(This article was originally published in a local NCT newsletter)
In 2000 an international trial (know as the ‘Hannah Trial’) was carried out to try and establish some clearer answers about whether a planned caesarean section or a managed vaginal breech birth was safer for mum and baby. The trial results have been interpreted in various ways, but as a result caesarean section has become the ‘normal’ way – and sometimes the only option offered – for a breech baby to be born. The trial results have been criticised as being heavily flawed and in 2006 a follow-up to the trial concluded that ‘a planned caesarean birth is not associated with substantially better or worse outcomes for women and children two years after birth’ and one report concluded that the original ‘Hannah Trial’ recommendations should be withdrawn. There is no clear-cut evidence about which mode of birth (caesarean or vaginal) is safest overall.
If you are considering a vaginal breech birth, then there are some important things to consider; Breech births are managed in different ways by different health care professionals: some management options for the birth will usually be under the care of an obstetrician and normally involves epidural anaesthesia, use of the lithotomy position (stirrups) an episiotomy and often the use of forceps. Other practitioners will offer a ‘hands-off’ and physiological birth, where the woman is usually encouraged to adopt an all fours position and neither opiates or epidurals are used.
Almost everyone agrees that if labour does not progress smoothly then it is safer for mother and baby for a caesarean birth to be offered. In the UK about half of the women who start off in labour with a breech baby will end up having a caesarean.
If your baby is breech you should be offered and External Cephalic Version (ECV) at around 37 weeks. This is performed by an obstetrician under the guidance of ultra-sound, using gentle manipulation on the abdomen to try and turn baby. Success rate is about 50%. It is not usually painful but may be uncomfortable and there is a small chance of causing your baby to become distressed.
Moxi-bustion is an alternative remedy (see an experienced practitioner) that has an approximately 80% success rate of turning baby and is a simple non-invasive technique.
(visit www.acupuncture.org.uk for practitioners).
This article is just a brief summary. For further useful reading I have the following resources available for loan:
Information taken from NCT information sheet: for full references, access to research articles or to borrow any resources please contact Angela at angela@northsurreymidwives.co.uk @nor
If your baby remains breech and you decide that you would like to birth your baby by caesarean, then it is worth considering how you would like to meet your baby and your options during a caesarean birth. The NCT has put together a guide for a caesarean birth plan (below) which you may find useful.
Whether you know in advance or not, a Caesarean birth is still YOUR baby’s birth. There are a number of issues you may want to think about beforehand. You may find it worthwhile to jot them down on a separate piece of paper and attach it to your birth plan. Please discuss this together. You may also wish to include contingency plans for a baby needing special care. (This has been written with feedback from parents whose baby was born by Caesarean.)
Anything else that is important to you.
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