HOW TO MAKE A CHOICE
Having a breech baby throws you into a decision-making circus. Do you try to turn the baby? How do you give birth? Should you do ECV? Which of the myriad methods for turning will you pursue? How much time should you spend trying to turn the baby? How much money? When do you stop trying? When should you schedule a planned cesarean for? How far are you willing to travel for a vaginal birth attended by a skilled caregiver?Here is a decision-making information sheet put out for Australian parents. The terminology and clinical atmosphere is a bit different in the U.S., but it’s useful regardless.
If you want to make the best decision you can, it’s easier when you know your options and what they mean. For the full spectrum of options and what they mean concerning breech babies, find someone local who can sit down and help you understand or get my Breech Baby Handbook, which is like a virtual breech consultation.
In order to make any of these decisions, it’s useful to know how you want a decision to be made.
Which of these feels most right to you concerning the care of your baby and yourself?
A. I prefer to make the final decision
B. I prefer to make the final decision after seriously considering my doctor’s opinion
C. I prefer that my doctor and I share responsibility for the decision
D. I prefer that my doctor makes the decision after he/she seriously considers my opinion
E. I prefer my doctor to make the decision
F. I’m not sure
Once you know which category of decision making you would like to pursue from above, you can get started making the decisions.
A. If you want to make the decision without your doctor/midwife’s input, all you need to do is research as much as you feel comfortable with, ponder, and make the decision that feels right in your mind and your heart. Cheesy, but foolproof.
B. If you want to see what your doctor/midwife thinks before making a decision, do some research on your own and get an idea of how you are leaning. Then present your thoughts to your caregiver and ask for their professional opinion. If their opinion leans the same direction as yours, convenient. If not, search for more professional opinions (people who could just as easily have been your caregiver) and see how they lean. Then, see above.
C. If you want to share the decision-making, you don’t feel comfortable making a decision about something you are not familiar with and will be more comfortable having an expert caregiver’s advice. Assuming you respect and generally find yourself in alignment with your caregiver’s philosophies, and that s/he will spend the time to discuss it, you should have a relatively easy time of it. You are on this site which means you are doing some research, which is good. Consider what makes sense to you and what feels right, and then talk to your caregiver.
D. If you would rather not make the decision, and you trust your caregiver to make it for you after a brief talk, it is simple. You are reading this, which means you are interested in knowing information and developing preferences and opinions. Do however much of that feels right without stressing yourself, and then tell your caregiver what you think. Express that, though you trust his or her decision for your care, you hope your thoughts and wishes will be considered.
E. If you implicitly trust your doctor to make decisions for you, you are very unlikely to be reading this at all. Just make sure your caregiver really is someone you trust with the life of your baby and yourself.
F. Well, aren’t you up feces creek? No end of questions and problems rattling around in that mind of yours. If you have a doctor or midwife that you love and trust, I would always suggest option B or C, depending on your own personality. If you don’t like what your caregiver has to say about things, you can find another in a hurry or research your little heart out while considering your gut about the thing.
SOME THINGS TO CONSIDER
You cannot save your baby
(Some thoughts about risk): If you are already a mother, you make decisions about your child that increase morbidity and trauma risk every day. If you step outside your house, if you let her ride a bike, if you attend group classes with other children sneezing, if you feed him pop tarts: you are increasing the risk of injury to your child. These things also increase your child’s quality of life, and you cannot keep her from every risk. You would not let your begging 8 year old go sky diving to increase his quality of life, but you would let him climb to the top of the playground. You cannot escape risk. You must make decisions about what risks are smart risks, and which are risks you take because of coercion, social pressure, or because you don’t understand the risk.
When debating between vaginal or cesarean breech birth, you are comparing an elevated risk vs. an elevated risk. Since cesareans are a dime a dozen, and everyone thinks of them as a way of avoiding risk, we forget to talk about the risks of major surgery that involves extracting a tiny human from your abdomen.
Listen to your gut. Listen to your doctor, your research, your friends and family. And then put it all aside and check in with yourself. We often make instinctual or gut feeling decisions that are the right ones.
Make a decision based on love, not fear. Fear is not real and makes bad decisions. Learn what you can, think about it, and make the decision you think is best based on love and trust.
Remember that you are the consumer. You (perhaps through your insurance) are PAYING for a service. This doesn’t mean you get what you want; but it means you have the right to full information, to ask and to be heard. And you have the right to look elsewhere.
You have the right to choose
You have the right to refuse treatment
You have the right to demand treatment
You have the right to a second or third opinion
You have the right to leave a practice
You have the right to ask for a referral
Your doctor has something called fiduciary responsibility which means that if a you want something that is reasonable but s/he can’t do it, s/he has the duty to support you, find someone who can do it, or figure out a way to make it work. This includes planning a c-section where your baby never leaves you, moving around or eating during labor, and having a vaginal breech birth. Unless there are extenuating circumstances, none of these things is unreasonable and you can find someone to support you. And:
You have the right to tell your doctor s/he is being unethical when they will not respect your decisions, use scare tactics, or pressure you into a birth you do not feel good about.
You must remember that your provider has rights too, and that no matter what you choose there will be risks to you, your baby, and your doctor/midwife.
Register to receive the FREE breech fact sheet and decision making guide!
Here is a fairly comprehensive blog post that could help breech mamas make decisions, including a great overview of the options, turning techniques, and embedded video.