Arvizu: Should All Breech Babies Be C-Sections?
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Thursday, January 22, 2015
Erin Arvizu, GoLocal Worcester Health Columnist
In a perfect world, all babies in utero would wiggle themselves into the optimal position to exit the womb - head down into the birth canal facing their mother’s back. The reality is, however, that about 4% of babies present bottom first (breech), which adds risk to both neonate and mother. The American Congress of Obstetrics and Gynecologists recommends that the decision of how a breech baby is to be delivered should be based on the experience of the healthcare provider. Consequently, most breech babies in the US are born via Cesarean Section.
Two years ago Kelley Garon faced the difficult situation of carrying a breech baby. “The risks that were laid out,” Garon said, “were potential loss of oxygen to the baby and increased chance of hemorrhaging to me. If I had him 200 years ago, we’d probably both be dead.” When a baby is in the head down position, the biggest part of the body – the head – has a chance to mold as it passes through the pelvis. But when a baby is born bottom first, there’s an increased risk that the head will get stuck after the rest of the body has been delivered, which can potentially be a life threatening situation for the baby. After weighing the risks with her doctor, Kelley decided it was best to deliver her son via C-Section at UMASS Memorial.
Although studies have shown planned Cesareans for breech babies can lower neonatal morbidity, it also increases maternal morbidity. Cesarean Sections have become so common in the US over the last twenty years that today, one in three babies are born surgically. As a result, twice as many women in the US die from childbirth complications than they did thirty years ago. So in an attempt to reduce maternal morbidity, reduce healthcare costs and reduce the Cesarean rate, should we encourage more women to attempt to deliver breech babies vaginally?
In Canada, healthcare professionals used to deliver breech babies primarily through C-Sections, but now recommend vaginal delivery whenever possible. If baby is in the frank breech or complete breech position, labor occurs after 34 weeks gestation and both mom and baby are otherwise healthy without any known abnormalities, the mother is encouraged to attempt a vaginal delivery in the hospital. If the United States’ maternal death rate were the same as Canada’s in 2013, 680 women would not have died as a result of childbirth complications.
Last year when Jessica LaFave learned her daughter had flipped breech, she would have jumped at the chance to attempt a natural delivery. LaFave said, “My experience with the midwives at St. Vincent’s was great and up until Emilia flipped breech, my wish for no interventions was honored and supported. Once she flipped,” she added “it was game over and I had no option but to have a C-Section.” The Perinatologists at UMASS seem to be more open about allowing women to attempt breech vaginaldeliveries although most are still delivered via C-Section.
If you find yourself carrying a breech baby, talk to your healthcare provider. It’s your body and yourbaby and a vaginal breech delivery may be a viable option for you.
If you need help exploring your birth options, stop by Wild Orchid Baby located at 490 Shrewsbury Street in Worcester and chat with local birth professionals and childbirth educators.
Erin Arvizu is owner of Wild Orchid Baby.
Related Slideshow: Top 10 Hospitals in Massachusetts Rated By Patients
Using the latest results from the Hospital Consumer Assessment of Healthcare Providers and Systems, also known as the HCAHPS Survey, GoLocal has created a ranking of New England's Best Hospitals Rated by Patients.
Read more about GoLocal's methodology here
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#10 Newton-Wellesley Hospital
Newton, MA
New England Rank: 58
No. of Beds: 313
Newton-Wellesley Hospital is a member of Partners Healthcare, a network which connects their facilities to other centers throughout Massachusetts such as MassGeneral. Newton-Wellesley Hospital is also partnered with Tufts Clinical and Translational Science Institute.
Highlights: 84% of patients who have stayed at Newton-Wellesley confirmed that they would recommend the hospital.
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#9 Wing Memorial Hospital and Medical Center
Palmer, MA
New England Rank: 56
No. of Beds: 74
Established in 1913, Wing Memorial Hospital and Medical center is committed to serving the communities of Quaboag Hills and Pioneer Valley. Wing Memorial Hospital joined UMass Medical Health Care, bolstering its already strong reputation and ensuring quality healthcare.
Highlights: 75% of Wing Memorial Hospital patients reported that they were informed and instructed before receiving any medication.
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#8 Athol Memorial Hospital
Athol, MA
New England Rank: 55
No. of Beds: 25
Athol Memorial hospital staffs 50 physicians to oversee 25 beds. Since 1950 the non-profit Athol Hospital has offered state of the art healthcare, renovating and importing new technology every few years.
Highlights: 82% of patients said that both their rooms and bathrooms at Athol Memorial hospital were always clean.
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#7 Harrington Memorial Hospital
Southbridge, MA
New England Rank: 52
No. of Beds: 114
Southbridge’s own Harrington Memorial Hospital has served the South Central Massachusetts' community since 1931. Harrington Memorial is committed to providing quality healthcare for the local community while upholding their reputation.
Highlights: 82% of patients at Harrington Memorial claimed that their physicians communicated well with them.
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#6 Nantucket Cottage
Nantucket, MA
New England Rank: 47
No. of beds: 19
Founded in 1911, this not-for-profit regional medical center is the only hospital on Nantucket Island.
Highlights: At Nantucket Cottage Hospital communication reigns supreme—88% of patients reported that their nurses always communicated well, and 86% said the same of doctors.
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#5 Mount Auburn Hospital
Cambridge, MA
New England Rank: 42
No. of beds: 213
Founded in 1886 as the first hospital in Cambridge, Mount Auburn provides a number of clinical services to area residents, including cardiac catheterization, laboratory services, rehabilitation services, and specialized services for men, women and seniors.
Highlights: At Mount Auburn communication shines—82% said nurses always communicated well, and 83% said the same of doctors.
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#4 New England Baptist
Roxbury Crossing, MA
New England Rank: 31
No. of beds: 150
New England Baptist Hospital (NEBH) offers nationally recognized expertise in orthopedic surgery, and is the official hospital of the legendary Boston Celtics, and has provided services to U.S.Olympic teams, elite athletic associations and individual elite athletes. But based on the responses, every patient is treated like an elite athlete.
Highlights: The overall patient experience at New England Baptist was incredibly positive—90% said they would definitely recommend the hospital to another person.
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#3 Martha's Vineyard
Oak Bluffs, MA
New England Rank: 21
No. of beds: 19
Since its incorporation in April 1921, Martha's Vineyard Hospital has been committed to delivering high-quality, compassionate medical care to each and every member of the Vineyard's year-round and seasonal community, as well as all who visit.
Highlights: The overall patient experience at Martha’s Vineyard Hospital was incredibly positive—83% said they would definitely recommend the hospital to another person.
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#2 Clinton Hospital
Clinton, MA
New England Rank: 16
No. of beds: 41
Clinton Hospital is a 41-bed nonprofit, acute care community hospital. The mission of the hospital is to deliver high-quality, comprehensive services to the local and extended community with excellence, compassion and competence. Organized in 1889, Clinton Hospital has been a member of UMass Memorial Health Care since 1998.
Highlights: The overall patient experience at Clinton Hospital was incredibly positive—85% said they would definitely recommend the hospital to another person.
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#1 Fairview Hospital
Great Barrington, MA
New England Rank: 2
No of beds: 25
An affiliate of Berkshire Health Systems, Fairview Hospital has been the center of healthcare in the southern Berkshires for nearly a century. A federally-designated Critical Access Hospital, Fairview provides a full range of primary care services, including 24-hour Emergency Department, surgery, obstetrics, rehabilitation, cardiology and a comprehensive list of diagnostic services including state-of-the-art diagnostic imaging and laboratory services as well as therapeutic and prevention programs that address the health needs of the community.
Highlights: This hospital that dedicates itself to compassionate care has much to crow about, particularly the work of its nurses, who 91% of respondents said always communicated well with them (the highest ranking in the Top 50).
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