Dec 292012

“If this wasn’t your first baby, we’d be more ok with you doing a vaginal breech birth. But since it’s your first, we’re worried the head will get stuck in your pelvis since your cervix has never stretched that much before.”  - OB to mother with a breech baby

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 December 29, 2012  birth, breech, OB  Add comments

  66 Responses to ““…We’re Worried The Head Will Get Stuck In Your Pelvis…””

  1. Isn’t this… Relatively reasonable? I don’t think she should necessarily be risked-out, but I thought head entrapment was more of a concern for first-time moms for this very reason.

    • That was my thought too. Granted I know next to nothing about breech delivery, but this is what I’d heard.

    • It seems to me (from a layperson’s knowledge) that cervices don’t necessarily “stretch out” like a pair of old jeans; they either dilate or they don’t. It also depends on the type of breech; if it’s a frank breech I’d imagine that the body would more than “stretch” the cervix beyond what the head would need to pass through.

      • I can’t speak for everyone, of course, but I can tell from my cervix checks for NFP that it feels different. That may or may not have anything to do with its stretchiness during labor, of course, but since multips dilate at a faster rate than primips (on average) I would assume that once the cervix has “learned” how to open, it does so better.

        I’m not, however, sure what that has to do with head entrapment, since the cervix is going to open as wide as the presenting part no matter what birth it is. It may take longer for a primip to reach complete dilation, but it seems as if once she’s reached complete dilation, she should be complete, breech or vertex. It’s not as if a primip’s cervix is waiting like a steel-jaw trap to clamp down on the baby’s shoulders once the buttocks pass through, whereas a multip’s cervix is floppy and saggy. ;-)

        • Without re-researching it, I think the issue may be that the cervix might be just a bit stretchiER on a multip, meaning in the case of possible head entrapment, instruments or other outside assistance to get the cervix from “as wide as the presenting part” to “as wide as the head” might be more effective. IDK if I’m remembering it correctly, and I’m completely open to learning new ideas about the subject, but that was my vague understanding.

          Again, not sure it should rule out vaginal birth for all primip breeches, but it was at least my understanding that the risk may be higher.

          • Thank you — that makes sense. “Easier to stretch during dilation” would seem to lead to “easier to stretch manually in the event of an emergency.” Now whether that’s a false parallel I can’t say, but it passes the “initial logical hypothesis test.” :-)

    • I’m pretty sure this is crap. The largest risk of head entrapment in a breech birth is when baby is premature. Basically with a premature baby the shoulders are more narrow than the head so baby’s body may slip through before fully dilated and the head can be left behind, vs. a full term baby where the shoulders are more broad and if the shoulders can get through the head can. Being a first time Mother should not play into this at all.

    • The cervix does change after a birth, it is never just as tight as it was before, so that is part of the statement is true. What is more concerning is breach type, if this is a footlong breach then, she should be risked out (because I think everyone is for footlongs for head entrapment)

      • Okay? Your point is, then? VERY few people support vaginal footling* breech* birth for that reason. What in the OP in any way indicated footling breech? The fact that the OB said “we’d be more okay” if she were a multip implies a more “reasonable” breech position, like frank or complete.

        *proper spelling

      • Autocorrect nabbed you, huh? :-)

        • Ah, good point, Jane. I admit, I am more likely to correct a misspelling from someone who irritates me than from someone with whom I generally agree. Terribly unfair, occasionally hard to resist… usually comes back to bite me. :)

          • I got an Iphone for Christmas….

          • Ah, and it thinks it’s smarter than you when it comes to spelling little-used words? :-) When Safari upgraded, I permanently disabled the autocorrect because there were some words it wouldn’t let me spell no matter how often I fixed them, and sometimes it would all be written fine and when I hit “post” it would helpfully fix them for me. :-b I got nabbed on this site a few times for that. ;-)

            Enjoy your phone!

    • As someone who had a vaginal breech first time round, the most important thing i found is position position position. Both for bubs and mum. This is why footling is more risky than the other positions, because with feet first the baby can start coming out before the head can fit through the cervix and get stuck, also the cord can slip out easily (however footling can still be managed by SKILLED attendants, just wouldnt be my personal choice) where as with complete or frank (at term) their butt/hips/legs are pretty similar in diameter to the head in terms of fitting through the cervix

  2. One of the big risks with breech isn’t just the whole first time mom thing… In fact that should be the encouraging part. This mama needed encouraging and relaxation to birth a breech baby. In my midwifery course,we discuss how to comfort and soothe a mother for breech delivery. Why can’t OB’s learn the same… It was a 3 hour course… The key to birthing a breech baby is to NOT stress out the mama after the birthing process (pushing) has begun. The cervix can close involuntarily if she is scared or made to feel inadequate… I hope this mama got everything she needed to have the birth her and her baby deserved <3

    • Oh, you took one 3 hour course and you have breech birth all figured out. Guess those YEARS of advanced education and training were worthless for the OB.

      If the baby’s head gets stuck for whatever reason, no amount of comforting and soothing words will get it out. Woo.

      • Yeah, the 3-hour course isn’t impressing me, either, but most OBs have next to no training in or about breech birth. So.

      • *vaginal breech birth

      • In her (possible) defense, though, it sounds like the “3-hour course” was about how to handle a breech mom emotionally… not that she only got 3 hours of education on vaginal breech birth.

      • Think you’re attacking the wrong person here. I mean seriously. . . Think before you speak.

        • Wow! A lot of these ‘women’ are here to support birthing and women’s rights to being respected… I can’t believe how these ppl act! You should feel ashamed. It sounds like HippieMaMa just went through a course of how to support a breech delivery, Not how to manage one herself.
          Like I tell the kindergateners I teach, don’t say anything you wouldn’t want said to yourself.
          Dreamy & Samantha are just Bullies!
          You attacked a midwife student because she said she took a 3 hour course (probably just the basics) & didn’t understand why and O.B wouldn’t/couldn’t take the same course?!?!?
          A Plea From A Fan Of Tee;
          Do you see anything wrong with these actions from women on here?

      • Actually, how much education do most current OBs get on how to deliver a breech? I’m not being snippy: aren’t they taught that a breech is an automatic C-section, to the point where most of them have never caught a breech baby even when the baby is in a favorable position and the mother is a favorable candidate?

        Ina Mae Gaskin in her second book (forgetting the title, sorry) says that it’s important for OBs to learn how to deliver breech babies because sometimes, it’s going to happen. An undiagnosed surprise breech discovered at crowning, for example. Or a friend of mine who showed up at the hospital in labor and whose baby was coming so fast that the doctor said, “Well, we’re doing this thing, aren’t we?” Or a baby delivered during a power outage or other crisis where the surgical suite is less safe than the L&D room. Her point in that book was that most OBs section automatically and have never even seen a breech delivery, let alone attended one themselves. :-(

        • My long-winded question being (and maybe Goldilocks can answer this) how much training in breech delivery is standard for an obstetrician?

        • Exactly this. At 35 weeks my daughter was footling breech. (having turned DURING the NST from head down to footling breech.) I had to be induced for high risk reasons, and they were going to “let me try” an ECV in the OR with a spinal… if it didn’t work, automatic c-section. Even though this was my third and my previous child before her was 9.5 lbs with a 38cm head – no complications, no tears. soooooo why couldn’t we have just tried???
          It ended up she turned head down again, and FELL OUT when I was 8cm. She was just 6lbs and sooo tiny. She probably would have fallen out as a footling breech too.

          • The problem is there are more potential complications with a footling than with frank. Cord prolapse is a very serious complication, life-threatening, and much more likely to happen with footling breach than frank. Which is why alot of footlings are c-section birth, or attempted ECV.

      • Seeing as an OBs training on breech birth amounts to “if the baby is breech at 36 weeks they WILL not turn, attempt EXCEPT and if that doesn’t work schedule c-section…. ” The OBs years of training in everything else isn’t going to help him when the only thing he’s learned about a woman presenting breech in labor is ZOMG PANIC!!!! I NEED AN OR NOW!!!!!!

        • ECV, not except. Damn autocorrect.

        • Yeah, my son was breech until 38 weeks. When I went in for an ultrasound to confirm the breech at 36 weeks the OB told me to schedule a c-section for 38 weeks to be safe. I was with a midwife at the time that was very experienced in breech birth so we just planned for that.

          I AM happy my son turned, because I don’t think that breech is ideal, but I was shocked that the OB just offered automatic section EARLY rather than just wait and see what happens.

      • I wish the medical professionals attending my son’s birth had training in comforting a frightened patient, even just a 3 hour class. I might have had a better outcome.

      • I guess people didn’t see where i even said the 3 hour course covers how to support (comfort&soothe) a mother with breech delivery. Most midwifes risk out of delivery breech and remain as doulas so a medical attendant with surgical training can help deliver and if neccessary perform a c-section.

        So now a lil personal note. I love this page. It is what inspired me to be a midwife. Thankyou to the nice ladies. But seriously, 3/4th of you are rude bitches.
        Yeah, i am talking about You, ‘Samantha’. Fuck This Shit. Oh and Fuck You.

        • HippieMaMa I’m not trying to be rude, but it’s the truth. You have no formal medical training. An OB does. Perhaps they don’t have training “comforting” a mother through a breech birth and perhaps they jump right to a Csection because they’ve never seen a vaginal breech but the fact is, by so doing they avoid a potentially catastrophic risk (DEATH by head/cord entrapment) and all by guarantee a live baby. Their goals are different. They aren’t all that worried about the baby going through the woman’s vagina, but that they can ensure a LIVE baby at the end of the day.

          I had a homebirth with a CNM. I’m pregnant now and expect to have another homebirth with another CNM. But I would never hire a CPM for a homebirth. They have no formal medical training and could be licensed in NO other industrialized nation in the world. A friend of mine had a birth center birth last year with a CPM who failed to recognize the baby’s malposition, pushed against it for 45 minutes, transferred and was immediately corrected by an OB. What ELSE is that CPM going to miss in a delivery?

          You do a disservice to women and babies to suggest that by knowing more about supporting a mother through a breech birth (or any aspect of birth) supercedes an OB’s years of training and expertise just because they haven’t seen a vaginal breech.

          • Guess you didnt read my post x-(
            I Never Once Said I Know More Than An O.B. NOT ONCE.
            I even said that we risk out of breech deliveries, have an OB assist and we stay around as a DOULA. We go through the 3 hour starting course on breech so we dont freak out ourselves or the patient. This 3 hour xourse is tailored by the One And Only Ina May Gaskin.
            You are so quick to ASSume Arent Ya?
            P.S: i stand by what i said. F.U. & BTW i am a RN that decides to repurpose my medical training.

          • You must be one of those Horrid O.B’s here to haunt us :-
            Thats my only reasoning for why you,Sam, is so damn nasty.

          • Never once did Samantha say she was or wasn’t an OB! Don’t just assume she is one because she is catty. She could be a CPM, CNM, or just some women with google.

          • No doctor can gaurantee that mom or baby won’t die in a c-section. It is major surgery. If you can’t keep that in mind then you know nothing of balance and are only basing decisions on fear and lack of control. If saying to yourself when a mother dies after/during a c-section that “We did everything we could do.” is justification in your mind for having forced her into a c-section she didn’t feel was necessary then you don’t belong in medicine.

        • It is kind of fun that I am running into another student on the webs. The goals are very similar in the end if you think about it (learning to be baby catchers), but I suspect the paths we take will be very different. I was inspired to go into OB by reading Midwifery Today, its funny the things that change our path.

  3. Let’s not be nasty to one another. She took a 3 hour course in how to comfort,soothe,and encourage. That most likely wasn’t her entire education,just a very important part. Her post simply said that OB’s aren’t known to encourage and soothe. I agree. As far as noone being educated in breech births, blame the insurance companies that told hospitals that they’d lose their funding if they didn’t stop performing “dangerous” procedures such as breech births.

  4. Well, I know from my personal experience with my first baby being a frank breech, that you can have them safely vaginally. I think a lot would depend on your doctor. Since we have a family history of having breech babies, I told my doctor and said that I would want to try to turn the baby. Well, she never said anything and at the very end of the pregnancy said, “well, still breech. We will schedule your c-section for next week.” WHAT???? What do you mean STILL breech!?!?!? <– My response. Well, this office in known for c-sections and they did make my whole pregnancy miserable. I switch to a high risk doctor who only does breech babies, multiples and high risk situations. He took one look at me, at my baby and said I would have no problem delivering. I was in labor for less than 5 hours and that was with them slowing me down a week after the switch.

    So, my suggestion is to find a doctor with the experience to work with you. They will know if it is going to work for you and your baby or if it isn't. I believe that with experience, a lot can be done safely. I also believe that not all situations will allow it. So do your research and feel your instinct.

  5. disclaimer: limited knowledge on breech birth

    Wouldn’t the concern be the pelvic bones moreso than the soft cervix? And correct me if this is stupid, but in the incredibly rare event that the cervix DOES reverse dilate some between the birth of the body and the head, in this type of emergency as a last resort (this is hypothetical, because I have no idea if this even happens, it sounds so obscure) could the attendant reach up and cut through the cervix to free the head? Since being trapped by the cervix IS a “soft tissue” thing, is that possible? Course great care would need to be taken to avoid cutting the baby’s neck! (eeek!)

    One potential (rare) complication I’ve heard of is if the baby startles after the body is born, they tilt their head up instead of tucking their chin like they need to to be born. And that can cause entrapment. I think thats part of the reason for “hands off the breech” because touching the baby (or YANKING) could trigger the startle reflex.

    • Amen to hands off! But there are ways to get a un-tucked chin out, primarily reaching a finger into the baby’s mouth and pulling the jaw/chin out of the cervix.

      • Right, I’d heard of that method! But the point is, when the head is stuck in that manner, its not stuck on the cervix!

        • this is precisely what i picked up on. the cervix stretching (or dilating as most ppl say) has nothing to do with concerning women about an “untried pelvis”. seems this ob was in a hurry to disuade the mum and got a bit mixed up….perhaps the woman wasn’t given quite enough information to make an informed decision?

  6. I don’t know for sure, but I’ve heard it helps to deliver most of the baby in a standing position and then squat to deliver the head to give the widest pelvic opening at the point in time when it’s needed most.

    • That’s kind of how my first baby (a complete breech) came out – I was stretched out in the birth tub when I pushed out her feet and body, then I got up and squatted to get her head out.

  7. A first time Mom is just as capable of delivering a breech baby as anyone else. There are two problems here. First of all, OB’s have little to no training in regards to vaginal breech births. The reason behind the first problem is the second problem… we live in a cover your butt society. (Especially in regards to medicine!) Doctors flip out at the first sign of anything “abnormal” because veering off the beaten path opens things up for complications and complications open things up for lawsuits. Does that make their attitudes towards it right? Of course not! But I do think it helps explain it.

    (Yes, I know I’m speaking in generalities.)

    • Glad to see you posting Tee. I’ve missed seeing you here.

      • Ach, thank you! It’s nice to know that someone missed me. Honestly, the fact that my comments kept getting eaten just became a little too much. This is a wonderful site and I love participating here but it wasn’t worth the stress! I’m glad I’m able to post now. ::knock on wood::

  8. The biggest problem with breech delivery is head entrapment. After the first baby the birth canal is stretched so it would be easier to delivery a breech on a multip. Due to the risk of perinatal death a c section is recommended for all breech deliveries. It’s not saying that it can’t be done but its not as safe.
    I am CERTAIN that there will be a ton of arguments that its totally safe and OBs just like to cut. BUT this is a choice that a mother has to make and live with. Be sure that you are WELL informed if all the risks and benefits. Personally I wouldn’t risk head entrapment. I’ve done well over a thousand deliveries, and believe me entrapment does NOT end well.

    • I agree with you 100%. I’ve seen the numbers: 1 out of 40 breech babies die. That is 2.5%. Way higher than the 0.7% of VBAC that rupture. Higher even than the 2% of amnios that are followed by miscarriages. I wouldn’t do it. Now if another mother is feeling like she is on the 39 out of 40 side that is her right. But I wouldn’t risk it. But, and this is a big but, this conversation should not be taking place before labor starts or water breaks (whichever comes first) Any doctor who tries to schedule a c-section for 38 weeks because baby is breech at 36 weeks is an a$$hole who is completely ignoring that baby could flip before 41-42 weeks! And any doctor who breaks a woman’s waters without realizing that baby is breech and then goes screaming for an OR because he/she caused the freaking emergency is an a$$hole. (yes, we had one of those on here about 1 1/2 years ago.) Sometimes midwives do stupid things because they don’t know everything doctors know and sometimes doctors do stupid things because they don’t know everything midwives know (palpitation for one and keeping things calm for a possible second.) And they really should stop fighting and starting working together! Act like professionals and lay out the risks. Most moms are reasonable and baby centered enough that they will make the decision the doctor wants without the BS and manipulation.

      • They shouldn’t be doing a c/s at 38 weeks anyways! They are very serious about the new guidelines of nothing before 39 weeks unless medically indicated. It’s not much but it’s a step in the right direction!!
        I hope the OP got to make her own decision!

      • I’d be interested in seeing a breakdown of the breech death statistics controlled for other factors. For example, my brother was born vaginal breech (I think footling), but he was also several weeks premature, born several days after PPROM, to a mother who got absolutely no prenatal care and used a variety of illicit drugs. (He was adopted.) If he had died, would it have been because he was breech or because of the various other factors?

        • (ftr, not trying to argue that breech birth doesn’t have risks, because I honestly haven’t looked into it, so I don’t have the information to say)

          • Sadly, we won’t be bringing our sweet baby boy home tomorrow. Instead, we will be burying him. Our sweet, much loved and much desired little grandson perished last Friday as he was struggling to be born. His cause of death was head entrapment. He never had a chance.

            He was a footling breech, but the positioning of the placenta made it impossible for his mom to deliver him via C/S. Extraordinary measures on the part of medical staff could not deliver his head . He died with half of his body protruding from his mothers birth canal, and half still in her pelvis. She, our little Eli who was no longer alive, and his Daddy had to remain in this position for over an hour waiting for his mother’s cervix to release it’s grip on his head so he could finally deliver.

            He was never able to take a single breath, never able to open his eyes, never able to grasp our fingers with his little hands. Not even once.

            His birth was a hugely traumatic event for the 20+ medical personnel who tried so very hard to save him. These are super experts with every advanced technique, true expertise and experience, and all possible equipment available to them. These are super specialists who are known for their ability to beat poor odds. But they could do nothing to change the outcome of Eli’s birth despite their heroic efforts.

            In the end, our little Eli’s strong steady heartbeat fell from strong and vigorous, to thready, to nothing. His poor bruised little head finally delivered on its own, long after his heart had beat it’s last.

            His mother and father are devastated and traumatized. His mother suffered physically traumatic procedures to try to help him and suffered internal injuries as a result. She hemorraged after his birth and was at high risk of bleeding out. She underwent emergency surgery to save her life.

            Eli’s OB is traumatized and wept openly. His neonatalogist and perinatalogist is are both deeply shaken. Everyone in the room was crying.

            This all happened at one of the four best institutions in the USA for handling obstetrical and perinatal emergencies. The best of the best.

            Head entrapment does happen. The results are tragic. The interventions are few and brutal. The outcomes are poor. This condition isn’t a joke or a myth. It is all too real.

            If your OB tells you that you are at risk for this complication, please don’t blow him or her off. Please don’t “doctor shop” or worse- seek out a midwife who will reassure you that the vaginal birth you desire will turn out well. Please don’t seek to find someone who will agree with your desire to have a vaginal birth. Don’t let well meaning advice from others sway you. It isn’t worth the risk. It isn’t worth a life, or maybe two.

            We will never forget the things we saw that day. We will never forget holding our precious little Eli, so still in death, and caressing his poor bruised head. We will never forget the heroism we saw that day, or the heart. We will never forget the agony of every moment and the zeroing of hope with each second of entrapment.

            Will this happen to you? Maybe not. But, is it worth the risk to find out?

            If you are the mother whose child dies in this horrific way, then the mortality statistics are 100 percent for you. And they are very high for any child who becomes entrapped.

            I’ve learned that this kind of event is considered to be one of the the worst nightmares for OBs. Ask questions, get a second opinion from a high risk OB. Listen. Please don’t take chances.

            Yes, vaginal birth is beautiful. It is preferred. But, please don’t risk your baby’s life to experience it.

            If even one of you makes a choice that avoids the loss we have experienced, then Eli’s death will have served some purpose.

            Please love your baby more than you want to experience vaginal birth. Don’t take the chance of walking the hard road we have found ourselves on. Please. It is a road of lost hopes and shattered dreams. Please do not join us on this empty road.

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