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excuse my ignorance...


Forum: Labor and Childbirth

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  #1  
May 14th, 2010, 04:52 AM
3xCrazy's Avatar Mega Super Mommy
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But why are breech vag deliveries so harshly frowned upon?
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  #2  
May 14th, 2010, 06:33 AM
WhoaMomma!'s Avatar Danielle
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Well they're not frowned on here

But a lot of medical professionals won't do them because once the baby's body enters the birth canal, the head must be delivered immediately or the baby will be permanently impaired or die. Practitioners are terrified that the head (because it's the largest part) won't pass through the cervix after the body has already come down. The baby will be hung and die before you could ever get into an OR or anything like that to save him.

The reality is that vaginal breech deliveries are safe IF the practitioner is experienced at delivering the body in such a way as to reduce the risk of the head becoming entrapped. According to my Mom - who delivered many vaginal breech babies - it is imperative that the mother not have an epidural because she may need to change positions very suddenly to free a sticky baby. Upright pushing positions are also key so that gravity is pulling the baby out instead of putting pressure from the baby's head against the cervix and increasing the odds of getting stuck. The OB really needs to not touch anything and let the baby come naturally. That goes against EVERYTHING they are taught in med school. If the mother is not upright (squatting, standing, or kneeling), then the practitioner needs to actually deliver the baby in the reverse direction they are used to. If you watch a baby being born, the OB will catch the head and then guide the baby towards the floor to free the body in a smooth motion. But in a breech delivery, the OB needs to catch the butt (difficult to do when you consider it's slippery and round and doesn't have a neck to grab onto) and guide the body towards the ceiling to allow the head to slip out safely. Otherwise, too much pressure is placed on the baby's neck and can cause damage or cause the baby to become hung in the pelvis.

Soooooooo.....in answer to your question. Vaginal breech deliveries are frowned upon by the majority of Obstetricians because nobody sues you and very rarely do you risk losing a baby if you just opt for the version or the cesarean. They don't see any benefit to delivering a vaginal breech, but lots of risk. They are frowned on by the minority of the OB community who DOES do them in that it is a skill. My mom calls it an art. And so when they KNOW that medical schools are no longer teaching vaginal breech, but they see young OB's willing to try them anyway - they find that to be very reckless. Finding a provider who is willing to deliver a VB, who has been properly trained in HOW to do it, and who has malpractice insurance willing to cover that procedure - is tough. It's a little easier with homebirth midwives and SOME (rare) hospital based midwives bc they are not bound by the same malpractice insurance (usually) and bc midwifery schools are waaaaaaaay more likely to teach VB delivery than a med school.
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  #3  
May 14th, 2010, 08:14 AM
ChicaChels's Avatar Platinum Supermommy
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yep mostly because there is a risk that the baby could get hanged, but danielle covered all that. they're not even teaching midwifery students how to deliver breech babes anymore
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  #4  
May 14th, 2010, 01:08 PM
WhoaMomma!'s Avatar Danielle
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What happens when one turns in labor and they don't know until he's on his way out??? I would think they would NEED to know how even if they don't choose to perform them.
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  #5  
May 14th, 2010, 01:14 PM
Isaeph's Avatar Jennifer the Momma
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No kidding! I think I heard here that homebirth mw's aren't allowed to attend a known breech delivery. Stupid. I know if I have a breech delivery, I'm going to have my bff and her MIL come over. Her MIL was an L&D RN for 20 years and she's all for me and my bff doing UC deliveries.
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  #6  
May 14th, 2010, 03:13 PM
NutMeg76's Avatar Platinum Supermommy
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Fear.


That said. In Canada it has recently been declared by their version of the ACOG that vaginal breech is a viable option. We are hoping that it means there will be more trained providers in that country and that maybe the US will get their heads out of their hiney and re-evauluate the culture here too. I know it was discussed at length at the recent conference, which of course I can not remember the name of
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  #7  
May 14th, 2010, 04:18 PM
flitabout's Avatar Platinum Supermommy
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I think that I read in that article that they will again be requiring VB to be taught in med schools before the art is lost. Maybe they are sick of paying for unnecessary c/s? Another bonus of universal health care?
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  #8  
May 15th, 2010, 01:11 AM
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Quote:
Originally Posted by NutMeg76 View Post
Fear.


That said. In Canada it has recently been declared by their version of the ACOG that vaginal breech is a viable option. We are hoping that it means there will be more trained providers in that country and that maybe the US will get their heads out of their hiney and re-evauluate the culture here too. I know it was discussed at length at the recent conference, which of course I can not remember the name of
"Fear" That's what motivates so many things...and it is sad, cuz reading this post is giving me all sorts of thoughts, like is the risk worth it to avoid the c-section? Which really is SAFER for the baby? And then for me probably the vaginal birth, but Amber is more important here to me...GAH!
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  #9  
May 16th, 2010, 02:54 PM
NutMeg76's Avatar Platinum Supermommy
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Quote:
Originally Posted by LJD3Tdance View Post
"Fear" That's what motivates so many things...and it is sad, cuz reading this post is giving me all sorts of thoughts, like is the risk worth it to avoid the c-section? Which really is SAFER for the baby? And then for me probably the vaginal birth, but Amber is more important here to me...GAH!
I know that some would call me selfish, but for me, my life is more important for my older children. I have survived the death of my child, my children have survived the death of their baby brother. But, I see their grief and how the loss of a little person they never even got the chance to meet has hurt them so deeply. I know that the loss of my life would be so much worse for them. So for me, the risk of my death is worse than the risk of my baby's death. I know that I might get 'flamed' for that, but it really is how I feel. I felt that way before Colm was stillborn last year, and I still feel that way.

Does this mean that I would refuse a c-section absolutely for all reasons? No, but it does mean I will be more prudent in agreeing to one. It means I will exhaust all other possibilities before having a surgical birth. Yes, I will do one to save the life of my baby, but only after all the risks have been assessed and it is certain that the benefit outweighs those risks.
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