November 26, 2003

Breech birth options

There was an interesting phone call today, from a woman expecting her fourth baby. All her babies had been big (over 10 lbs or 4 kg) and all had been born very easily. In fact numbers 2 and 3 had been unplanned homebirths due to very rapid labours.

This pregnancy (she was 34 weeks) was turning out a little differently. The baby had decided to adopt a breech position, although it had turned to vertex for a while before again resuming its head up posture. The woman had been under pressure from 20 weeks to be induced (“you have such quick labour, come in and we will induce you so you don’t have to worry about getting to the hospital in time”) which she had already dismissed as nonsense. Another unplanned home birth was not going to be a problem for her, and in fact she quite liked the idea, because of its convenience.

With the baby being breech, things had changed. She was now told it would have to be a caesarean, and she was adamant about not wanting surgery. As she pointed out, she could manage 4 children under 6 years as long as her health was OK, and she could see it would be very difficult, if not impossible, to care for her family if she was recovering from surgery. In desperation she was calling anyone she could find for ideas on how to turn the baby, but had been receiving no help at all. Finally, the local Childbirth Education Association gave her my number and suggested she call me.

We talked for a long time and I was impressed with her clear grasp of the situation, her insight into her own body and baby and her common sense attitude. She knew about the various kinds of breech presentations and felt that this baby was in a footling position (although she was reluctant to have this confirmed with ultrasound because of the pressure she would again be under). She knew that there was a good chance this baby would be bigger than the last one, possibly over 11 lbs. Even given these facts, she still didn’t want any surgery, so we talked about ways of getting the baby to turn, including moxibustion and external cephalic version. We also talked about waiting until labour started if she did reluctantly accept a caesarean, to avoid prematurity for the baby.

I was surprised that no mention of ECV had been made at the public hospital she is attending. At the last consultation in the clinic, the doctor, who had confirmed the baby’s breech position, dismissed her questions with a pat on the knee and the comment “you’ll be OK”. This was not helpful for a woman who already was being treated for a raised blood pressure and was anxious to know as much as she could. I felt it was disgraceful treatment from this Registrar, who should have had more sensitivity and concern for her emotional state as well as physical state.

I am hoping that she will contact me again. I gave her the website address for the moxibustion treatment details, and she was keen to hunt down the moxa sticks (trawling through the Yellow Pages for a herbal remedy or Chinese medicine retailer was to be her next step) and I offered to find a practitioner who could perform ECV at term if she needed one. With a baby due over the New Year period, she will be under a lot of pressure to be induced.

Women with such clear visions and insight need support and encouragement, not doubt, doom and gloom. Talking to her was refreshing and uplifting for me and she was grateful to be able to talk to someone who had a positive approach. She has promised to let me know how it goes and I hope she calls after the holidays with the news that either the baby turned and was born (as usual) at home quite spontaneously, or that she got to the hospital so late in the labour that her breech baby was born vaginally. Either way she will be happy.

Posted by andrea at November 26, 2003 07:34 AM

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Posted by: blackjack on January 19, 2004 10:34 AM

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I am 36 weeks pregnant with me first child, an 8.2pound baby boy. I myself am only 152cm tall, and the baby is in a breech position. I also have a low placenta, apporximately 4cm from the cervix. The doctor today gave me a choice to make within the next week to try an ECV or opt for a caesarean. Which is safest for the baby and me.

Posted by: Marianne on June 2, 2004 02:42 PM