M.
Congratulations to your friend on her pregnancy! Has she read this? If not, it's an excellent starting point:
http://www.ican-online.org/resources/white_papers/wp_bree...
http://www.ican-online.org/resources/white_papers/wp_bree...
http://www.ican-online.org/resources/white_papers/wp_bree...
I don't know how far along your friend is in her pregnancy, but if she really does want an unmedicated vaginal childbirth, there are many options she can explore to try to have one. Many will try to dissuade her, but she does have options. I encourage her to seek out mothers who have planned to vaginally birth a breech baby and speak to them, pick their brains about their experience.
No OB can force her to have a c-section - this is MAJOR abdominal surgery. Your friend is the customer, and she is hiring the OB - not the other way around. Bottom line, she can refuse to consent to the surgery, wait until she is in labor, and then head to the hospital and refuse a c-section -- BUT, this is NOT ideal, not the safest path (the OB on call might have no experience w/ breech). I personally would hesitate to go that route unless I exhausted all others (more on that below).
It's important to know that for breech birth:
* Breech babies should birth by propulsion NOT traction (No one pulling on the baby!!! Let the mom & her uterus expel/push out the baby, as it is designed to do. Many nightmare birth stories from moms who had huge episiotomies for breech birth years ago are because of OB intervention/management coupled with medicalized birth instead of an unmedicated mother being supported to birth in an optimal position.)
* Best breech birth position for mom is usually UPRIGHT (standing, lunging, squatting) - not on her back!!! While this is true for most births (gravity helps - back lying is generally not helpful), but doubly important for breech.
* It is safest to be attended by a professional who has EXPERIENCE attending breech births. While there are some old-time OBs out there still practicing who know how to attend a woman birthing a breech baby (most are retired, but some still exist - though check that they're not episiotomy and intervention happy), the vast majority of OBs these days do not know much about vaginal breech births, won't have experience, or will be too hands-on (possibly creating a problem where one did not exist). A safer, more ideal choice for breech would be a well-respected certified professional midwife (CPM) or direct entry midwife (DEM) who has experience attending a breech births. Contact me if you'd like help getting dialed in to your local midwifery community.
http://www.breechbabies.com/breech_birth_vs_breech_delive...
While a c-section is a wonderful surgery when there is a true emergency, breech presentation alone is not an emergency. Yes, a lot of moms say "it was no big deal" to be cut open, but truly, who would really want to start off the newborn baby period recovering from major abdominal surgery? I can tell you that caring for a newborn is exhausting enough *without* having to deal with recovering from major surgery. What the OBs *don't* tell you is that there can be many, many lasting negative effects of c-section:
* higher rates of post partum depression (no fun!)
* higher rates of infection (incision)
* due to painful incision/sutures, difficulty holding baby, antibiotics (can result in thrush for mom & baby), and mom's body trying to heal from major abdominal surgery, breastfeeding rates are lower --> so baby & mom miss out on all the great health benefits of breastfeeding like reduction in risk of cancers, baby misses out on wonderful immunological properties of breastfeeding, reduced risk of obesity, fewer illnesses and less severe illnesses, etc.
http://www.breastfeedingbasics.com/html/breastfeeding_aft...
* significantly higher miscarriage rates for future pregnancies
* reluctance of current OBs to support women who want VBAC (vaginal birth after c-sec) for future babies
And that's just a short list. :(
http://www.ican-online.org/resources/white_papers/wp_csfa...
After an unmedicated vaginal birth (where the mom has been allowed to birth in the position she chooses), most moms report feeling great. Tired, yes, because it is work to push a baby out! But also energized & alert, ready to hold their baby and start breastfeeding (instead of in recovery from surgery, needing help to hold baby). Moms who birth vaginally do not have to worry about a c-sec incision getting infected or the stitches of the wound popping open. Again, the birth & newborn period in general is hard work, but c-section surgery makes it even harder.
Did you know that breech birth happened vaginally without much issue as recently as 30-40 yrs ago? And that the c-section rate has skyrocketed to about 30% in that time? (Expected, acceptable rates are around 10%.) Certainly the increased c-section rate is not all due to breech, of course, but it *is* due to the increase in common interventions (induction, pitocin augmentation, high rate of epidurals) and repeat c-sections that have been all the rage since birth became so medically managed in hospitals with women immobile on their backs (due to high epidural rate, if a woman chooses an epidural for pain management, her chance of c-section increases significantly).
*Breech presenation is a variation of NORMAL!!!* It is not necessarily an emergency or complication. Some breech positions carry risks (footling breech is higher risk for cord prolapse/compression, for example), but breech should not automatically equal surgery. Did you see one of the other moms who replied here? Her 7th baby was breech, and she had a vaginal birth w/ her OBs. Why didn't they section her? They even tried to turn the baby (external version) but could not do so... Did you see what they found out when the baby was born? Her baby *needed* to be breech because the baby knew what position was best for her to be born (she had her cord wrapped around her neck 2 times)! It's important to trust our babies and trust our bodies to know how to birth (it works superbly more than 90% of the time).
Sorry to go on so long about this, but it's one of those subjects that I feel passionately about because rarely is it discussed in a balanced way - most assume that breech means c-section, but it does NOT. Just look at all of the responses here so far! Most are saying, "Don't sweat it, just accept that you're going to be cut!" Is that balanced?
I encourage your friend to read, read, read the birth stories of women who have had vaginal breech births! Spend some time searching on this topic on Google, on mothering.com/dicussions, on midwifery forums (home birth or birth center midwives), on natural parenting message boards.
Look at the pictures of homebirthed vaginal breech births versus the very medically managed hospital breech births, and see if there's not a big difference. The proof is in the pudding - in many breech situations, it can be done safely for mom and baby. I encourage your friend to contact by email any of the mothers whose birth stories she reads (they'd probably be thrilled to offer support, share information about their experiences w/ breech birth, etc).
Here are some resources for your friend to check out if she wants to explore her options. With more information about vaginal breech births, she can make a more informed decision. She may decide to go ahead with the c-section or she may decide to fight for her rights to have a vaginal breech birth. I want her to have the information so that she CAN choose. I just wouldn't want her to choose c-section out of lack of information or out of fear, just as I wouldn't want her to choose vaginal breech birth without knowing about what it entails and how it differs from vertex presentation/birth, or without her knowing of her option to have a c-section.
Vaginal breech resources:
* Neonatal mortality rates were higher among infants delivered by cesarean section (1.77 per 1,000 live births) than for those delivered vaginally (0.62).
http://www.nytimes.com/2006/09/05/health/05birt.html?ex=1...
* Optimal Fetal Positioning, great site! Don't miss the section on avoiding cesarean...
http://www.spinningbabies.com/
* Birth Story of a mom whose 2nd baby was breech, she went through the whole "do I have a c-section?" debate, tried everything to get the baby to turn... she went into labor the morning she was scheduled for her c-section, and gave birth vaginally as she arrived at the hospital to a 10 lbs, 5 oz baby. Inspirational, very worth the read!
http://www.wonderbabydesigns.com/family/KieranBirth1.htm
* Pictures & birth story of double footling breech here:
http://www.birthingway.com/footling_breech.htm
Frank breech birth here: http://www.breechbabies.com/new_years_breech.htm
* A VBAC Breech Birth http://www.mothering.com/discussions/showthread.php?t=424742
* Many more pictures, stories of vaginal breech births here: http://www.breechbabies.com/pictures.htm
Lastly, if she does decide to go with a c-section, please encourage her to hire a doula, make a Birth Plan/Birth Preferences sheet to print out and take with her to the hospital, and really own her birth (instead of just getting shuffled through the system without a lot of say). There are many things she can do to put in place the extra support she will need during & after a c-section such that she can increase her odds of breastfeeding successfully, for example. It's very worth it to put a lot of effort into research, self-education, self-reflection (excellent book for this is Pam England's 'Birthing From Within'), and planning for all possible options/outcomes (vaginal, c-sec, etc.) during her pregnancy so that she feels at peace with her birth (however it happens.
As for vaginal breech info, it may take a little more digging, a little more effort, but she can likely set up an environment in which to birth her baby vaginally if she wishes. Or, she can put the pieces in place to have a very positive experience with a humanized (instead of medicalized) c-section. I hope she has a wonderful birth, no matter what path the baby takes to come out!