. I’ve seen this with IUGR babies where someone has mapped the growth centiles according to fundal height. I’ve had cases where the baby comes out <<3rd centile, but all the fundal heights were measured at the 75th, complete dissonance between estimate and actuality. I think someone measures it, or feels it, and subsequent examiners are influenced by that and try and make their examination 'fit'.

        • Tigger_the_Wing

          That story makes me even more grateful for my hideous second delivery. My son had also been cleared by an obstetrician as being head down – the evening before I went into labour. I’d been in hospital for ten days, because he kept turning round and rupturing the membranes. My delivering midwife refused to believe me that he had somersaulted overnight, until his feet appeared. He was an emergency forceps delivery and, despite being a month early, he had a huge head so the pain was horrific. He’s now a happily married father-of-two in his mid thirties, and a martial arts instructor. I could have lost him, of course, just like the Mum in your story. Doesn’t bear thinking about. Nowadays, of course, his position would have been discovered by ultrasound as soon as I went into labour, and I would have had a c/s instead.

          My second breech delivery was the younger of my six-weeks-early twins, 25 years ago next month. He turned sideways as soon as his brother was delivered, and after being turned vertical came out feet first. But that was easy – he was much smaller than his twin, so he didn’t get stuck, and I had been hooked up with an epidural which had numbed my left side, halving the pain.

      • Sarah

        I know breech would get you risked out of any freestanding MLU and most hospital MLUs, and if you insisted on homebirthing, you’d be doing it against NHS advice. They prefer you on a CLU if you’re attempting a vaginal breech birth.

        However, I know women sometimes deliver on CLUs whilst attended by a midwife with an OB overseeing, in some circumstances. Dunno if breech is one.

        • mabelcruet

          Yes, I think in ‘along side’ midwife units with the consultant led unit right next door it’s safe, as they have the same access to consultant care and theatres. In the NHS, the midwives are around even in the very high risk cases, they still deliver a lot of the care before, during and after birth even for complex cases. I don’t know what goes on in some units, but the one I’ve worked with most frequently is a high risk tertiary referral unit, and there is a good relationship between the medical and midwifery staff.

        • Tigger_the_Wing

          As I have said before, one of my twins was breech. Of course, being twins, the room was already full – anæsthetist, two midwives and a senior midwife, one obstetrician, two pædiatricians, two pædiatric nurses and a partridge in a pear tree. After the first twin was born, the second turned sideways, and the OB supervised the senior midwife turning him straight. When it was obvious that he’d turned breech, the midwife stepped aside to let the OB take over, but he stopped her and said “One day you’ll have to deliver a live breech baby and there won’t be an obstetrician to help – isn’t it better that you do your first one with me standing behind you?” She was delighted.

          Afterwards, she explained that until that day she’d only been allowed to deliver breech babies who had already died; live breeches were always delivered by OBs.

          • FallsAngel

            Aren’t you glad she waited until your child was safely delivered to tell you that?

          • Tigger_the_Wing

            Of course! I was already on tenterhooks after hearing what the OB had said!

          • shay simmons

            I dunno — parts are me of wincing at the thought of being a training aid for breech birth.

          • Tigger_the_Wing

            Well, I wasn’t exactly her first (although the other poor mums had been delivering dead babies, so that must have been an entirely different delivery room atmosphere) and the OB was literally standing right behind her, between my feet as she was standing between my knees. Compared to the way his second biggest brother had been delivered, number four son’s birth was sunshine and roses!

          • shay simmons

            You have four boys? Your place must be a riot!

            Seriously, I grew up in a big family (4 boys, 3 girls) and wouldn’t trade it for the world, although there were times…

          • Tigger_the_Wing

            It was a riot – four sons and a daughter; and, most of the time, daughter’s friend who had lost her mother to a brain hæmorrhage when she was eight. They’re all grown up now, and most of them are parents themselves.

            When I was in hospital last summer, lying down patiently while paddles were stuck to my chest in case my heart didn’t re-start by itself when they stopped it, I was chatting to one of the nurses and the fact I have twins came up. Another nurse said “Oh! You have twins? How old are they?” I answered “Twenty four.” She was surprised, and said that she thought I was going to say about twelve, and that I must have been a baby when I had them. When I saw how shocked she was when I told her that they are my babies, and that my eldest had just turned thirty six, I didn’t have the heart to tell her that my oldest grandsons were almost sixteen!

          • shay simmons

            Clean living and pure thoughts have obviously kept you young-looking.

    • Sarah

      I hope you’ll be willing to step in and participate in those arguments if necessary!

      • mabelcruet

        No, I’ll get chased out of the room, all I can do is keep pulling the dead baby card. I always have to tell myself that I only ever see the bad outcomes and most pregnancies are reassuringly healthy and come nowhere near me.

        My two biggest issues are failure to recognise IUGR-about 80% of my term stillbirths are IUGR or <10th centile and post dates stillbirths. Most aren't recognised as IUGR (and what's scary is that in a lot of these there is complete dissonance between the fundal heights as measured antenatally and the baby's weight at birth-its in the order of many centiles, 1000g + at times). And for some of my stillbirths, there have been times when the mum's dates were being pushed back and back because the baby was measuring small, and the assumption always seems to be that her dates were wrong, not that the baby had early onset IUGR.

        And post dates stillbirths are just so sad. When mums are getting their dating scan done in early pregnancy, they are given dates like 6+2, or 7+4, very precise. But at the other end, they are allowed to go over to T+12 on the grounds that 'baby will come when he's ready', 'we'll let you go over because we don't know exactly'. Why? I'm tired of getting post date babies.

        • Mel

          Spawn-baby’s NT ultrasound helped clarify something that had been bothering me. My LMP date had him being conceived over a week before the 3-5 day window that I knew he was conceived in because we were using OPKs. The sonographer explained that the dating window was 3-5 days – but Spawn was measuring 8-10 days younger than expected from my LMP date so they re-did his due date to a few weeks later.

          When he was born, he had the characteristics expected of a 26 week, 3 day baby – not a 28w, 1 day baby.

          Obviously, we didn’t make it to term – but I wasn’t going to mess around if he wasn’t born by 41w 0d. We had two data points stating that he was due right around March 1st – and I wanted my uterus back by March 8th at the latest.

          • StephanieJR

            I’ll have to ask my mum more tomorrow, but both my (older) brother and I were somewhat premature; I’m not sure what his supposed due date was, but he was born March 31st. My date was anywhere between Christmas and New Year; I ended up on December 8th. We were both just over 5 lbs, and I had a touch of jaundice.

            Anyway, that’s about all I can share. Nothing as exciting as Spawn’s, whom continues to be awesome.

        • StephanieA

          This is so sad, but I find it so interesting as well. Please keep sharing your knowledge.

        • Kelly

          So are you saying that the doctors should have caught it or that we don’t have the technology to catch it?

          • mabelcruet

            Speaking very generally, I see very similar features in many stillbirths. In some centres there may not be any scans done after the 20 week anomaly scan, and fetal growth is assessed only by fundal height measurement. What I commonly see are babies with failing placentas-the placentas were functioning well enough until 30+ weeks but in the last few weeks, when the baby is trying to chub up, fetal growth outstrips placental function. It could be due to the placenta being too small (and that’s hard to assess antenatally), or maternal arterial perfusion isn’t up to scratch, or due to a specific placental condition like delayed maturation, MPFD, chronic villitis, etc- these are problems because there is no antenatal test for them and they can only be diagnosed if the placenta is examined microscopically after birth, and they can all recur in future pregnancies so it’s especially important to know about them. And to top it off, I commonly see infection in these placentas-my gut feeling is that the baby was failing to grow but just about hanging on, then the stress of labour was too much for the crappy placenta to cope with and the baby becomes acutely hypoxic and asphyxiated. Or the placenta is just about coping, but a little bit of infection sets in, and a more robust baby and placenta might have shrugged it off, but a small, growth restricted and stressed baby couldn’t and succumbs to infection.

            But if we aren’t assessing fetal growth and placental function towards the end of pregnancy we aren’t going to pick up on the babies and placentas who might not be able to cope with labour. What’s sad is that a lot of my cases come from pregnancies that are considered low risk. I don’t work in obstetrics, but I know in the NHS there is a huge pressure on obstetricians and midwives, and midwife led care is cheaper with less ‘medicalization’ of pregnancy which is what women appear to want. I see far fewer stillbirths from high risk women because they get delivered earlier and by section.

            All of that is very generalised, obviously, but many of my cases, from various different centres, are very similar.

          • Kelly

            Thanks for such a detailed answer.

        • BeatriceC

          A old colleague of mine and his wife needed IVF to get pregnant. At one of their later ultrasounds, one of her OB’s office partners tried to change her dates based on fetal size. Ummmm, no. In this case they knew *exactly* what day conception happened, with zero chance of being wrong. Their regular doctor was reportedly not happy.

          • lsn

            What the hell?! One of the advantages of IVF is knowing exactly what date transfer happened. Thank God no one tried that when my son started measuring significantly behind growth.

          • Allie

            Ha! Yes, my due date was initially based on my LMP, but I made them change it because we knew pretty much to the hour when she had been conceived. The adjusted date was 3 days earlier, and I was scheduled for induction exactly at 40 weeks, and not a day longer (I was 42 and didn’t want to take any chances). Luckily, I went into labour at 39+5 and had her 1 day before the scheduled induction.

        • Pcogale

          I actually had my due date changed to reflect the kid was small at an 11 week ultrasound. The OB said that they usually go by LMP but if it’s out by more than a week then they will go by ultrasound – so I had 10 days added to my due date. I knew my LMP too. Kid looked like she was 3 days early according to the U/S date, but when she came out she looked a week late ie no vernix, peeling, dry skin in the days afterwards. I suspect that the small size was that she was probably a twin (midwife said that there was a second attachment on the placenta – wish I’d looked but I didn’t as I was too busy enjoying the new baby on my chest). Second baby I reckon died about 8 weeks gestation (lessening of hyperemesis on that day before going back to the usual symptoms) but because it wasn’t long before the ultrasound I can surmise that I had 2 smaller kids before that which is reflected in the size of the surviving fetus at the time. She was 40th centile when born so not IUGR or anything and I think fundal height was quite appropriate. Second kid was 5 days over – fully expected that knowing the length of my cycle – no talk of postdates but I didn’t get to my 41 week appt. And kid number 3 thought she’d come 10 days before EDD.

  • crazy mama, PhD

    Got to love the anti-epidural sentiment thrown in there, too: “she is the only one who doesn’t pressure them to get epidurals.”

    I was “pressured” (by which I mean my OB required it) to get an epidural for my VBAC, with the clear explanation that it was for the safety of my and my baby. When you’re attempting a higher-risk birth, they want to be able to get you into the operating room as fast as possible if something goes wrong. It’s not an intervention just for interventions’ sake.

    • Steph858

      The natural birth crowd would probably consider the mere offer of an epidural to be ‘pressure’.

  • amazonmom

    There is a lot of moaning and lamenting at the hospital where I work about how the OB docs don’t do vaginal breech births. The implication is that the OBs could just learn the skill but they just don’t want to and if they did the risk would be the same as a head down birth.

    The stupid makes my head hurt.its so offensive and insulting to the OB dept to suggest they are too lazy, dumb, or both to deliver breeches. The safest way is Csection or the docs would be doing something else!!

    • crazy mama, PhD

      Ugh to that. Even leaving aside whether vaginal breech birth is a good idea at all, an OB who isn’t trained in it can’t just learn it at the snap of a finger. They’d have to observe many such births and practice with someone who was trained.

      • Roadstergal

        With a mortality rate of 6/1000, to have a breech-experienced OB in every major metropolitan area, you’d need an avoidable body count.

        • Karen in SC

          It’s my understanding that OBs deliver breech babies butt first during a c-section so it’s not an unknown skill.

          • crazy mama, PhD

            I would assume pulling them out through a C-section incision is quite different than vaginal delivery, though? The head can’t get impassably stuck during a C-section.

          • amazonmom

            Breech head entrapment was the most horrifying delivery I ever saw.

          • Tigger_the_Wing

            I can imagine, although I’d rather not.

            My husband said he was deaf in one ear for a week after I delivered my second son – he was holding down my top half as they were getting my son out with forceps, no time for niceties like pain relief. I don’t like thinking about what would have happened if they hadn’t been able to get him out as quickly as they did.

          • Mel

            Actually, it can if the uterus clamps down too early.

          • crazy mama, PhD

            Yikes! What happens then? Additional incisions?

          • Helen

            In a csection, the doctor just reaches in and scoops the baby out. There are no bony passages to navigate, no perineum to stretch. And no cervix to close before the head is delivered. A vaginal Breech birth is fraught with the danger of cord prolapse, cord compression before the head is delivered, and arm or fetal skull entrapment. It also has the issue of non-productive labor — it is harder to push a baby foot first through the cervix than head first, because a skull makes a good battering ram.

          • Mariana

            That’s how my boy came out, butt first through a csection. He was transverse with his head right against my ribs (ouch!!)

        • amazonmom

          Exactly. None of the crazy people at work care about the pile of dead and injured babies – or they honestly don’t believe any babies would die or be injured. Scary stuff.

      • amazonmom

        Hearing lactation staff say that OB docs are just too lazy to learn the skill and practice and just do c sections instead really pisses me off. Then of course I hear about how some hippy dippy homebirth midwife knows more than said OB docs, and I have to fight the urge to say something rude

      • Sarah

        Which of course might well require more women to choose to attempt breech birth in the first place.