Why it’s wrong to insist a breech baby can’t be delivered naturally

This is something I’ve been wanting to write about ever since having my own very personal experience. What has stopped me? Fear. Fear because childbirth is such a personal experience – mothers should be able to make up their own minds without pressure.

Fear because this is such a contentious subject, even within the NHS itself. But I can’t help feeling that women who are pregnant with a baby presenting in the breech position should at least know that they have a choice, or at least the ability to make an informed decision about the birth.

So here is my experience…

When I was pregnant with my first baby I was told, when I was around 35 weeks, that my little bean was in the frank breech position – bum down with his legs straight up and feet squarely in front of his face. It can’t have been very comfortable!

Up until that point I had been planning for and hoping to have a natural home birth. We had enlisted the help of two of the most wonderful independent midwives – who were very happy for me to deliver my baby at home, both having had experience in delivering breech babies.

Their confidence was inspiring but something changed for me at that point. I started to get scared.

This was because the NHS, as soon as my baby’s position was confirmed as breech, began to tell me I had to opt for a c-section as is their policy when it comes to breech babies.

In a flash I’d gone from planning a home birth to preparing for surgery. To say I was in complete turmoil would be an understatement.

All mothers dream about what their baby’s birth will be like and most have to make some adjustments but this was truly taking the biscuit! But these midwives, despite what the NHS had told me, encouraged me to research the options and leant me a pile of books to read.

Once I started reading up on the subject, I realised what a crappy situation we expectant mothers of breech babies are placed in.

Breech babies account for between 3-4% of babies born and their breech presentation is not ‘abnormal’ as some may lead you to believe, but an unusual one (as the guru of midwives Mary Cronk put it).

Being pregnant with a breech baby does not mean you cannot give birth to your baby naturally as long as some very simple rules are followed (full term, what breech position are they in, otherwise in perfect health, experienced medical team).

So why is it that there seems to be a blanket rule to deliver breech babies via c-section?

It all started with the Hannah et al Trial of 2000 published in the Lancet. A randomised trial comparing risks of vaginal breech delivery and breech elective c-section concluded that all mothers expecting a breech baby should be offered an elective c-section.

This trial has since come under fire for its narrow scope and methodology, with many suggesting the conclusion is misleading.

In Scandinavia, for example (where large studies into breech births have taken place with more positive conclusions) they have not changed their policy to this day with regards to encouraging mothers who want to deliver vaginally to do so, despite the Hannah Trial.

Unfortunately, because of the study, many hospitals in the UK have stopped offering women the choice. This has in turn lead to the de-skilling of the medical profession with regards to vaginal breech deliveries.

With the guidance and help of the independent midwives I found myself meeting with the head of obstetrics at the hospital where my baby was born.

It turned out that half of the consultants were not comfortable with assisting in a breech delivery, the other half (who had nearly all trained overseas, I might add) were experienced enough that they were happy to deliver my baby naturally.

Basically, if I went into labour ,whether or not I ended up having a c-section depended on which of the consultants was on call that night.

This seemed to me the best outcome I could hope for under the circumstances, and we agreed that that was how we were going to manage my ‘upside-down’ baby.

What did strike me was the eagerness of the midwives I spoke to at the hospital. One in particular told me that she was very interested in being present at the birth so she could learn from an experienced consultant.

The delivery of breech babies hadn’t been properly covered in her training (as there was deemed to be little point) and she wanted to learn – so much so that she gave me her number in case I went into labour!

This had fired me up, and as I neared my due date I not-so-patiently waited for my baby to start showing signs of wanting to born.

Breech babies cannot be induced and so we had booked an elective c-section for two weeks after my due date.

Every night I would go to bed thinking “tonight could be the night!”

In the meantime I tried moxibustion (a traditional Chinese medicine therapy which consists of burning dried mugwort on particular points on the body – v smoky), lying on all fours with my arse in the air (undignified) and an unsuccessful ECV (bloody painful!).

Alas it was not meant to be. The day before my c-section I readied my bag in much the same way as I would pack for a holiday, setting my alarm for an ungodly hour the next morning to make my appointment with my new baby.

I felt deflated. Had I made a fuss only to end up delivering my baby via c-section anyway?

No. I had tried. I had read, fought and questioned in order to have been given a choice. I did not want just to be told that this was it, and be done with it.

This did not sit well with me. I was, just to be very clear, always prepared to take the route that meant my baby and I, but particularly my baby, would be safe.

But I wanted to make sure I had exhausted all my options, and that I was informed about why and what was happening and going to happen with MY body.

A couple of weeks after my breech baby arrived safely via c-section I called the midwife who had been so eager to help.

I thanked her and informed her that I had ended up having a c-section. She already knew as she had kept tabs on my case.

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She told me that the week after my baby’s birth another lady had gone into labour with an unexpected breech at the hospital.

It was too late to operate on her and she ended up delivering her baby naturally, on all fours as is required. It was a beautiful birth, a success, and both mother and baby were well.

She had been able to assist. She thought of me and of how I would be pleased.

Aurora with baby Sebastian
Aurora with baby Sebastian

Further reading:

‘A Breech in the System’ a documentary by Karin Ecker (and from where I shamelessly took the title of this blog).
‘Breech Birth’ by Benna Waites.
‘Breech Birth – What Are My Options’ by Jane Evans.
‘Keep Your Hands off the Breech’ by Mary Cronk (AIMS Journal Autumn 1998, Vol 10 No 3).
‘Breech Presentation, Caesarean operation versus normal birth’ by Gina Lowdon (AIMS Journal Autumn 1998, Vol 10 No 3).

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