Any midwives/drs? Induction of breech

[wkmmum]

I'm 41+5 and baby is breech. Had ECV yesterday which was very scary and didn't work - baby's heart rate dropped and very nearly ended up with crash section. But fortunately all is fine now and baby is wriggling away in there!

My plan has always been for a vaginal breech birth and I have written a plan with the consultant midwife. If baby doesn't arrive by Friday I'll be going in for daily monitoring as I'll then be 42 weeks.

But I've just had a call from the consultant to say that they've decided they'll make an exception and induce me if I want it! Completely took me by surprise as it's never been an option. I've got to go and see the consultant tomorrow to talk it over. And I'm also going to ask her to check whether my cervix is favourable as I wouldn't want induction if it isn't (whether breech or not).

But right now I feel a bit lost. As inducing when breech just isn't done I don't know where to look for help and advice. Obviously it's my decision but I don't even have others' experiences to look at.

Sorry this is so long but don't want to dripfeed. TIA xx

[crunchingautumnleaves]

Sorry, no personal experience but from all I've read, if it were me there's no way I'd accept induction of labour with a breech baby. This article by Mary Cronk (bit of an expert midwife on breech deliveries) is great. And, if you're on Facebook, the breech babies club has a lot of good links & I'd imagine could help out with any questions you have re breech births.

[crunchingautumnleaves]

Oh & I'm not a MW or doctor - just v interested in all things birth related & do a lot of reading of books, articles, research etc

[mayhew]

My understanding as a mw is, a breech needs to come by itself for the best chance of a safe delivery. Artificially stimulating labour for induction or augmentation is not to be recommended. If you were my client, I would suggest either
:waiting as long as takes for labour to start. That means that daily monitoring would be recommended from 42 weeks, to check on placental health.
:elective section.

A sweep would not be contraindicated though?...

[Honkyponk]

Is this your first baby?
I would want to know why exactly they want to make an exception for you, as induction for a breech is very unusual. Is your cervix very soft and open already? Do they think it would be very easy to induce your labour? Is your baby's bottom deeply engaged within your pelvis? Who would be supervising your labour directly (ask specifically about the seniority of the obstetric registrars working on delivery suite)? How far would they be willing to take the induction? Ie. if labour doesn't start after one vaginal pessary what then?
The royal college of obstetricians offers guidance on breech birth which states induction can be considered if individual circumstances are favourable, but in practice the vast majority of obstetricians would not be comfortable with this scenario. Of course, there is no concrete evidence for induction with breech to guide you in your decision making, only the personal experiences of the doctors advising you. What we do know is that for a first time mum, there is a slight increased risk for the baby who is breech with vaginal birth vs Caesarean section, and I hope that this has been discussed with you already. One could therefore reason that an induction might increase this risk.
Ultimately you need to make the decision that is right for you and your family, but you need to have a frank discussion with your obstetrician tomorrow ( and this definitely needs to be at a consultant level).
Good luck and enjoy your baby!
(I'm an obstetric reg enjoying my first baby!)

[wkmmum]

Thank-you all for your replies. I've got a lot of thinking to do and a lot of questions to ask...not least of which is why they've suddenly hanged their minds!

This is my 2nd baby but my son is 8 now so it's been a while - not sure if that makes a difference. Baby's bottom isn't engaged at all. Not sure whether my cervix is favourable but I'm going to ask her to check tomorrow.

Will be sitting down and making a long list of questions to ask tomorrow and even then I'm going to say I need time to think. This is too big a decision to make there and then xx

[lurcherlover]

Have just asked my SIL about this for you (she's an obstetrician) and she was v surprised they are even considering inducing a breech. She said her very strong recommendation if you were her patient would be for a c-section as it would be safer for baby.

[DoulaKate]

Sounds like you're doing the right thing; taking it one step at a time, sitting down and writing lots of questions, so that you are as well informed as possible and armed with all the facts in order to make your own decision and be able trust your instinct. You never know, baby may make the decision for you over the next couple of days! Good luck

[lou4791]

I agree with Crunching- you need to look up the teachings of Mary Cronk and Jane Evans. They are extremely knowledgeable and experienced midwives in breech births. Unfortunately many medical practitioners ( midwives and doctors at all levels) today lack the skills and experience necessary to properly care for breech births with confidence. I would need to have real trust in my caregivers and i'm afraid I would not be trusting of a medical practitioner who advises induction of a breech baby. Breech babies should never be forced in any way. If you read a little about Mary Cronk's explanations for this you will understand why. So, this would leave the options of awaiting baby naturally and quickly seeking out caregivers that you can trust to care for you in labour ( AIMS may be able to help with this or perhaps your local supervisor of midwives)or choosing an elective section. If you decide to choose a section there are many ways in which you can feel more in control of the situation and have options about the way you would like things to be (e.g .baby not to be taken away unless absolutely required, skin to skin, music, delayed cord clamping( very important one)). AIMS should be able to help with this too. I wish you well.

[lou4791]

Please let us know how you get on x

[wkmmum]

Sorry for not replying sooner....

The whole thing became academic in the end as my waters broke at 12.45am yesterday and contractions started soon after. All was progressing fine and the consultant midwife was even going to let me have a water birth! But at 9cms everything stalled and despite the mist horrendous contractions I've ever had I didn't progress any further.

Ended up with c section and the result is DS2, born at 14.28 yesterday at a whopping 9lb 12oz!! Bearing in mind I'm slim and 5ft 1, and he was breech, he was never going to arrive naturally. Plus his head is 37.5 cms!!!

But despite ending up with a cs I don't regret trying for a natural birth. I know I did all I could, gave 100% and the decision to have the cs in the end was the right one xx

[lou4791]

How wonderful. Congratulations.
Sounds like your care was good and the decision for a caesarean at that late was the right one too. Really well done.

[TaggieCrimbleBlack]

Hurrah! Congratulations.

That is quite a good size head

Enjoy lovely baby snuggled.

[mrscogon34thstreet]

congratulations! Your post + the newborn I saw in the supermarket today has made me broodilicious!

[Jollyb]

Many congrats - was interested to hear how things worked out for you.

[crunchingautumnleaves]

Glad you were able to have a good try at it, sounded v hard work so well done. My best wishes for a speedy recovery & enjoy snuggling with your baby - perfect weather for it!

[mmmmsleep]

Congratulations! Well done. Enjoy your little one and hope all goes well with recovery.