Although most doctors plan a C-section for breech babies, having them the old-fashioned way may now be possible—especially if you're a Kardashian.
Like any expectant mom whose birth plan isn't ending up the way she wants, Kim Kardashian West was not happy to learn her baby is breech. For most of the four percent of pregnant women having a breech baby, the head-up position means a planned C-section. But instead of resigning herself to that, the reality star is thinking about attempting a vaginal delivery. "As I lay awake late at night, researching, I've learned that you actually can deliver a breech baby," she wrote on her website. "I found it very interesting that I do have this option to deliver a breech baby as opposed to just jumping into a C-section. Obviously, if it's an emergency and for the safety of my son, I will get a C-section—but if I don't need one, I'd rather not."
Should breech mean C-section?
Kardashian West's sentiments echo the frustration of many pregnant women who are told by their doctors that they must have a cesarian, especially since the rate of C-sections in the United States has risen to 32 percent—more than double what the World Health Organization says it should be. But are vaginal deliveries of breech babies actually even done anymore? "It is possible, but it is not common," Siobhan Dolan, M.D., M.P.H., a professor of clinical obstetrics, gynecology and women's health at Albert Einstein College of Medicine/Montefiore Medical Center in the Bronx, N.Y., and a medical advisor to the March of Dimes, tells Fit Pregnancy. "More than 85 precent of pregnant women with a breech presentation at 37 weeks deliver by cesarean section."
The reason for this has to do with the mixed results of studies on the safety of such vaginal deliveries. Risks of breech births include the head becoming stuck in the pelvis, as well as cord prolapse, in which the umbilical cord becomes pinched and cuts off the baby's oxygen. In 2000, a study called the Term Breech Trial showed more complications in breech babies who had been randomly assigned to be born vaginally than in those who had been assigned a C-section. This led the American College of Obstetricians and Gynecologists (ACOG) to issue a statement saying that vaginal deliveries of breech babies were no longer appropriate.
But, follow-up studies on those same children found no long-term negative effects from the way they were born—and other studies using strict criteria for delivering vaginally (instead of a random assignment) showed good outcomes for babies, according to Eve Karkowsky, M.D., a maternal fetal medicine specialist at Montefiore. "All of this research contributed to current thinking, which is that vaginal delivery of a breech baby can be safe—but it should be done in very specific situations," she tells Fit Pregnancy. Because of the new research, the ACOG revised their position, saying that vaginal delivery is within the standard of care under certain circumstances. "These criteria can vary, but for most institutions who support vaginal breech deliveries the criteria would include a baby that is correctly in position, either frank [legs straight up] or complete breech [knees bent], so that the cervix is appropriately dilated by a larger part of the baby," Dr. Karkowsky says. "Criteria would also include a baby that is not preterm, one that is not too big nor too small. Most importantly, the criteria include the need for a skilled provider, one who is comfortable with breech delivery."
Docs with skills
This can present the biggest problem for women who want a vaginal breech delivery, because finding a doctor who is willing and able to attempt one, and a hospital that can support it, can be difficult. "Important factors to consider include how experienced your obstetrician is with performing vaginal breech delivery and also, if your hospital has a protocol in place for identifying appropriate candidates for vaginal breech delivery as well as monitoring them in labor," Dr. Dolan says of deciding whether to attempt one.
Unfortunately, today many obstetricians are more comfortable with the scalpel than with difficult hands-on deliveries. "I feel fortunate that my doctor Paul Crane is one of the few doctors that still does this," Kim Kardashian West wrote on her blog. "They just don't even teach it anymore." In fact, older doctors (Dr. Crane is just over 70) might actually have more expertise in this area than younger ones. "Since breech deliveries became less common, fewer and fewer providers feel comfortable with this procedure, and so this is often a difficult criteria to satisfy," Dr. Karkowsky says. Even Dr. Crane admitted in an interview that vaginal breech deliveries are "incredibly stressful."
Turn, baby, turn
So before deciding on a vaginal birth, the first course of action is usually to try to get the baby to turn head down on its own. Kardashian West says she's been trying "anything to still turn the baby. I lay practically upside down three times a day for 15 minutes. I play music in the right position and ice my belly in certain spots to get him to squirm out of the breech position. I even started acupuncture where I burn moxa (mugwort) on my pinky toe every day! I am even attempting hypnosis!" Karkowsky says she's counseled patients on many of these techniques as well. "The data about any of these options is very mixed, and it's not clear that they help. But they have very few risks, so depending on the patient, they may be worth pursuing," she says. There are also some chiropractic techniques that may help, but talk with your OB before attempting any of these methods.
The most powerful tool doctors have for trying to turn baby is an "external cephalic version," commonly just called a version or ECV, which is done around 36 or 37 weeks. "External cephalic version is a procedure that can be performed by your doctor in which external pressure is used to try to get the baby to do a forward or backward somersault so that his or her head is down," Dr. Dolan says. "It works about half the time and is more likely to be successful in women who are having their second or third baby, rather than their first." This is good news for second-time mom-to-be Kardashian West, who says she will be trying one. There are some risks involved, though. "The baby might feel stressed by the attempt, or labor or bleeding might commence, or the water might break," Dr. Karkowsky says. "Very rarely, these might lead to the need for an urgent or emergent cesarean section. These complications, however, are pretty unusual; ECV is usually quick, and well-tolerated by both the mom and the baby."
As concern rises over the high rate of C-sections (major surgery which comes with its own set of risks), more and more women may be interested in having breech babies vaginally—and this demand in turn might change how doctors are taught the fundamentals of delivery. In the meantime, if your baby is breech, talk with your OB about the best way to handle your particular situation. "Even for those women who still greatly desire a planned vaginal breech, I always review that utilizing the strict criteria that I mentioned means that many women will not qualify at the time of delivery and may end up with a cesarean section," Dr. Karkowsky says. "Often during labor things change. We always want to come to a plan of care that feels safe and comfortable for the patient and for the provider. Having a really in-depth discussion with the patient about her priorities and concerns means that when circumstances change, we can change the plan together, while hopefully maintaining that sense of comfort and safety."