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Your options if your baby is in breech position

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Your options if your baby is in breech position

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Depending on your situation your choices may include:

The Royal College of Obstetricians and Gynecologists (RCOG) currently recommend that you have a planned elective caesarean section at about 39 weeks pregnant, however we are here to support and advise you about your birth options so that you can make an informed choice. You will be referred to a consultant to discuss your options and you will also be able to speak to a supervisor of midwives for further information and support.
Vaginal breech birth
One research study suggested that breech babies were less well around the time of birth when they were born vaginally compared to being born by elective caesarean section. However at 2 years of age the study found there were no differences in the development or wellbeing between babies born vaginally or by caesarean section. More recent research suggests that women and breech babies who are full term (over 37 weeks) and are otherwise healthy and well in pregnancy and who go into labour spontaneously are just as well around the time of birth when compared to those babies born by caesarean section, but with less risk to the mother.

The benefit to having a vaginal birth for the mother is that you will have less chance of heavy bleeding, infections and complications in subsequent pregnancies and births. You will have more chance of being mobile after the birth, have a quicker recovery and be in the maternity unit for less time after birth. The benefit for the baby is that it will have better preparation for breathing after birth as labour squeezes the lungs and promotes hormones that help the adaptation to being outside the womb.

The possible risks to having a vaginal breech birth to the mother is a chance of requiring a caesarean section during labour (estimated to be about 15-20% of all planned vaginal breech births need to have caesarean section in labour) and damage to the perineum / pelvic floor during birth. The possible risks to the baby of being born vaginally (normally) are an increased chance of the baby needing help immediately after birth (this would be needing some support with breathing at birth - for this reason we advise you have your baby in a maternity unit where neonatal support is available). Some breech babies need help for their bodies and heads to be born; if clinicians need to help your baby to be born there is an increased chance the baby may have bruising due to the maneuvers we use (note that these maneuvers can be needed during a breech caesarean section delivery too).

It is suggested in studies that having a clinician with knowledge, skills and confidence in vaginal breech birth may influence the outcome for you and your baby. At BSUH we have a number of midwives and obstetricians who have experience in vaginal breech birth and all our midwives and obstetricians have regular updates on how to support vaginal breech birth. However we acknowledge that, as most known breech babies are born by caesarean section the experience and confidence with breech birth is limited at the moment. For this reason we usually approach care as a team, pooling our knowledge and skills. There is always a Consultant Obstetrician and Supervisor of Midwives on call 24hrs/7days a week who can offer support and guidance. We suggest you consider who you would like with you in your birth plan.

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Breech means your baby lying with its bottom, knees or feet at the bottom of your womb. As pregnancy progresses, most baby's will usually turn into the head first position, but about 3/100 (3%) will not and stay breech after 37 weeks of pregnancy.

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Artificial seeding for a planned caesarean - pros and cons

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Artificial seeding for a planned caesarean - pros and cons

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Caesarean birth information: what happens? Types of anaesthetic used? Planned and unplanned caesarean

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Caesarean birth information: what happens? Types of anaesthetic used? Planned and unplanned caesarean

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http://www.labourpains.com/UI/Content/Content.aspx?ID=28

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From home birth to planned caesarean. A beautiful picture story

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From home birth to planned caesarean. A beautiful picture story

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Making decisions about common interventions 

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Making decisions about common interventions 

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https://1drv.ms/w/s!AsOQ2z55amcsgkoK1ljMRonVlsHh

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https://pregnancy.cochrane.org/sites/pregnancy.cochrane.org/files/public/uploads/cochrane-review-of-ecv-at-term.pdf

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Most women know induction is no walk in the park.

For some mothers and babies, it's safer for labour to start sooner rather than later, but the idea of being induced can be stressful.

Induction means asking your body to begin labour before it is naturally ready. This can be a slower, more difficult process and it is normal to feel some concern about how you will cope.

If you do need an induction, you don't have to give up the idea of a positive birth, or one without pain medication.

8 Ways To Have A Positive Induction Birth

Here are 8 tips for a positive induction birth:

#1: Understand Labour Induction

If you have time and there is no emergency, look at your options for induction. A Bishop's score can be performed to see how close you are to labour, and which method of induction is most likely to be successful. If you are induced before your cervix is fully ripe, there is a greater chance that you will be in for a longer labour, which increases the risk of interventions.

Each form of induction has its pros and cons. It helps to know what is likely to happen in each situation, and prepare for how you will meet the challenge. Don't forget - the preparation you have done for a natural labour still counts too! You can use that knowledge to help you understand how labour works, even if it doesn't start under your own steam.

#2: Have Birth Savvy Support

Having support during labour is always important. When it comes to induction your birth support can be crucial. Make sure your partner understands the process of induction, so he isn't caught out by the intensity.

Or hire a doula, who is an experienced birth support person. Doulas know lots of techniques to help women cope with labour and can help you get through an induced labour.

#3: Prepare Your Environment

Natural labour happens best under certain conditions: darkness and privacy, quiet and safety. These conditions are still important even if your labour is induced, and will allow you to feel as close to having a spontaneous labour as possible. You are less likely to feel tense and frightened when you are owning your birth situation.

Dim the lights or close the curtains. Have your music and essential oils ready. Ask your care providers to respect your birth wishes for quiet voices and privacy. Some women use eyeshades to keep out sights and light, which can help them to go inwards and focus on labour rather than the clinical situation of induction.

If you have monitors attached, or a drip put in for artificial oxytocin, sit on the birth ball instead of the bed. This gives you more freedom of movement as the ball allows you to rock and move your hips, lean forward into the bed or wall, or bounce and move your legs.

#4: Prepare To Find Your Way Through

Labour under your own steam has a unique pattern. Some women have long, slow first stages, others have short and furious active labour. The hormones your body produces during natural labour help you to cope with the growing intensity and strength of contractions, pulling you into a trance and helping you to find your way through each one.

Depending on the method of induction used, you might go quite suddenly from not being in labour to being in labour, with no gentle build up. The intensity can be a challenge and, to get you through, it can help to have some really good tools in your pain management kit, such as:

Breathing techniques.

Hypnobirthing.

TENS machine.

Relaxation exercises.

Having your partner or birth support use acupressure, hip squeezes, or warm compresses.

Being as active as possible - use the birth ball, stand up, or lean over; avoid lying down, but if you need a rest, lie on your left side.

Having coping strategies in place can help you to focus on staying within and finding your way through the pain. If you can accept and move past the fear then you are more likely to work with it and not tense up.

If your labour has been induced with artificial oxytocin, and contractions are well established, you can request to have the drip turned down or even removed. Discuss this option with your care provider beforehand.

#5: At Some Point It Will Get Too Much

Remember, in most cases, induction overrides your body's normal hormone production. Your body doesn't know to release endorphins, which are nature's pain killer. There will most likely be a point during labour where you will feel the pain becoming bigger than you. If you have been coping well until this point, you might think there is no way you can continue, and start thinking about pain medication.

It is likely you are entering into transition, when the cervix nears complete dilation. Transition is a time of emotional and physical upheaval. It is not uncommon for women to decide they can't go on without drugs, or become convinced they will be in labour for days, and just want to go home! This is a normal part of labour and signals that your baby is close to being born.

You might start feeling more pressure in your bottom, and the sounds you make might change. Your midwife will probably register these and ask if you feel 'pushy'. If you have a cervical check, it is likely you will be almost or completely dilated.

#6: Stand And Give Birth

Lying down or semi reclining while giving birth increases the chances of a prolonged second stage, fetal distress and use of interventions. Your tailbone needs space to move as your baby's head passes through the pelvic space, and your pelvis also needs freedom to open. The best positions to adopt when pushing are active ones.

Being active during labour doesn't mean you have to be walking or climbing stairs. Active labour positions are those that allow you to move with your body and the contractions. Is it possible to do this with monitor belts and possibly a drip in place? Definitely. Your partner, doula or midwife can support you in different positions, such as squatting, kneeling, leaning forward or standing. If you do need to rest, try lying on your left side and have someone hold your upper leg.
Read more about the benefits of an active labour and birth.
#7: The Third Stage

At the moment of birth, your body produces a high surge of oxytocin. This surge stimulates strong contractions after your baby is born, which sheer the placenta away from the uterus wall, and clamps the blood vessels.

Depending on the method of induction used, you might be able to leave your baby's cord intact and have a natural third stage. Most hospitals have a standard policy to give Syntocinon or Pitocin (either via drip or injection) to speed delivery of the placenta, and lessen the chance of excessive bleeding.

If your labour was induced by medication, your body won't have produced the same levels of oxytocin as would naturally happen in a spontaneous labour. Your care provider will prefer to manage the third stage but you can ask for your baby's cord to remain intact for as long as possible.

#8: Protect The First Hour

Once your baby is born, you will be able to sit back and feel the benefits of such a positive and calm birthing experience. You will have achieved a birth where you were in control and the clinical aspect was not the bigger picture.

Take this time to soak in your new baby; skin to skin and early breastfeeding will help to promote your natural oxytocin production. You can read more about the benefits of the first hour.

Being induced can feel as though your plan for a natural and positive birth experience is going out the window. But with careful preparation and determination, you can achieve a wonderful and empowering birth.

Recommended Reading: Natural Labour vs Induced Labour - 6 Main Differences.

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8 Tips For A Positive Induction Birth | BellyBelly

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Most women know induction is no walk in the park. For some mothers and babies, it's safer for labour to start sooner rather than later, but the idea of being induced can be stressful. Induction means asking your body to begin labour before it is naturally ready.

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For babies born by caesarean, is vaginal seeding helpful?

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For babies born by caesarean, is vaginal seeding helpful?

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Should Caesarean-section babies be smeared with a sample of their mother's vaginal fluids as soon as they are born?

"Vaginal seeding" is not mainstream medicine, but it is growing in popularity.

The idea is to give these newborns something they missed when they emerged into the world - the good bacteria that live in their mother's vagina.

A swab is taken of mum's vaginal fluid, which is then rubbed on to her child's skin and mouth.

The hope is this microbial gift will boost their child's long-term health - particularly by reducing their risk of immune disorders.

It is a crucial time.

We might have been sterile in the womb, but in our first few moments of life an invisible bond is being established between baby and bacteria.

It's a relationship that will last a lifetime, and the first contact is as important as a first date.

"The first time a baby's own immune system has to respond are to those first few bacteria," says Prof Peter Brocklehurst, from the University of Birmingham.

"That we believe is important for, in some way, setting the baby's immune system."

There is a noticeable difference between the microbiomes - the collection of bacteria, viruses, fungi and archaea - of babies born vaginally and by Caesarean section.

It lasts for about the first year of life.

A baby born vaginally is first exposed and colonised by microbes from their mother's vagina and gut.

But for Caesarean-section babies, the first exposure "if they're lucky", says Prof Brocklehurst, comes from the very different organisms on their mother's skin.

He is running the Baby Biome Study to see if these different microbial colonists on Caesarean-section babies explain why they have higher rates of diseases such as asthma and allergies later in life.

The microbiome

You're more microbe than human - if you count all the cells in your body, only 43% are human

The rest is our microbiome and includes bacteria, viruses, fungi and single-celled archaea

The human genome - the full set of genetic instructions for a human being - is made up of 20,000 instructions called genes

But add all the genes in our microbiome together and the figure comes out at between two million and 20 million microbial genes

It's known as the second genome and is linked to diseases including allergy, obesity, inflammatory bowel disease, Parkinson's, whether cancer drugs work and even depression and autism

More than half your body is not human Gut Instinct: Why I put my poo in the post
The early interaction between the immune system and microbes appears crucial.

Obviously our bodies do attack the dangerous ones - but the overall relationship between microbial and immune cells is about more than conflict, it's a far deeper dynamic.

Graham Rook, a professor of medical microbiology at University College London, says the microbiome is the immune system's teacher.

"This is a learning system, it is like the brain. Now, the thing about the adaptive immune system is it needs data, just like the brain needs data."

Listen to The Second Genome on BBC Radio 4.
The next episode airs 11:00 BST Tuesday April 17, repeated 21:00 BST Monday April 23 and on the BBC iPlayer
And that "data" is coming from microbes and the chemicals they produce. They provoke a reaction in the immune system that can last a lifetime.

Prof Rook says: "The initial setting up of the immune system occurs during the first weeks and months of life.

"We know that because there's a window of opportunity during those first months of life when if you give antibiotics you can disrupt the microbiota and then in adulthood those individuals are more likely to have immunological problems and are more likely to put on weight."

This is the idea that some parents are buying into when they perform vaginal seeding.

Do dogs boost a baby's microbiome?

Even the type of home you bring your baby back to may affect their long-term health.

Research has shown households with dogs have lower rates of asthma.

The idea is they help us swim against the hygiene tide by traipsing their muddy paws round the house and sticking their noses into everything.

"The speculation has always been that the dog brings, from the outside, microbes that are helpful in stimulating the infant's immune system," says Prof Anita Kozyrskyj, from the University of Alberta.

She is analysing data on about 3,500 families in the Canadian Healthy Infant Longitudinal Development Study.

One of its findings is that the microbiomes of three-month-olds is far richer and more diverse (a good sign) if there is a pet in the house.

Two types of beneficial bacteria seemed to be more common.

"The Oscillospira have been associated with leanness and the Ruminococcus have been associated with reduced risk of allergic disease."

Breastfeeding or formula, antibiotics and method of delivery all affect the microbiome.

But studies into the microbiome and long-term health have often been too small to be definitive.

The Baby Biome study is aiming to collect faecal samples from 80,000 babies.

That will be a lot of soiled nappies to analyse, but it will be an unparalleled resource for interrogating the impact of decisions made around birth.

Many of those will be out of parents' hands.

No doctor or parent would hold back on life-saving antibiotics because of an uncertain long-term impact.

Breast milk feeds gut bacteria

This study will let scientists see which microbes the body first hooks up, what that means years later and, tantalisingly, whether damaging relationships with the wrong bacteria can be repaired.

The faecal samples will end up at the Wellcome Sanger Institute in Cambridge and in the hands of microbial enthusiasts such as Dr Trevor Lawley.

"My latest favourite microorganism is Bifidobacterium," he says.

"It is one of the first bugs to colonise humans early in life, and we believe they feed off sugars in the breast milk.

"So, there's a very sophisticated evolutionary set-up where the bugs are passed from the mother to child and the mother nurtures that bug to establish the early microbiome."

Dr Lawley's lab will be trying to uncover every microbe that colonises a newborn and what that means later in life.

He thinks the end result of the project will be to change policy around avoidable antibiotic use and Caesarean sections.

Or, alternatively, "maybe we could culture the bugs from the mums to purposefully colonise the babies to allow their microbiome to mature and develop properly" - in other words, a scientifically controlled version of vaginal seeding.

So are some parents just ahead of the game?

Prof Brocklehurst says: "At the moment some parents believe this hypothesis enough that they are doing their own vaginal seeding.

"Now, there could be real downsides to that."

One concern is dangerous bugs could be transferred.

Up to a quarter of women are thought to carry group-B strep in their vagina, and exposing babies to this bacterium could be fatal.

Prof Brocklehurst says: "It too early to start introducing bacteria artificially into the baby until we've got a good handle on how likely this is to be the mechanism or not."

Follow James on Twitter.
Illustrations: Katie Horwich

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Should Caesarean-section babies be smeared with a sample of their mother's vaginal fluids as soon as they are born? "Vaginal seeding" is not mainstream medicine, but it is growing in popularity. The idea is to give these newborns something they missed when they emerged into the world - the good bacteria that live in their mother's vagina.

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Natasha' story - a positive first birth

It became more and more intense and then before long, there was a change and I was pushing the baby out. I had brought lots of nice relaxing things with me (led tea lights, scented oil etc) but found I only wanted simplicity - my husband's hand and calming music.

read more...

The final moment - how does birth feel?

Podcasts

Have a listen to these podcasts - they cover everything from what you need to give birth, coping and comfort, doulas, choices. Women's confidence around giving birth used to be drawn from other women - see these podcasts the same way. Experience, stories, handed-down wisdom...there's so much to learn and find out about...

read more...

Delphine's beautiful birth

ll morning I laboured up to 10cm.... in and out of the pool twice, on my knees leaning over the bath with Kim massaging my back, going up & down stairs two at a time sideways in a squat whilst pausing to puff on gas & air... sitting on a chair, on the toilet... lay down on my side... it came to midday and I was fully dilated and started trying to push. I could feel the baby's head at the end of my finger - she was so close!

read more...

Jade's Story

A letter of congratulation to... me.

Dear me,

You may not remember the she-woman that you became in the early hours of 26th October 2017... so let me remind you.

Hmmm. Ok well - it didn't quite go as "planned".

Suffice to say that you went against every point made in your everso funny birth plan (we'll come back to its hilarity later)

read more...

Gemma's story - Tommy's birth

At 5am or thereabouts, on a cold morning in December, I woke up with a slight discomfort. My waters broke. I was amazed, terrified, exhilarated and bewildered. I called out to my husband from the toilet 'Andy, it's started!'.

I was aware it could still be a very, very long time before we met our baby so reassured Andy we should just get back into bed and sleep.

Within 30 minutes or so mild contractions had started, but I still wanted to stay in bed and was almost in denial about what was happening. I wanted our doula to know that things might be unfolding, so sent her a text and then carried on pretending it was a usual Monday morning.

read more...

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Natasha' story - a positive first birth It became more and more intense and then before long, there was a change and I was pushing the baby out. I had brought lots of nice relaxing things with me (led tea lights, scented oil etc) but found I only wanted simplicity - my husband's hand and calming music.

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TENS, Gas and Air, Pool, Pethidine, epidural - pros and cons of your options during labour

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TENS, Gas and Air, Pool, Pethidine, epidural - pros and cons of your options during labour

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Short very informative video on making a caesarean birth a positive experience

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Short very informative video on making a caesarean birth a positive experience

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https://youtu.be/fR-39ITbJOQ

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NICE guidelines in induction of labour 2014

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NICE guidelines in induction of labour 2014

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Inducing labour | Guidance and guidelines | NICE

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Evidence-based recommendations on inducing labour in a hospital-based maternity unit setting

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Evidence and decision-making around induction of labour for post dates

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Evidence and decision-making around induction of labour for post dates

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Evidence from individual studies and audits

Induction Audit at Princess Ann hospital Southampton

Jan 2010-April 2011

The audit was carried out on first time mums being induced for ͚post-dates͛ i.e 12 days or

more past their estimated due date

Results

Spontaneous vaginal birth 30%

Caesarean birth 35%

Forceps or Ventouse 35%

RCOG (Royal College of Obstetrics and Gynaecologists)

Patterns of Maternity care in English Hospitals

2011/2012

** This data is for first time mums

Induction of Labour average 26.9% , lowest 16.9%, highest 37%

% of emergency CS  Average30.2%, lowest 20.4%, highest 40.3%

in induced women

% of emergency CS  Average 11.6%, lowest 7.0%, highest 17.2%

in labours starting

spontaneously

The Cochrane review on Post Dates Pregnancies: recommendations

on which NICE guidelines on Induction are based (note how this contradicts the previous evidence)

"There is a strong body of evidence however that demonstrates that induction of labour at term and prior to 42 weeks of gestation (particularly between 40 & 42 weeks) is associated

with a reduction in perinatal complications without an associated increase in CS rates. It seems therefore that a policy of induction of labour at 41 weeks in post-term women could be beneficial with potential improvement in perinatal outcome and a reduction in maternal complications

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Understanding what induction might mean for you

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Understanding what induction might mean for you

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Ten things I wish every woman knew about induction of labour - Dr Sara Wickham

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In modern Western culture, most women and families know about induction of labour before they even become pregnant. They know that it is suggested when it is felt that it would be safer for the baby to be born than to stay inside its mother.

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Caesarean Birth - what happens during the birth?

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Caesarean Birth - what happens during the birth?

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https://youtu.be/wdyzAuc3Ff8