Coming Out Bass Ackwards (As They Say Down Here)

Before we go into the breech situation, let's get transverse out of the way. Your baby is lying transverse if its head is on one side of you and its bottom is on the other side, instead of one or the other being at the bottom of your uterus. Your only option, in this situation, is a C-section; the baby cannot come out any other way. So that's easy enough.

If your baby is breech, especially if it's your first baby, your doctor or midwife may recommend that you have a C-section. It might not sound like a recommendation; it might sound like a fact. But the truth is, it's advice. You, the pregnant couple, are in charge of this decision.

Before you can decide whether this is good advice or not, you need to know (a) why your doctor is giving you this advice, and (b) what the alternatives are.

Your doctor is suggesting a C-section because a baby's head is by far the largest part of its body. In a "regular" birth, the head comes first; if it doesn't fit into the mother's pelvic cavity, then the whole baby remains in the uterus, where an emergency C-section can be performed to take baby out. If the baby is breech, however, the feet, bottom, belly and shoulders can all be delivered before it is discovered that the head does not fit. There's precious little that can be done at this stage to get the baby out safely.

At this point a C-section sounds like very excellent advice, wouldn't you agree? But that's not the whole picture.

Your doctor or midwife will almost always try to turn the baby a few weeks before your due date, so that the whole breech problem is solved by the baby not lying breech anymore. (They'll also try this with a transverse baby.) This procedure is called a version, and from what I have heard from my soldiers in the field, this is a very unpleasant procedure which takes your breath away and basically hurts like heck. (Though probably less so than a C-section without anaesthetic. If you think this never happens, ask my friend Geri. She had to wait so long for her C-section that the anaesthetic wore off, and she felt everything. The doctors were so busy getting the baby out that they apparently did not hear her screaming that she felt everything. This is, fortunately, even less common than a transverse baby.) A version is also infrequently successful in turning the baby.

My chiropractor tells me that there is a chiropractic procedure involving one "trigger point" (whatever that is) which is nearly always successful in turning the baby, and doesn't hurt like a version. I don't know anyone who's had this done, however, so I can't vouch for it. I do know that, should I have a breech baby and a midwife concerned about my ability to deliver it vaginally, I'd sure as heck try this chiropractic trigger point thing.

Another option, slightly less scientific but more preventative in nature, is the practice of wearing a long necklace with a bell at the low point, down near the beginning of your pubic hair. This idea was passed on to me by some of my friends in the Netherlands; I don't know if it has wider popularity. The theory here is that the baby likes the sound of the bell, and turns herself head down to get a better listen. I don't know if this works, either; friends who've done it had head-down babies, but maybe they would have anyway - it is a far more common position than breech. If you find yourself with a breech baby around 32 to 36 weeks, you could test this theory by starting to wear a bell, thereby providing experimental evidence that it works (or doesn't work, as the case may be).

But let's suppose you've had a version, seen the chiropractor, and worn a low-hanging bell to no avail. Your baby is still breech. Is the recommended C-section the only reasonable option you have?

No. Remember, the concern is that your pelvic cavity is not large enough to allow the baby's head to pass. (If this is true, then you'd be having a C-section eventually, no matter how the baby was lying.) But the overwhelming majority of women have perfectly fine pelvic cavities for normal-to-largish babies (10 pounds and up, even - remember, it's head circumference, not weight, that can cause a tight squeeze). And this perfectly fine pelvic cavity has been enlarged during your pregnancy, as hormones loosen your ligaments and allow the pelvic bones to slip apart from one another. So chances are, you have plenty of room for that baby. (This also explains why your doctor might not recommend a C-section with a second or later baby; your pelvic cavity has been "proven" with your first baby.)

This would merely be reassuring, but not convincing, if it stopped there. But your doctor or midwife can check (via x-ray, and sometimes via manual measurement alone) to see if your pelvic cavity is of sufficient size. If it is (which is most likely so), and the baby's head is of non-gargantuan proportions (which can also be checked, via ultrasound), then there is no reason you can't try delivering your breech baby vaginally. (There is one caveat: if your baby is footling breech, meaning one or both feet are presenting instead of its butt, there is a large risk of cord prolapse, a life-endangering condition which requires emergency C-section. In this case, you will almost certainly want to skip the prolapse and go right to the C-section.)

Naturally, you will want to choose a care provider who agrees with this reasoning and who has experience delivering breech babies vaginally. If you think you'd want to try vaginal delivery of a breech baby if it came to that, be sure to ask your care provider at visit number one how she feels about that.

If you decide you'd rather go with a C-section for your breech baby, you can still wait until your due date (assuming everything else is fine). (For some reason, doctors schedule breech-baby C-sections anywhere from one to three weeks in advance of the due date, which has always left me wondering what the likelihood is that a breech baby, left to its own devices, will turn head down during the last week of the pregnancy.) At any rate, remember that scheduling a C-section is a matter of convenience, mainly for the hospital and the doctor. What's the worst thing that can happen if you wait until your due date? You could go into labor on your own, and then you'd have an "emergency" (i.e., unscheduled) C-section. That beats showing up at 6 AM for your scheduled C-section, and waiting around for eight hours because some other woman had the nerve to need an emergency C-section during your OR reservation.

As with the rest of life, there is no guarantee that it will all work out swimmingly in the end; but this can be applied to everything, including having a C-section or delivering a head-down baby or driving your car to the hospital. What "no guarantee" really means is that you have to choose what you think is best in the absence of total unwavering certainty. Well, this is what we do all the time every day of our lives. I'm pretty sure these particular strawberries don't have salmonella, and there's no poison in this bottle of aspirin, and my gas tank is not going to explode. The risks are exceedingly small, but they are there.

So arm yourself with as much information as you can, decide what you want out of your birth experience, determine what you think the risks are each way, and make your best choice. Take into account anything that makes your situation unusual. Just remember that it's you making the choice; don't pin it on the doctor if you opt for a C-section you don't really want to have.

Resources