"Uh-oh," the ultrasound technician sighed. That's not something I ever wanted to hear while someone checked on my unborn baby. She turned the screen toward me and frowned, "He's breech."
It was surreal. I'd already been through one low-risk, unmedicated, natural birth, and I had been certain that I was going to get to do it again. Although I've always understood that C-sections are a life-saving intervention, I thought of them as something that happened to other moms, not to me. The fact is that C-sections are major surgeries that have risks, some of them very serious. Except when there's a clear need for surgical delivery, it's usually in the best interest of Mom and Baby alike to deliver the baby the old-fashioned way, which had been exactly my plan. Now all of that was in question, and I was left wondering: should you always get a C-section if you have a breech baby?
The unfortunate fact is that, for now, we simply don't know for sure whether it's always safest for breech babies to be born by C-section, but some studies have provided some clues. In 2000, the American College of Obstetricians and Gynecologists decided to recommend against vaginal delivery for breech babies. This was because a large study had found that serious complications were much less common among breech babies born by C-section. Only 1.6% of breech babies born by C-section had serious problems, while a whopping 5% of breech babies born by planned vaginal delivery had serious problems. Breech babies born by C-section also had a lower rate of death during and shortly after delivery. With those stats, it would seem clear that it's safest to always deliver breech babies by C-section.
But, shortly after that, several other studies were released suggesting that, in some cases, a C-section might not be the safest way to deliver breech babies. Follow-up studies on breech-delivering moms and babies, for example, found that, two years after delivery, there were no differences between the experiences of moms who had breech babies by C-section compared to moms who had breech babies vaginally. The rate of breastfeeding, pain, incontinence, menstrual problems, depression, and "distressing memories" of giving birth were the same whether moms had their bottom-first babies naturally or surgically. They also found that the rates of developmental problems were the same among breech babies regardless of how they were born, even if they experienced severe problems during or after delivery. Since then, there have also been several studies that have found the same rates of complications between breech babies regardless of how they're delivered.
Based on the newer information, the ACOG now gives advice to moms and doctors that is at once both reassuring and upsetting, since it means the decision isn't nearly as simple as we'd like. We simply don't know whether it's safest to have a breech baby by C-section or not, so the choice ultimately lies in the hands of the mom and her caregivers. Ultimately, while most doctors will still recommend a C-section as a general policy, there are some cases in which it might be equally safe (or, possibly, even safer) to have a bottom-first baby the old-fashioned way.
You might be able to have your breech baby vaginally if:
- Your doctor is experienced with delivering breech babies and feels confident that she can deliver your baby safely without a C-section.
- Your baby is in a frank or complete breech position (butt-first) and it not foot-first.
- You've given birth to at least one baby before, since this seems to reduce the chances of something going wrong with your breech baby.
- You have never had a C-section before.
- You are in at least the 37th week of pregnancy.
- Your baby doesn't have any birth defects that were detected on an ultrasound.
- Your baby is not expected to be very large or very small.
- You don't have unusually narrow bones in your pelvis.
There isn't a simple answer to the question of whether or not a breech baby should automatically mean a C-section, but most moms and doctors will opt for a planned C-section most of the time. Many will also want to try other ways of "turning" the baby before labor, which may carry risks but can also reduce the chances of a C-section. And, in some cases, breech babies will actually flip themselves around before, or even during, labor, enabling moms and doctors to avoid the problem altogether. If your baby is breech and can't or won't be turned to a head-down position, make sure you have a detailed talk with your doctor about different options for delivery. Only an expert can help you determine which route is truly safest for you and the baby.