Wednesday, 4 May 2016

Breech Delivery - you have options

I have been touched by the difficult decisions that go in to delivering breech babies.  And it's really really important to know that you do have options.

I taught two clients in close succession whose babies were in breech position; both 'frank breech' (bottom down, feet stretched up). Both women were healthy, fit, first-time mothers. Both couples took their hypnobirthing courses and went on to plan their home water births.  However, during routine antenatal checks, the babies were both determined to be in a frank breech position during the last few weeks of pregnancy. They both attempted the whole range to ways to try to get baby to turn, and both babies weren't for turning.  The decision both mums faced was c-section or attempt at vaginal delivery in hospital.  Both handled this very significant change in plan amazing well.


Before, I summarise the decision-making process of each: one had an elective c-section, the other a vaginal delivery, it's worth noting that breech presentation is a variation of normal.  And the significant reason why c-section is offered is simply due to loss of skilled midwives over time.  With more and more, and more, women accepting the option of c-section, fewer midwives put into practice the skills they were trained to use when baby is breech. That means maternity departments are unable to guarantee an adequately skilled midwife will be available at the time of delivery. 

Of the two mums mentioned above, the one that went for the vaginal delivery had to 'shop around' at 39 weeks for a hospital that could support her choice adequately. The hospital she was with originally couldn't promise a midwife experienced enough with breech vaginal delivery.  In the end, mum chose a great hospital in London that had a dedicated policy for supporting vaginal breech delivery.  At 39+1 she booked in with her new hospital, and at 39+3 spontaneous labour began.  Lucky timing!  Mum used hypnobirthing for a long labour, lasting nearly 2 days, the hospital supported all of her choices, using the pool for part of the labour.  When the baby was finally ready to come, mum was out of the pool.  The only time she used any drugs was when she had some gas and air for an episotomy so baby could be assisted out with forceps.  This mother was the 'talk of the maternity unit' according to her husband.  Her practice and effective use of hypnobirthing helped her to avoid hefty drugs and c-section, but also aided her decision process to ensure she got the birth of her choice.

The second mum made a very different decision based on reasons that were compelling, unique and important to her.  This mum was with a different, but equally good London hospital.  On exploring her options, she understood that there might be some uncertainty around vaginal delivery of a breech baby, which raised some personal concerns.  After meeting one-to-one with her for an additional relaxation and hypnosis session, it was revealed that the priority of guaranteed skin-to-skin with her newborn was way more important to her than delivering vaginally.  This mum herself never experienced the loving touch of her own biological mother, because she was adopted at birth.  So, for her, having a plan for a gentle 'natural c-section', where skin-to-skin, delayed cord clamping, softer lighting etc, were arranged, felt like a better option for her.  Afterwards, mum reported that the birth was a positive experience, a calm and joyful day.   
 

So , there were good reasons each mum came to their own, very different decisions. And for both, all that they learned during the hypnobirthing course helped them to make the right decision for them. 

The important thing about both situations is that both sets of parents explored all their available options, asking intelligent questions and making informed decisions.  And those decisions were based on not simply based on weighing up statistics, hospital policies and feasible care available, but more importantly how they felt emotionally about what they may or may not have wanted for their birth experience. 

Some people have strong feelings of fear regarding abdominal surgery, some people may have experienced previous emotional and/or physical trauma which leads them down one path or another, or there may be any number of other personal reasons coming in to play. All of these are valid and important, and parents-to-be must be supported through this process, without judgement and with the gentlest possible care.