vaginal breech birth vs. cesarean - what are the risks?
It’s estimated that 3-4% of babies are in breech position, that is butt or feet down, at term (37 weeks gestation or later). It’s a common position in mid-pregnancy, with 25% of babies in breech position at 28 weeks. The number drops to 7% at 32 weeks. Breech presenting babies are a variation of normal, and not an inherently dangerous situation. What’s dangerous is the lack of professional training around vaginal breech birth. In the hands of skilled practitioners, the risk can be minimal. Speaking of risk, let’s have a quick look at how risk might be presented by a medical professional.
“Your baby is four times more likely to die during a vaginal breech birth than a C-section.”
Not only is this fearmongering, it doesn’t paint the full picture. The above statement portrays the relative risk, which doesn’t mean much unless you also look at the absolute risk. Below is the absolute risk of perinatal mortality (death), taken from RCOG’s Green-top Guideline No. 20b.
Planned cesarean section after 39 weeks gestation = 0.5 / 1000
Planned vaginal breech birth = 2 / 1000
Planned cephalic (head down) birth = 1 / 1000
Even if you are given the above statistics, it still isn’t the full picture because these numbers focus only on the short term risk of perinatal mortality, or infant death. It’s common for medical professionals to spend little if any time discussing short term and long term risks for both the baby and birthing parent. To make an informed decision, you need all the information.
RISK TO BABY
Babies born via planned vaginal breech birth have increased risk of low Apgar scores and short-term complications. However, vaginal breech birth does not increase the risk of long-term morbidity (medical problems caused by a treatment).
Let’s compare that to your baby’s risk after a cesarean. Babies born via cesarean are more likely to develop childhood asthma as well as autoimmune and allergic diseases. They will also most likely have reduced biodiversity in their gut microbiome and may be at greater risk of childhood obesity.
RISK TO BIRTHING PARENT
While there is some risk of morbidity in the birthing parent following vaginal breech birth, there are more risks to the birthing parent who undergoes cesarean surgery. Short term risks include increased risk of hemorrhage, hysterectomy, and difficulty nursing. Long term risks encompass not only the pregnant parent, but future babies. Your chance of a repeat cesarean increases, as does risk of placenta previa or accreta, uterine rupture, and stillbirth.
Believe it or not, there are actually benefits for the birthing parent if they opt for a vaginal breech birth. There is a lower risk of trauma to the perineum and birth canal and no need to recover from a major abdominal surgery. There is also reduced risk in subsequent births compared to subsequent births after a cesarean.
You will encounter risk no matter how or where you choose to birth. Ask yourself - which risks am I willing to run?
I encourage you to be critical of any research you read regarding birth. There are so many factors involved, many of which aren’t recorded or reported. The data may be decades old, from a different obstetrical climate. Many studies are done in hospital settings that are not optimal for physiological birth. If physiological birth is your goal, especially physiological birth outside of the hospital, take study results with a grain of salt.
If you are looking for more information or education on vaginal breech birth, please visit Breech Without Borders, as well as their YouTube channel.
I am not a medical professional. The information in this post is not intended as medical advice. Please consult with your intuition and your healthcare provider about what is right for you and your family.
