Breech birth

Merry - posted on 08/19/2011 ( 346 moms have responded )

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Is it safer to do a csection for breech or is it safer to do a vaginal birth for breech.
Drs in my area say surgery is safer, but I really wonder if this is just because they get paid more for a surgery.
Now if you mess with a breech vaginal birth I know it's dangerous but I've seen many successful breech births where they let moms body do it's thing and not try to help much.....

So i know the general consensus I'd that c section is safest for breech, but is it possible that vaginal breech can be just as safe?

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Kate CP - posted on 08/21/2011

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Did the baby die unexpectedly? Was the cause of death unknown?

Yes? Then it was SIDS.

Merry - posted on 08/21/2011

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Well tbh, we don't know what causes sids so anything, including a c section, could be a factor.

Tanya - posted on 08/21/2011

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Kate, it was not even REMOTELY a case of SIDS. This baby was very, very sick for the entirety of her very short life. And it started from the moment she was born.

Tanya - posted on 08/21/2011

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Sara, I think a lot of OBs are totally right in recommending a c-section for a breech baby, because they have never done it! It WOULD be extremely dangerous. With an attendant who knew how to handle breech births WELL, and was able to do a symphysiotomy if necessary, it's a very different story.


I absolutely agree that most OBs are NOT thinking about money, or even liability, when they suggest a c-section for breech presentation.

Kate CP - posted on 08/21/2011

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"I know of a baby who recently died from unknown causes. She was born via c-section, and was never healthy, but had appeared healthy all through the pregnancy. We will never know if it was caused by the c-section or not, but we have to remember that a c-section isn't a guarantee of a good outcome any more than any other method of giving birth is."

That would be called SIDS and it's not because a baby was born via c-section.

Sara - posted on 08/21/2011

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I think you do have to make the choice for yourself, I totally agree with that. But I trust my doctor to give me their educated and experienced opinion. I think there are a lot of women (at least a lot of women I've talked to on this site and others) who think doctors are just trying to make more money or make it easier on themselves by doing a c-section instead of attempting a vaginal delivery, and I just think that's ridiculous. I go to a doctor because I don't have a medical degree. And while I am terrified of a c-section as well, I think there are a lot of women who feel they are trying to be "controlled" by their doctor and so they would ignore and go against medical advice just so they could have the vaginal delivery they are "entitled" to, which isn't always the wisest course of action, IMO. Just my personal observation!



And I have known a woman who died from a c-section as well, from a blood clot. So, there are no guarantees, that is true. But again, I trust my doctor to tell me what they think will give me the best outcome. They're not heartless people, I know surgeons who are devastated when they lose a patient, and I imagine it would be twice as hard for an OB who is holding not only one, but two lives in their hands.

Kate CP - posted on 08/21/2011

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The risks of complications during a c-section are infinitely smaller than the risks of DEATH AND BRAIN DAMAGE to both mother and baby if you're trying to open the pelvic girdle further WHILE THE BABY IS ALREADY TRAPPED.

Tanya - posted on 08/21/2011

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I know of a baby who recently died from unknown causes. She was born via c-section, and was never healthy, but had appeared healthy all through the pregnancy. We will never know if it was caused by the c-section or not, but we have to remember that a c-section isn't a guarantee of a good outcome any more than any other method of giving birth is.

Tanya - posted on 08/21/2011

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Krista, there are risks to a c-section, too. The chances of a baby becoming truly stuck during a breech birth with a SKILLED attendant (not in the scenario with a woman lying on her back being told to push by someone who is just hoping for the best) is fairly small.


Honestly, I'm not SURE if it's worth the risk. Having a "broken" pelvis would be pretty unbearable for me. Losing a baby is totally unthinkable. But, having a c-section terrifies me, too. Not only for my health, but my baby's.


So, I don't think there is an easy answer, and there certainly isn't one answer for every mother! Each woman has to look at her body, her obstetrical history, her attendant, and make that decision for herself.

Sara - posted on 08/21/2011

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I think it is because, Tanya, time is of the essence in a situation like that. If the baby is trapped, for whatever reason, then it's almost certainly going to have it's oxygen supply compromised or completely obstructed, and all the procedures you're talking about require time. So, why risk it in the first place? I'm 37 weeks pregnant with a transverse lie baby, and while I'm hoping she'll still turn, I'm more than willing to have a c-section if it means that my baby will get here safe. To me, a vaginal birth is not more important than a healthy baby.

Krista - posted on 08/21/2011

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Cripes. And in the meantime, while y'all are fucking around with hacksaws and whatnot, the baby is completely de-oxygenated and becoming brain-damaged, if he's not already dead.

Seriously. Is it really worth the risk? Not to me, it's not.

Tanya - posted on 08/21/2011

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It says:
The most common indications are a trapped head of a breech baby, shoulder dystocia which does not resolve with routine manoeuvres and obstructed labour at full cervical dilation when there is no option of a caesarean section. Currently the procedure is rarely performed in developed countries, but is still routine in developing countries where caesarean section is not always an option.[3]


So....in a situation where the baby was going to die before they could do a c-section, why couldn't they still do a symphysiotomy?? It says it's "rarely practiced", not NEVER.

Tanya - posted on 08/21/2011

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Ok, found it, it's actually a symphysiotomy. I suppose there would be limitations to its effectiveness, in that you can only spread the symphysis pubis so far! Having had symphysis pubis dysfunction during my second pregnancy, I can imagine how painful it would be, but I would absolutely tell them to do it if my baby's life were in danger.

I'm sure there are extremely rare cases in which even a symphysiotomy wouldn't work, but I would think those would be cases in which the mother had a pelvic deformity of some sort.

Kate CP - posted on 08/21/2011

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I have never, EVER heard of a woman's pelvis being broken to free an entrapped head. Not only is the pelvic girdle damn hard and hard to break, it becomes more flexible during pregnancy to allow it to separate during birth. PLUS it's damn painful to break a bone. The only way I could imagine that a pelvic bone could be broken manually would be to cut into it with a saw. And I don't see that happening if you have a baby in the way. You just can't get enough torsion with your hands to snap the pelvis of a grown woman. I don't think this is possible.

Tanya - posted on 08/21/2011

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I've never tried, but I wouldn't imagine it would be easy! It's obviously not something that would be done lightly, or commonly. It's a last resort when it's either that or let the baby die. But just because it's not easy, doesn't mean it's not possible.

Kate CP - posted on 08/21/2011

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Do you have any idea how hard it is to break a pelvic bone in a healthy, young woman?

Tanya - posted on 08/21/2011

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Did they break their pelvises to try to get the babies out? I was under the impression that breaking the pelvis would almost certainly free the baby.


I guess when I said "the worst that can happen", I meant IF you have an attendant who is skilled in breech birth. If you don't, then yes, you are definitely risking the death of your baby.

Mary - posted on 08/21/2011

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Of course I remember the details; I doubt there is anyone who was working there at the time who doesn't remember them. As I said, this was traumatic for everyone, not just those directly involved. I was not exaggerating when I said it still haunts me.

One was a primip, and two were multiparous. The one which I was present for was having her 3rd baby. Her first two babies each weighed well over 9lbs. SHe had absolutely no other risk factors or issues, and her prior labors had all been relatively short, with very brief second stages. This baby weighed 10lbs, 3 oz.

And before you ask, she did not have an epidural. She came in in spontaneous labor, at 38 5/7. Upon arrival, when it was discovered she was breech, spontaneously ruptured, and 5cm, they placed an epidural catheter, but, at her request, did not dose her, since she wanted an unmedicated birth.

Nikki - posted on 08/21/2011

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Mary, that story is heart breaking :'( I would have a c section without a second thought if my baby was breech. I would not risk it.

Merry - posted on 08/21/2011

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Mary, idk if it even matters in how I'll remember that sad sad story, but were the moms whose babies died of head entrapment primips?
I know statistically c sections are safe, but surgery scares the heck out of me and if I ever had a breech baby idk if I'd be so stressed out over a section that I could cause harm to the baby by worrying too much. I definitely wouldn't risk a breech birth if it was my first, but I'm wondering if these ladies whose baby got stuck had other vaginal births first? Maybe you don't remember, but it would be helpful to know......

Sherri - posted on 08/20/2011

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It is not an option here if you have a breech baby it is an automatic c-section.

I wouldn't risk a vaginal birth personally and I am hugely anti c-section but if given the choice, I would opt for a healthy baby which would mean c-section for me.

Stifler's - posted on 08/20/2011

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I always laugh when I hear of doctors *wanting more money* and that's why they do caesars. They called a surgical team in at 1155PM to do my caesar. They had to pay all those people too. Pretty sure my doctor would have been paid just as much per hour to be using forceps or just being there at work. Do they seriously get paid per surgery or something?

Karen - posted on 08/20/2011

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I think it depends which kind of breech it is. If it's a footling breech - opt for the c-section. If it's a breech with the feet above the head - this one is OK to do naturally. Of course it will probably be a harder delivery. my one baby was breech and my doc said that it was fine to do naturally, I on the other hand was scared crapless! Good thing he turned!

Erin - posted on 08/20/2011

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I don't see defensive medicine as an indication of the doctor being a cold-hearted monster. It is a result of the system. Many doctors are forced (by insurance and hospital protocol) to go against evidence-based practice, and their own wishes. If they refuse, they are labelled cowboys. They may have their insurance yanked. One malpractice suit can mean they will no longer practice. They are between a rock and hard place.

Breeches, VBACs and multiples draw the most attention in this liability issue. ACOG put out recommendations that for a trial of labour after caesarian, the hospital must have an anesthesiologist, OB, paediatrician and OR on site and on standby. So a VBAC-friendly doctor who happens to work in a smaller hospital, without the resources, is immediately restricted through no choice of their own.

I agree doctors generally cop an unreasonable amount of blame when women's birthing rights are impeded. Their choices are often being restricted, just as birthing women's are, simply by being in the same system.

[deleted account]

Vaginal birth is safer with an attendant trained in breech births; the problem is there aren't many doctors trained in breech births anymore. So for those reasons, a c-section is probably safer. I had two breech deliveries -- the first was a scheduled c-section (with twins) and the second started as a VBAC and turned into an emergency c-section when the baby turned breech during labor. Breech is riskier when the amniotic sac is broken, which is what happened with my second delivery -- the sac broke at the start of labor, the baby turned, and his cord was coming out first with his feet. Not quite a prolapsed cord yet, but a few contractions away from it.

Krista - posted on 08/20/2011

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Exactly. I don't like this attitude that any time a doctor suggests a c-section, it's cause they're trying to make more money. Up here in Canada, women still get c-sections, and doctors don't get a ton extra for that -- if you look at the breakdown of costs, a c-section is $500 here. And yes, that is a lot of money to me, but to someone who makes almost $300K a year, it's not. So they're not doing them just for shits and giggles.

Dana - posted on 08/20/2011

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That's awful Mary. I'm always glad for your wise words, input and experience. I wish more people stopped and listened to you because I think you're right, we constantly see this attitude on here that Dr's don't know anything, they're out for more cash, they're afraid of law suits, a C-section is easier, etc... It's such an extremist point of view and quite misinformed.

Mary - posted on 08/20/2011

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When I first started working in OB, we still did vaginal breeches in my hospital (mid 90's). I would say, at that time, all of the practitioners, docs and midwives alike, were relatively experienced with them. While they were always more nerve-wracking, it never seemed like too big of a deal...until, within the space of one year, we had 3 babies die of head entrapment. The last one was, by far, the worst, as she was the receptionist for the OB who delivered her. She was known to most of the staff, and adored by this particular OB. It was absolutely soul crushing for the entire hospital (not to mention the woman and her family). Unless it was a case of twins, with baby A being vertex, we pretty much stopped doing them. This impacted not just the doc in question, but ALL of our practitioners. It just didn't seem worth the risk.



To whomever said that the worst that can happen is that they break the mother's pelvis to get the kid out - you are woefully wrong. The worst that can happen is that the head won't come out, your baby dies, and they have to shove the body back up and do a section to get it out. Sorry, but there is no way in hell that my "birth experience" is worth risking that. You could quote statistics at me all day long, and after seeing that just once, I never want to be a part of that again. I'd chose to be sliced open on a park bench without anesthesia before I'd attempt that.



It's also why, unless your practitioner is over 50 in the US, chances are that they are not skilled or experienced with a vaginal breech (and yes, that means midwives as well). I know that more than a few of have this unwarranted view that doctors are either lazy, uncaring, or just worried about their own bottom line (money or time)...but on this one, you are way the fuck off base. Any human who has been a part of a head entrapment would be hard pressed to continue to do them, when there is a safer alternative readily available. The reason the docs at my hospital stopped doing them had nothing to do with litigation or money; in the example I mentioned, there was no lawsuit, and that girl went on to have another baby that this same OB delivered (via section, as she did have a bit of PTSD, and would not even consider laboring again, even with a vertex baby). It was about the emotional trauma of watching a baby whose head is stuck die before your eyes. That experience stays with you forever.



I know this, because it has never stopped haunting me.

Stifler's - posted on 08/19/2011

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I would go c-section. But no matter what if I had another baby... I'd go caesarean. The recovery time was so much quicker (for me, maybe not for others).

Dana - posted on 08/19/2011

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In my case, I had a breech baby and delivered via C-section. Then in the midst of that they found out I had a bicornuate uterus. So, it is a good thing my doctor didn't encourage a vaginal delivery as that would have been really hard on my uterus and unsafe.

So really, you just never know. To me, it's not worth the risk.

Erin - posted on 08/19/2011

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I'm currently reading 'Pushed' by Jennifer Block, and have just finished the section on breech lol. She covers the fact that breech babies have historically been more of a problem. In the 1940s-1950s, about 1 in 20 died. But this was during the time of the 'assisted breech'... 'heavy anesthesia, manual pressure on the uterus, traction on the baby's body, and routine forceps to extract the head'... so is not a far representation of the safety of a physiological breech birth.

There was also a study (which has since found to be seriously flawed) published in 2000 that found a breech baby had a 3x greater chance of mortality during a vaginal delivery than it's vertex counterpart. This further solidified the general consensus among doctors that c/s is safer, even after critics tore the study apart and called for a retraction.

The biggest resulting problem with that is we now have a whole generation of doctors who have never even seen a vaginal breech, let alone delivered one. So faced with the choice between a vaginal breechwith an inexperienced practitioner and a c/s, I would choose the c/s. Things can, and do, go wrong with breech births. Especially when the attendant has no friggin idea what to do and starts pulling on the baby.

Like others said, frank breeches pose less of a concern than footling. And many breech-friendly practitioners will advice against vaginal birth if it's a first-time mother (primip).

So there is a lot to consider when deciding whether breech birth is 'safe'. We still have a few doctors around who do them (middle-aged or older), but we also don't have the hyper-litigious culture of the US. Fear of being sued has forced US doctors to practice defensive medicine, and nothing would look worse to a jury than a doctor losing a baby to a head entrapment.

[deleted account]

Yes, breech birth can be safe. But I had a c-section with my breech baby. There were a lot of reasons. Like Sarah M, my breech baby was undiagnosed. She apparently flipped between my last appointment and when I went into labor. We didn't know until I was 10 cm and ready to push. My water didn't break until I was ready to push, so the nurse couldn't feel through my sac. She was my first baby, and I was already at 10 cm, so there was no time to prepare for vaginally delivery...the doc and I chose c-section. He did try to manually turn her, but she wouldn't budge. Had we KNOWN she was breech, we might have made a different decision.

Jenn - posted on 08/19/2011

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No birth is 100% safe so a breech birth is even less so. I think it depends on whether it is the first birth, size of the baby and position of the baby. We tried to turn our oldest, to no avail. She was firmly sitting in my pelvis and after many lengthy discussions with my doctor, a very experienced OBGYN, we opted for c-section. I don't regret it a bit. She was healthy and that mattered most. My mother was frank breech and my grandmother said that delivery was the most pain she has ever experienced!

Tanya - posted on 08/19/2011

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With a midwife who is trained and experienced in breech birth? Vaginal birth is safe. SafER, I don't know, but usually c-section carries more risk than vaginal birth.


With an OB who has never seen a vaginal breech birth and would rather just do a c-section? I would NEVER attempt a breech vaginal birth!


There is a bit of an art to delivering breech babies vaginally. It certainly can be done, but if they get stuck, the attendant had better be well versed in the best positions to get the mother into in order to get the baby out.


Most babies' heads will fit through their mother's pelvis. If they do, in a breech vaginal birth, the worst-case scenario is that you have to break the mother's pelvis to get the baby out. And caring for a newborn with a broken pelvis wouldn't be very easy! For this reason, I don't know if I would have attempted a vaginal breech birth for a first baby. But, having had two babies vaginally with very large heads, I wouldn't hesitate to have a vaginal breech birth (with a midwife) if I were to get pregnant again.

Lady Heather - posted on 08/19/2011

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Yeah, I think there are a lot of factors you'd have to consider to decide if it's safe. I know my midwife has done plenty of breech deliveries, but she won't do them with all her patients. Last time I would not have been allowed because we weren't even sure if I could deliver vaginally to begin with (fortunately she flipped when labour started). This time my stubborn child is breech again. I'd consider a breech birth if my midwife said it was okay and if conditions were favourable.

Krista - posted on 08/19/2011

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It likely depends on the type of breech, as well as a whole host of other factors. If it's frank breech, then the risk of cord prolapse and head entrapment are lower than if it's a footling breech. As well, if the baby's head is hyperextended (where they're looking straight up), then there's a much greater risk of spinal cord trauma. This can be determined by ultrasound.

And of course, the skill of the obstetrician is a big factor. Some doctors are just not as comfortable or skilled doing vaginal deliveries of breech babies, and that's something that has to be kept in mind.

So it's POSSIBLE for a vaginal breech to be as safe as a c-section, but there are a ton of variables in place.

Merry - posted on 08/19/2011

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I've had two simple and uncomplicated vaginal births, both babies good sizes at 8 lbs each so idk, I don't have to decide what I'd do now but I feel like I'd prefer a vaginal birth.

Sarah - posted on 08/19/2011

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My youngest was an undiagnosed breech, so they only found out that she was once they'd burst my waters and I was in labour.
Once they found out, they gave me the choice to deliver naturally, but they also explained that there are risks involved and that it could be a more difficult birth.
As my eldest had been back to back which was a really traumatic birth for me (episiotmy, blood transfusion, in hospital for a week) I decided to go with the emergency C-section as I didn't really want to go through yet another traumatic vaginal birth, especially as this one COULD have been traumatic for the baby too.
Best decision I ever made!! I LOVED my C-section and recovered SO much quicker than with my vaginal birth, out of hospital in 2 days and no complications whatsoever.

I'm in the UK, so there was no question that they suggested a C-section for money.

I guess if a woman is confident that she could deliver a breech baby, and they had midwives/doctors/professionals/whatever that were confident too, then they should go for it. For me though, I don't think I'd risk it, I'm not very good at giving birth!

Kellie - posted on 08/19/2011

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Your a braver woman than me Laura! I'm lucky I was at the hospital, my daughter was "stargazing" and no amount of pushing was gunna get her out. I nearly needed an emergency c-section but luckily she turned with forceps.

For my "be prepared" brain and mental comfort I could never give birth at home, I've known people who have and it's been perfectly fine and I totally applaud you, but so not for me. I'm a chicken LOL

Nikki - posted on 08/19/2011

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I think the increased risk of a breech birth is greatest if it is a first birth, because the woman doesn't have a proven pelvis. You risk delivering the baby's body and then not being able to deliver the head, which would result in more intensive and dangerous surgery. I think it depends on the circumstances.

Merry - posted on 08/19/2011

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Yeah I'm hoping to do home births for any babies to come so I'd be upset if I had to have a csection since that's like dead opposite from a home birth. Breech is one of those fears I have had with both babies but both were head down :)

Kellie - posted on 08/19/2011

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Yeah she and the LO were lucky, his little foot was very blue for a while but no lasting damage (he's 9 months now).

I'm inclined to think that breach deliveries would have an increased risk of the cord getting caught up and getting in the way causing more damage than good.

But those are just my feelings, I'm not a Doctor, Nurse or Midwife.

Not something I'd thought about til I saw your OP. I like learning new things.

Merry - posted on 08/19/2011

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Yeah a prolapsed cord would be so scary. I'm mostly wondering cuz I've seen a few documentaries on tv where women do breech births and they always say how it's safe and stuff. I don't have much knowledge into it yet, just wondering.

Kellie - posted on 08/19/2011

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I think it would depend on the circumstances. My friends son was breach and she ended up with a prolapsed umbilical cord. So she was rushed into surgery for an emergency c-section with a midwives hand up her vagina from the time the prolapsed cord was discovered until the baby was delivered by c-section.

I'd have to research wether or not a vaginal breech delivery is just as safe but my personal thoughts would be that it's a harder way to deliver, placing more/bigger/unecesssary stress on Mother and Baby and that a c-section in this instance would be completely warranted and safer.

Your health care system in the States is way way WAY different to ours in Australia so I don't think money the doctor would get really comes into it here, our healthcare is free.

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