# stargazer breech?



## elanorh (Feb 1, 2006)

I've been wondering, having read Goer's book - she states that absolutely all stargazer breech babies must be delivered by c/s.

Looking at the pictures - it looks like a stargazer just has his/her head tipped up. Couldn't any breech babe, during labor, decide to do this? And, until nearly the end, couldn't they decide to tuck their head back down against their chest for safe passage, too?

I'm confused about this ....


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## BensMom (May 4, 2002)

I dont know but I wondered the same thing. When I was trying for a breech vag delivery, the OB confirmed that she was frank breech with a tucked chin, in order to make sure he would attend. I asked if the chin thing could change and he said no. Pretty definitively. But I was thinking like you, how hard would it be for a baby to move their head?

Hopefully someone else will chime in.


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## fireweed (Nov 27, 2007)

I, too, am wondering. Mine has a tucked chin, but is one leg frank, one leg footling, and I'm hoping she moves into a full frank position.


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## notjustmamie (Mar 7, 2007)

I'm in a research mood tonight, so I thought I'd investigate this a bit.

Stargazers are breech babes with a hyperextended head (a measured angle of more than 90°--I couldn't find a specific reference to what angle they were measuring, but I'm guessing it's from the chin, down the neck). Nobody seems to have studied this more recently than the late 70s and early 80s, but they determined at the time a significant proportion of vaginal breech stargazers (near 75%) sustained cervical spine injuries.

Study abstracts:
Hyperextension of the fetal head in breech presentation: radiological evaluation and significance (1976)
Hyperextension of the fetal head in breech presentation. A study with long-term follow-up (1981)
Neonatal fetal death following cesarean section secondary to hyperextended head in breech presentation (1983)

The only thing I really notice is they don't seem to indicate (at least in the abstracts) what the docs may have done to contribute to these poor outcomes. This article on Breech Delivery (from eMedicine) describes an awful lot of pulling and twisting. I'm not a birth professional, but it was my understanding that the "trick" to breech births was to mostly leave them alone (as noted on the Association of Radical Midwives site).

Who knows what the "real" numbers may be, but given that a c/s appears to virtually guarantee a better outcome in this particular case, I could see why just about everybody recommends it.


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## hapersmion (Jan 5, 2007)

It's too bad there's no good info. I agree with the PP that to really know the risks accurately, you'd have to study breech births with smart attendants who knew not to pull on the baby. It would also be important to know how many c/s babies STILL sustain the same spine injuries as they are pulled through the c/s incision - because I recall reading that babies are still injured in that way in breech c/s births.

If I had a stargazer, I would make them do an ultrasound right before pushing to make sure the position hadn't changed, before I consented to a c/s, I think.


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