Useful notes (O&G, MFM)

Breech birth (counselling)

Considerations for the mother

For babies born at term, the risks incurred by a Caesarean section (CS) are mostly to the mother, rather than the baby. The maternal risks of vaginal breech birth (VB) are similar whether the baby is breech or cephalic (head down), including:

  • Minor vaginal/perineal tears (up to 90% for first time births, but lower for women who have given birth before)  
  • Infection of the perineum requiring antibiotics (up to 1 in 7)
  • Damage to the anal sphincter (muscle controlling continence) and/or rectum: 1 in 179 (higher for first time births)
  • Pain (greater during birth compared to Caesarean section, but less after birth)

The risks of Caesarean section include:

  • Haemorrhage (higher with CS than VB)
  • Clots in the leg or lung: higher with CS than VB
  • Accidental damage to the urinary tract (1 in 1,000)  
  • Infection of the Caesarean incision/scar requiring antibiotics (up to 1 in 14)
  • A prolonged hospital stay (1-4 days) and a longer recovery time (up to 6 weeks)
  • Emergency removal of the uterus (1 in 500 for CS compared with 1 in 1,000 for VB)
  • Maternal death (1 in 4,000 for CS compared with 1 in 25,000 for VB)

For women who are aiming for vaginal breech birth, around 4 in 10 will be recommended to have a Caesarean section in labour.

Considerations for the baby

While most babies survive birth regardless of the way that they are born, there is a slightly smaller likelihood of mortality during/shortly after birth with a planned Caesarean section. These numbers are small: on average, 999 out of 1,000 cephalic (head down) babies survive, whereas this is 999.5 out of 1,000 for planned Caesarean sections, and 998 out of 1,000 for breech babies.

Considerations for a future pregnancy

  • Having had a vaginal birth before is a good predictor that a future vaginal birth would be successful.
  • In women who have had a Caesarean section before, there is an increased risk of uterine rupture in labour (1 in 500 for CS vs. 1 in 14,000 for VB) and of placenta accreta spectrum (placenta growing into/through the uterus; 1 in 1,000 for CS vs. 1 in 1,900 for VB).