C-Section Necessary For Breech and Twins?
Q: Today I accompanied my foster daughter to an antenatal at
KEMH. She is 33 weeks pregnant with twins, 3rd pregnancy.
First birth was difficult--forceps, 8 lb 8 oz.; second birth
was normal, 8 lb 8 oz. We have been querying the
recommendation for a c-section because the baby is breech
and because it's twins. The doctor said research previously
found the two modes of birth are equal in outcome but new
information says *definitely* c-section for all breeches
whether single or multiple, primip or multip.
Supposedly there is a multicentre research program taking
place, possibly out of Oxford, that has just been stopped
because the outcome for breeches was so bad. He was unable
to give me any other information and said the results
wouldn't be published until next year, so he couldn't help
me with my questions, such as those about maternal
morbidity.
This has upset my daughter of course--she feels devastated.
I know that she will have a c-section if it means her babies
are at risk, but she feels a little trapped. Any help with
information about this research? I don't want to give her my
intuitive response as I may be misleading her in my desire
for her to have a normal birth.
-Mary Murphy
====

I have personally delivered full-term twins at home, both
breech. The mom was scheduled for a c-section when the
ultrasound revealed one breech. The first baby was frank,
weighing 6 1/2 lbs. The second baby was complete, weighing 5
1/2 lbs. Both were delivered very easily and quickly, with
no problems at all. The mom had an intact perineum. The
family was very grateful and happy. Too many birth
attendants have lost the art of delivering twins or
breeches. C-sections are now the preferred choice. What a
shame!
-Alison
====

This is a hard one to comment on but I'd have to disagree
with the "all breech c-section" idea. Part of the problem is
lack of confidence and lack of experience on the part of
younger OBs who've mostly never done breech deliveries.
That's a compounding factor. The twin pregnancy is another
factor but a confident, experienced OB who is
"noninterventionist" in outlook would probably say that the
advice given is defensive medicine--i.e. they are afraid of
legal complications more than anything else.
-Phil Watters (OB in Australia)


Reprinted from Midwifery Today E-News (Vol 2 Issue 27 July 5, 2000)
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