Tuesday, August 27, 2019

To remember the Louwen maneuver (shoulder grip rotation)...just follow the rainbow!

If you attend upright breech births, you may have used the Louwen maneuver (shoulder grip rotation). It can be tricky to remember which way to rotate first and how far around. So I came up with this illustration.

Remember: the baby follows the rainbow across the sacrum, then comes back to mama

(It's the same process in mirror image for a LST breech)

Read more ...

Tuesday, August 13, 2019

Manhattan Breech Workshop

After months of waiting (and a last-minute venue change), we are thrilled to announce the Manhattan Breech Workshop! It takes place at NY Open Center (near the Empire State Building) on Oct 26-27. To register: bit.ly/manhattanbreech


Read more ...

Wednesday, August 07, 2019

RCOG and SOGC estimates of term breech mortality

With the recent release of the 2019 SOCG breech guidelines, I created this updated graphic. It illustrates the likelihood of perinatal/neonatal mortality after vaginal breech versus planned cesarean section.
Using the RCOG's numbers, the *additional* risk of a vaginal breech birth, compared to a vaginal head-down birth, is 1/1000.

Here's another way of looking at it:
Baseline risk of mortality after pCS @ 39 weeks: 1/2000
+
Additional risk from last weeks of pregnancy & labor: 1/2000
+
Additional risk of a vaginal breech birth: 1/1000
=
2/1000
Ps, if you liked this post, would you please consider donating to Reteach Breech? Thanks to a matching grant, all donations will be doubled AND all perks are half-price! Donations are tax-deductible in the US.

https://chuffed.org/project/reteachbreech
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Sunday, August 04, 2019

Support Reteach Breech and double your donations & perks!

Exciting news--thanks to a generous matching grant, all donations to the Reteach Breech campaign will be matched AND all perks will be doubled.

For example, if you donate $25, you'll get access to the breech workshop videos (normally $50) AND your donation will be doubled to $50!

Other amazing perks you can get...

  • T-shirt for $30 (normally $60)
  • Onesie for $38 (normally $75)
  • Athletic t-shirt or flowy tank top for $50 (normally $100)
  • Linocut for $50 (normally $100)
  • Klean Kanteen insulated thermos for $75 (normally $150)
  • Maternity t-shirt + baby onesie for $100 (normally $200)
  • ALL THE THINGS for $200 (normally $400)

Donations will be doubled and perks will be half-price, up to $5,000 or until the end of the fundraiser, whichever comes first.

Donate today before this amazing offer runs out!


Read more ...

Wednesday, July 31, 2019

Prince Edward Island Breech Workshop

Register now for the Prince Edward Island Breech Workshop Sep 28-29. This is the only Canadian workshop offered in 2019. To register: bit.ly/peibreech


Thanks to a generous donation from the Coalition for Breech Birth, we are offering two scholarships to the workshop for Canadian providers: one for a physician/resident/medical student and one for a midwife/midwifery student. Any Canadian provider may apply; preference given to providers serving the Maritime provinces & Newfoundland.

To apply: Send an application letter to breechworkshop@gmail.com. Please state your province, qualifications, and how you plan to use the knowledge gained in the workshop in your community.

Deadline: August 14


Read more ...

Monday, July 29, 2019

Prince Edward Island Breech Workshop Scholarships

The Coalition for Breech Birth has generously donated funds to sponsor 2 scholarships to the Prince Edward Island Breech Workshop! Any Canadian provider may apply; preference given to providers in the Maritimes & Newfoundland.

1 scholarship is for physicians/residents/medical students
1 scholarship is for midwives/midwifery students

To apply: Send an application letter to breechworkshop@gmail.com. Please state your province, qualifications, and how you plan to use the knowledge gained in the workshop in your community.

Deadline: August 14


Read more ...

Monday, July 15, 2019

Please donate to "Reteach Breech"

My years of breech research and advocacy have finally come to fruition! Please donate generously to Breech Without Borders' fundraising campaign so we can reteach breech. We are raising funds to purchase two obstetrical simulators for our breech training workshops.

If you have ever benefited from reading my blog, following my children's births, watching my educational breech videos, or sharing my breech infographics, please donate today.

If you care about women's autonomy in childbirth, please donate.

If you care about reducing the cesarean rate, please donate.

And of course, please share widely!

I want to create a world where every provider has vaginal breech skills and where every woman can choose how her breech baby is born.

                  
Read more ...

Sunday, July 14, 2019

Madison Breech Conference: Envisioning Autonomy, Biodiversity, and Sustainability

Save the date for the Madison Breech Conference on Nov 9-10! The conference focuses on 3 main themes: autonomy, biodiversity, and sustainability in breech birth.

We'll be discussing barriers to providing breech birth, as well as solutions for providers and administrators. We'll be listening to providers share their struggles and triumphs in supporting breech birth in their various settings: from rural to urban, from family medicine to midwifery to maternal fetal medicine, from supportive hospitals to hostile hospitals. We'll learn about breech birth from a human rights attorney and from a journalist who writes about women's experiences of pregnancy and birth. And of course we'll be teaching breech birth, with hands-on simulation training and an emphasis on physiological breech birth.

This is a conference you don't want to miss! Stay tuned for updates.


Read more ...

Friday, July 05, 2019

Auckland, NZ Breech Workshop

Breech Without Borders is bringing four breech workshops to New Zealand in November and December. The first takes place in Auckland on Nov 25-26. It will be held at the Kawai Purapura Retreat Centre, just north of Auckland.

Click here to register.

The workshop costs $450 NZD ($350 for students) and includes 15 hours of instruction and hands-on practice. We have applied for continuing education credits through the Midwifery Council.

For more information about the workshops and instructors, please visit www.breechworkshop.com.


Read more ...

Monday, June 10, 2019

Western Pennsylvania Breech Workshop

Breech Without Borders is offering a breech workshop in western PA on Sep 21-22. The workshop is ideal for birth attendants in W/central PA, E/central Ohio, western New York, northern West Virginia, and western Maryland.

The workshop includes 15 hours of instruction and hands-on training. To register: https://breechwithoutborders.ticketspice.com/western-pa-breech-workshop

Optional NRP certification on Sep 20.

For more information about the workshop: www.breechworkshop.com



Breech photo credit: Karyn Loftessness Photography
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Sunday, June 09, 2019

Detroit Breech Workshop

Breech Without Borders is offering a breech workshop in Detroit on Nov 2-3. The workshop includes 15 hours of instruction and hands-on training. To register: https://breechwithoutborders.ticketspice.com/detroit-breech-workshop

For more information about the workshop: www.breechworkshop.com



Breech photo credit: Karyn Loftessness Photography
Read more ...

Saturday, June 08, 2019

Central Indiana Breech Workshop

If you live in Indiana, western Ohio, eastern Illinois, or northern Kentucky, please consider attending the Central Indiana Breech Workshop! It is located in the Indianapolis metro area and offers 15 hours of instruction and hands-on training.

To register: https://breechwithoutborders.ticketspice.com/indiana-breech-workshop

For more information about the workshop: www.breechworkshop.com



Breech photo credit: Karyn Loftesness Photography
Read more ...

Friday, June 07, 2019

Dallas Breech Workshop

Come to the Dallas Breech Workshop on Oct 9-10 at the Addison Conference Centre. We are approaching our registration cap, so act quickly to reserve your spot. To register: https://breechwithoutborders.ticketspice.com/dallas-breech-workshop

To learn more about the workshop: www.breechworkshop.com


Breech photo credit: Karyn Loftesness Photography
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Wednesday, June 05, 2019

Memphis Breech Workshop

Registration is now open for the Memphis Breech Workshop on Oct 4-5. Take advantage of early bird prices through June 30. Registration includes lunch and snacks both days.

To register: bit.ly/memphisbreech

Accommodations are available at the Mayberry Hill Homestead ($50/night per bed). Please contact LyndaHoskins@bellsouth.net to reserve.


Breech photo credit: Karyn Loftesness Photography
Read more ...

Monday, June 03, 2019

Prince Edward Island breech workshop

Are you a birth worker in PEI, New Brunswick, or Nova Scotia? Come to the PEI Breech Workshop on Sep 28-29. Registration is now open.



Read more ...

Sunday, June 02, 2019

Dover Breech Workshop

Breech Without Borders is bringing several workshops to North America and New Zealand in 2019! Our first workshop takes place in Dover, NH on August 17-18.

Ideal for midwives, physicians, and other birth workers in New England and southern Ontario.

This 2-day workshop provides 15 CEU contact hours (MEAC & ACNM). You'll receive both theoretical instruction and hands-on training with obstetrical mannequins. Space is limited and early bird pricing ends June 30. Wentworth-Douglass employees receive a 25% discount. 

To register: bit.ly/doverbreech

To learn more about the workshops, please visit www.breechworkshop.com.



Breech photo credit: Karyn Loftesness Photography
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Saturday, March 23, 2019

Breech love


Let's send some unconditional love to all those little breechlings with stressed mamas who have few or no options for a vaginal birth.

Let's demand that every hospital offering maternity care also offer 24/7 access to vaginal breech birth...because a mandatory cesarean violates basic human rights, legal rulings that uphold the right to refuse surgery, and medical ethics.

Let's teach midwives and physicians, in or out of hospital, how to do a vaginal breech. Standing or sitting. Kneeling or supine. Water or land.

(Linocut made by me...breech is always on my mind)


Read more ...

Friday, January 04, 2019

Is examining home breech outcomes problematic? A response to Hilda Bastian

After the publication of my article Breech birth at home, co-authored with Dr. Stuart Fischbein, we were invited to write a guest blog for Biomed Central. We wanted our paper to start a conversation about breech birth generally, and breech birth at home specifically. With access to vaginal breech birth in hospital settings nearly nonexistent in the United States, women who want to avoid a cesarean section often have no choice but a home breech birth. Some of these would choose a home birth even if a hospital option existed, while others would prefer a supportive hospital setting.

A few days ago, several people alerted me to a blog post objecting to the publication of our article. Written by Hilda Bastian, the post was titled The Dangerous Allure of Breech Birth at Home – and a Problematic New Paper.

If I had the chance to sit down and have lunch with Hilda, here are some thoughts I would share.

First, I am grateful that she took the time to write up her responses and to be so thorough with her bibliography. I am an academic, and I love long lists of references! She included several that I hadn’t looked at yet since they did not come up in my literature searches (“breech” and “pelvic presentation” were my primary keywords). I will add them to the lecture on home breech outcomes that I give at my breech workshops. A sincere thank-you for that. (To date, my current lecture references Mehl-Madrona 1997, Bastian 1998, Johnson 2005, Deline 2012, Cheyney 2014, Cox 2015, Fischbein 2015, Bovbjerg 2017, Gr√ľnebaum 2017, and Fischbein & Freeze 2018).

A slide from one of my breech workshop lectures.
Hilda critiqued us for only including 4 studies about home breech outcomes in our introduction. This was in part a deliberate decision as we had already far exceeded the normal number of references for a research article (many journals limit the number of references to 25-30). We chose to include those 4 studies as they had the largest datasets of home breech births.

When I give my lecture on home breech outcomes, I usually start it by saying, “If you are a home birth provider, this is going to make you very uncomfortable. The numbers do not look good.”

I am surprised by Hilda’s certainty that the question of breech birth at home has been answered for good. I don’t disagree that the existing literature shows poorer outcomes for home breech birth. But—and this is very important—we also found that these studies lacked information about nearly every aspect of a planned vaginal breech birth: training and experience levels of the birth attendants, selection criteria, labor management, maternal motivations for choosing a breech at home, or local hospital options for a breech presentation. None of these factors were measured or studied.

In other words, all we have are raw numbers: X number of breech babies had poor outcomes. We don’t know what caused those higher levels of bad outcomes. With the existing research, we could only speculate: Was it lack of adequate experience with some of the attendants? Lack of ultrasound to confirm head flexion? A mother insisting on having her baby at home and the midwife agreeing to honor her autonomy despite less-than-optimal circumstances? Undiagnosed fetal anomalies? Problems with hospital transports?

Our study is significant because it was the first to begin answering these questions. We know the provider’s skill level, selection criteria, and labor protocols. We know what equipment was present at the birth and the training of the entire birth team. We know why women chose home birth and what the local hospital options were (very few, if any, which led women to seek Dr. Fischbein’s services).

Yes, there were some poor outcomes, and we gave information about the circumstances and sequelae surrounding each one. Although we didn’t have complete medical records for some of the hospital transfers, the parents personally transmitted information about their hospital stays to Dr. Fischbein. We reported all adverse outcomes whether in hospital or at home. (The author suggests we might have left some unreported.)

There was one brachial plexus injury (ongoing at 6 months of age) that occurred at home after a terminal bradycardia and subsequent maneuver to help the baby be born quickly. The other 4 adverse outcomes all occurred after the women had transported to a hospital in stable condition due to stalled labor. 3 of the 4 were neonatal morbidities; they occurred with a receiving physician who offered augmentation and vaginal delivery with forceps and vacuum extraction if needed. One neonatal death occurred when a woman was admitted for a cesarean due to stalled labor, and the surgery was inexplicably delayed for more than 2 hours.

From an intention-to-treat paradigm, all of these poor outcomes would be attributed to home birth as that was the original intent at the beginning of labor. However, Dr. Fischbein and I believe that the circumstances that led to poor outcomes in the hospital transports were not primarily related to the planned location of birth.

I participated in the first two Home Birth Consensus Summits in 2011 and 2013. One area of consensus was that hospital transports need to be seamless. When women fall through the cracks, they and their babies suffer the consequences (as we can see with the one neonatal demise). The solution isn’t to outlaw homebirth, but rather to work on better collaboration and communication so women can move from home to hospital with loving support, professionalism, and respect from both the transporting and receiving care teams. Please refer to the summit's Best Practice Guidelines.

I don’t expect everyone to support home birth with a breech presentation. However, I want to keep dialogue open. I worry that the author’s rhetorical techniques stir controversy rather than engage productively in making birth better for women with breech babies. For example, the author used click-bait titles (“the dangerous allure of breech birth at home”), chose emotionally-charged language (“dangerous and misleading,” “go off the rails,.” midwives who are filled with “hubris” and involved in the “heady stuff of euphoric legend-making”), and misrepresented my qualifications (she says I am a “doula and midwife’s assistant” and neglects to add that I have a PhD). To give Hilda credit, I don't think this last omission was intentional.

I’d like to step away from the fiery rhetorical flourishes and instead talk about the reality of what’s happening on the ground. Right now. With women in California or Oklahoma or Connecticut who are 39 or 40 weeks pregnant and have just discovered their babies are breech and have no options but cesarean at any hospital, anywhere.

To quote from the musical Hamilton, we have "three fundamental truths at the exact same time”:
  1. Hospitals in the USA continue to refuse to offer vaginal breech birth. Some even ban it despite having providers willing to attend vaginal breech births.
  2. Women continue to find a mandatory cesarean unacceptable.
  3. Breech is happening at home.
We can stay in the stratosphere of rhetoric and idealism, bemoaning the dangers of home breech birth. But I prefer to stay firmly rooted on the ground. It’s pointless to argue that home breech birth shouldn’t happen when there are no other alternatives offered. And none foreseeable in the near or distant future, either. ACOG certainly hasn’t done more than give watered-down lip service to vaginal breech birth. Even the SOGC’s vigorous support of vaginal breech training and re-education has done little to move the needle in Canada.

So that leaves us with this reality: breech is happening at home. How safe is breech birth at home, and can it be made safer? Our study only begins to answer those questions. The solution isn’t to stop asking the questions altogether because ACOG considers breech at home an “absolute contraindication.” (If we took ACOG at their every word, we wouldn’t be having any home births at all!) Instead, we need to keep seeking out more information. We need larger datasets of planned home breech birth with skilled attendants.

I am thrilled to announce that I will be working on one such dataset in the near future: over 550 vaginal breech births with a single home birth midwife. I know of another team currently doing data entry with another midwife’s breech outcomes (again, with numbers in the several hundreds). Between these two datasets, we might have 1,000+ home breech births to analyze. This far exceeds any of the largest datasets on home breech we have so far. Grunebaum’s birth certificate data (2017) included 553 breeches. Johnson (2005) had 80. MANAStats 2.0 and 4.0 combined had 539 breeches (Bovbjerg 2017). And unlike these other studies, we can account for numerous variables.

More importantly, I am on the ground actively training providers—midwives or doctors, home or hospital, anyone is welcome!—in vaginal breech birth. Under the umbrella of my nonprofit Breech Without Borders, I provide a full day of academic lectures on term breech outcomes (both home & hospital), maneuvers, normal & abnormal mechanisms, and nomenclature systems. An experienced physician or midwife colleague then provides another full day’s worth of instruction and hands-on training. I am optimistic that, with good training, we can make vaginal breech birth safer and more satisfying in any setting. I am disappointed that, to date, midwives have outnumbered physicians, residents, and medical students more than 50:1 in our workshops (and not for lack of invitations on our part!).

No matter if you vehemently disagree with breech birth at home, wouldn’t a policy of harm reduction (providing as much training & education to the people who are actually attending breech births) be better than simply stating it shouldn’t happen or, even worse, attempting to outlaw it (which will lead to some women choosing unassisted birth rather than being forced into a mandatory cesarean)?

I’ve gone on long enough. Dr. Fischbein and I both feel that our paper and our blog post speak for themselves. Take a minute to read them, and then come back and share your thoughts.

And more importantly, get out into your community and start demanding that your local hospitals offer vaginal breech births! Breech Without Borders will bring a vaginal breech workshop to any community that wants it.

Dr. Rixa Freeze, PhD
Read more ...

Saturday, December 15, 2018

Kansas Breech Workshop Sep 14-15, 2019

Breech Without Borders is pleased to announce a breech workshop next September in Rose Hill, KS!

Read more ...

Tuesday, December 11, 2018

Call for 2019 breech workshops

Who wants a breech workshop in their area in 2019?

Dr. David Hayes and I are thinking of blocking off a month or two in 2019 (probably August & September) to teach breech workshops around the country--and farther afield if you want us to come! Dr. Hayes is already getting inquiries from pregnant clients due in August, so he needs to decide relatively soon when to stop accepting clients.

Dr. Hayes is an obstetrician with Harvest Moon Women's Health who attends home births in Asheville, NC. He has experience attending breech in both hospital and out-of-hospital settings.

If you would like us to come teach a 2-day breech workshop near you, please let us know ASAP. We'd love to come teach breech in your area!

Your obligations:
  • find a venue
  • organize food/drinks
  • advertise
Our obligations:
  • set up online ticket sales
  • advertise
  • teach
  • provide ACNM & MEAC CEUs (we are also willing to apply for CMEs if your institution can help with that process)
We will reimburse all of your expenses such as venue rental, food, etc. After covering our travel expenses & speaking fees, all leftover proceeds will be donated to Breech Without Borders.


Read more ...

Monday, December 03, 2018

Hebrides midwifery documentary by Honey Bee Pictures

I'm excited to share a guest post from filmmakers Jacob ; Honey Hesmondhalgh-Scott of Honey Bee Pictures. They are crowdfunding to support their newest documentary project

Off the West Coast of Scotland lies some of the most remote islands in the UK, the Outer Hebrides.
With a rich cultural history, beautiful landscapes and a peaceful way of life, many thousands call these islands their home.

Living here comes with its own set of joys and challenges, but how does remote and rural midwifery impact a person’s pregnancy?

Especially if you’re unable to give birth on the island you call home.

A new feature documentary, currently in production, explores exactly this. It gives insight to the complications of pregnancy and birth in the Outer Hebrides and forms a portrait of the only midwife on the remote Isle of Barra.


Hebrides Midwifery Documentary - Trailer from Honey Bee Pictures on Vimeo.

On the Isle of Barra, Veronica, the island’s only midwife, expects 10-15 births per year, from a population of around 1,000. However, with no childbirth facilities on the island, all women leave at 38 weeks and travel to a hospital of their choosing to deliver. Meaning they could be away from home, away from family, for up to one month.

This upheaval can cause emotional, financial and physical stress. Though the NHS does provide some reimbursement, this never covers the costs in reality of moving a family away from their home.

The subsequent communication between hospitals and health boards, the crucial timing of the trip, the wellbeing of child and expectant mother, all falls to Veronica.

Previously a senior maternity co-ordinator in Lanarkshire, Veronica has been a midwife for 30 years.
Having dreamed of one day living and working in the Hebrides, 18 months ago, this became a reality and Veronica stepped back into community midwifery.

On an island with no obstetricians, gynaecologists, ultrasound equipment or labour ward, a tremendous amount of responsibility lies on veronica’s shoulders.

The Film

This independent documentary creates a striking portrait of life in the Western Isles--travelling with couples off the island across their pregnancies, flying out from the only airport in the world that lands on open beach, and learning first hand the realities of starting a family in the remote and rural Western Isles.

We hope to screen the film all over Scotland and the UK, in educational settings for universities and hospitals, international film festivals and online streaming platforms.

In other lovely news, Veronica has just been nominated for the Scotland Maternity and Midwifery Festival Achievement Award in recognition of her contribution to maternity services.

If you’re interested in supporting the film and keeping up to date with the production, we are crowdfunding to allow us to keep making the film.

If you can, please help by donating, sharing and spreading the film to your family and friends
Click here for the link and here for my Facebook page, where the film can be easily shared

To contact the filmmakers, you can get in touch through our website
www.honeybeepictures.co.uk.

Read more ...

Sunday, November 25, 2018

On your marks, get set, bake!

Over Thanksgiving weekend our kids watched several episodes of The Great British Baking Show. This inspired a round of baking today. We made a party bread stuffed with pesto, roasted butternut squash & onions, pine nuts, & sheep cheese feta.

Then we had a judging contest with Eric filling in for Paul Hollywood.

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Friday, November 16, 2018

My interview with Tracy Donegan of Gentlebirth

Listen to my interview about breech birth with Tracy Donegan! Tracy trained as a midwife in Ireland and currently runs GentleBirth.

The podcast is also available here on iTunes.




Read more ...

Friday, November 09, 2018

Breech birth at home: BMC series guest blog

Dr. Stuart Fischbein and I were invited to write a guest blog about our recent article in BMC Pregnancy & Childbirth, Breech birth at home.

Here is an excerpt from my part of the blog:
We are doing women enormous harm by taking away their bodily autonomy when their baby is breech. In theory, state and federal laws support the principle of informed consent and informed refusal, and nearly every hospital has a patient’s bill of rights that ensures consent before medical procedures. Yet we throw these legal and ethical rights away when a baby turns bottom-first.

We can do better. We owe it to the women we care for. Women should not be forced to leave the hospital in order to exercise their right to informed consent. Every woman with a breech baby deserves access to skilled providers in her own community who can support her, whether she chooses a planned cesarean section or a vaginal breech birth.
Read the rest of the blog post here.

Read more ...

Thursday, November 08, 2018

Saturday, November 03, 2018

Asheville NC breech workshop (Dec 1-2)


A 2-day workshop on vaginal breech birth with Dr. Rixa Freeze, PhD and Dr. David Hayes, OBGYN of Harvest Moon Women's Health.

ACNM & MEAC CEUs available (7 contact hours / 0.7 CEUs)

If you are on call or cannot come in person, the event will be livestreamed and recorded.

Saturday, Dec 1:

  • 9 am: Evidence on Term Breech Since the 2000 Term Breech Trial (Dr. Freeze)
  • 11 am: Breech Maneuvers from 1609 to the Present (Dr. Freeze)
  • 1 pm: Lunch
  • 2:30-6 pm: Breech skills and hands-on simulation training (Dr. Hayes)

Sunday, Dec 2:

  • 9 am: Breech Nomenclature (Dr. Freeze)
  • 10:30 am: Discussion/Q&A (Dr. Hayes & Dr. Freeze)
  • 12 pm: lunch
  • 2-4 pm: Breech birth at home (Dr. Freeze)


Drinks & snacks provided.
Read more ...

Wednesday, October 31, 2018

Happy 12th birthday Zari + Halloween pictures

12 already...


Zari was a spy...


Ivy was Poison Ivy...



Dio was a bat...


Inga was the Tooth Fairy (her name, not sure how this costume has anything to do with teeth!)

Who knows what I was...but at least I finished a skirt that I had started 6+ years ago


Read more ...

Wednesday, October 24, 2018

Breech birth at home (Fischbein & Freeze 2018)

After being under consideration for a year, our article on breech birth at home was finally published! Dr. Stuart Fischbein and I analyzed the results of 60 breech and 109 cephalic pregnancies under his care. Most took place at home and some in a freestanding birth center.


The article is free to download here: https://rdcu.be/8Zv1

We chose to pay for open-access publishing so that our article would be accessible to anyone free of charge. If you'd like to help support our work, please consider donating at our GoFundMe page.
Read more ...

Tuesday, September 18, 2018

Vaginal breech workshop in Decorah, IA Oct 13-14

Announcing a Breech Workshop in Decorah, IA on Oct 13-14! Please spread the word so we can re-teach breech.

I will be giving 4 lectures: evidence on term breech, breech maneuvers, breech nomenclature & risks/outcomes, and breech birth at home.

We have also two fantastic instructors for the hands-on skills portion. Cynthia Caillagh, with experience attending over 550 breech births, and Dr. David Schwartz, a family practice physician in Waukon, IA.

Livestreaming will be available if you cannot come in person or if you get called away to a birth.

ACNM & MEAC CEUs available.

Scholarships available (priority for single parents & LGBTQ birth keepers)

Click here to register


Read more ...

Friday, September 07, 2018

What freediving taught me about neonatal resuscitation

This semester I am teaching a class with the theme "Exploring the Limits of the Human Body." We are currently reading Deep: Freediving, Renegade Science, and What the Ocean Tells Us About Ourselves by James Nestor. This book is a fascinating narrative that combines ocean exploration, marine biology, competitive and research freediving, and dormant human abilities that originate in our deep oceanic past (the mammalian dive reflex, magnetoreception, and echolocation).


When freedivers experience a blackout--usually near the surface at the end of their dive--they still remain responsive to sound. After pulling the unconscious freediver to the surface, the safety team will call the diver by name and tell them to breathe: "Breathe, Alexy, breathe! Breathe, Alexy, breathe!"

~~~

From my time in the home birth world, I often heard midwives talking about how they involve parents in neonatal resuscitation. A common practice is to have one of the parents speak to the baby and encourage them to breathe.

I had always categorized this practice as a nice idea. It certainly wouldn't hurt, right? In fact, I did it instinctively when Inga was born; she lost color and tone after about 30 seconds and needed mouth-to-mouth. While I was resuscitating her, I was talking to her and encouraging her to breathe.

However, I never thought that there was a scientific or physiologic reason for calling the baby by name and telling them to breathe--until I learned about freediving. Even when all of their other senses are offline, a blacked-out freediver will still respond to sound.

~~~

Calling a baby by name and telling them to breathe, especially when done by a familiar voice, isn't just fluffy woo-woo. It's part of our basic physiology.

This was a lesson in giving more respect to the instinctual or "homespun" practices that have evolved with midwifery and home birth. How many other traditions have yet-to-be-discovered science behind them?



Read more ...

Wednesday, July 18, 2018

Ivy's nursing party

Every time one of our children decides they are done nursing, we have a nursing party. We make or buy a cake, we nurse one last time, and then we eat the cake!

Zari was 3 1/2 and chose a strawberry & whipped cream patisserie (we were in France at the time).

Dio was also close to 3 1/2 and wanted a Lightning McQueen cake. His wasn't fancy, but he loved it.

Inga was totally done right at 2 years. Not at all interested in nursing even after I had Ivy and was producing tons of milk. I made her a chocolate cake with blackberry frosting.

Ivy has nursed the longest of everyone, several months past her 5th birthday, probably because I didn't have any other babies :) Finally she decided that she was ready for her nursing party.

So yesterday, Ivy dressed up in one of her favorite outfits, brushed her hair, and placed her barrettes in rainbow order. We walked to one of my very favorite patisserie shops, Lac. We each chose our favorite patisserie. She walked home oh-so-carefully carrying the fancy box tied up with a ribbon. We nursed one last time--the last time in my entire life! I'm going to cry! Then we ate our "nursing cakes."


I've been breastfeeding for around 11 1/2 years straight, ever since Zari was born. I'm sad and happy at ending this part of my life.

Read more ...

Sunday, June 24, 2018

These are my hours

These are my hours. Let them be hard. I’ll ask for what I need.


This is one of the few lines of narration in the entire documentary These Are My Hours. Filmed entirely during one woman's labor, it is the first of its kind. I'm not one to use hyperbole, so when I say that this film was revolutionary and ground-breaking and magnificent and shattering, I mean every word.

The cinematography was stunning, capturing angles and moving shots that would have been nearly impossible to choreograph--even to imagine. And let's not forget the key reason behind this film's success: Emily Graham. Her expressive face and body. Her self-monologues that range from soulful to comedic. Her deep physicality and instinctuality. Her ability to make me feel like I was there, not just watching her but there, inside her body, living the experience.

I loved that the film didn't end right at the baby's birth. Instead, we watch Emily adjust to her new body and come back to herself. We see that birth is a process with an ascent, a peak, and a descent. All three steps require navigation and integration. The descent can be just as beautiful as it has the weight of the entire experience behind it.

The filmmaker had up to 3 cameras operating simultaneously, yet I never once felt like anyone else was in the room. That was a gift and a skill on both the filmmaker's and Emily's part. The music was minimal but exceptionally powerful. And some of the scenes still take my breath away when I think about them. I won't spoil the surprise here, other than to say that you ought to watch the film. Now. It's worth every penny. 

These Are My Hours is not a documentary about giving birth--it is birth. It follows Emily Graham through her labor, birth, and immediate postpartum. Or rather, we journey with her, inside her, as part of her. Besides a handful of narrative sentences and Emily's labor monologue, the documentary is almost entirely wordless. Birth is a process that transcends language and involves all of the senses, so the film's focus on the bodily experience and the near absence of language, interpretation, or commentary was fitting. I still struggle to find words adequate to describe the experience of watching These Are My Hours--a testament to the documentary's success.

As I watched this documentary, I realized: birth can speak for itself. It needs no champion or interpretation. We just have to be willing to listen.

Disclosure: I was not paid to write this, and I purchased access to the film myself. 
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Friday, June 01, 2018

Aug 18-19 Breech Workshop in Auburn, WA

Come to the Aug 18-19 Breech Workshop in Auburn, WA sponsored by Dr. Rixa Freeze, Breech Without Borders, and the Washington Alliance for Responsible Midwifery (WARM).

CEUs will be available (ACNM approved; MEAC applied for).

If you can't come in person, you can livestream the conference. We will also be recording and offering the workshops online.

I am presenting four lectures on Aug 18th, mostly theoretical/informational. Aug 19th will be taught by WARM and will focus on hands-on skills and applied practice.

Online registration here.



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Wednesday, May 09, 2018

Obstetric violence--where #metoo births birth

Obstetric violence is a real thing. It's a form of physical and sexual assault. It comes in many forms--from little things like clamping the cord when the mother has specifically said "no," to big things like non-consensual episiotomies or cesareans. I've seen it happen as a doula, and I've written about it in my PhD dissertation.

This recent article by Sarah Yahr Tucker knocks it out of the park: Doctors Frequently Abuse, Coerce, and Bully Women in Labor, Doulas Say.


If you want to make a difference, please donate to the "Mother May I?" documentary. If you donate today or tomorrow, a generous donor has offered a $5000 matching grant. Only 6 days left to fund the documentary!
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Tuesday, May 01, 2018

Announcing...Breech Without Borders

I'm excited to announce a new nonprofit initiative called Breech Without Borders (www.breechwithoutborders.org).

Breech Without Borders is an organization dedicated to disseminating knowledge about breech pregnancy and birth. It helps information cross linguistic, geographic, and knowledge borders by:

  1. Translating existing material about breech into multiple languages
  2. Supporting breech research, publication, conferences, lectures, and training workshops
  3. Making information about breech more accessible and understandable to both health care providers and to the public


Our website is a placeholder site until we can get a professionally designed site created. We already have a few translations done in French, German, and Dutch.

If you have a skill that you would like to contribute to Breech Without Borders--illustration, graphic design, translation, accounting, grant writing, etc--please get in touch with me.

Here are a few things we need help with specifically:

1. Someone to serve as Treasurer on the Board of Directors--preferably with accounting experience and/or familiarity with the financial requirements of US nonprofits.

If you can help in this capacity but don't want to be on the Board, I'd love you bring you on as an adviser to the Treasurer. (We have one volunteer already for the position, but she isn't familiar with US nonprofits, so I'm still open to finding a person with the right background).

2. Someone with medical illustration skills. I have several projects that need a series of illustrations.

3. Translations! We can always use more volunteer translators.

I'm in the process of writing the articles of incorporation and registering the nonprofit with state & federal governments. I'm really excited to get this project started!
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Monday, April 30, 2018

Illustrations of the breech mechanisms from a 1908 French textbook

This textbook by Farabeuf and Henri V is over a century old, but the illustrations are still some of the best I've ever seen. The attention to detail, the lifelike appearance of the fetus...beautiful.

These are the complete set of illustrations from the chapter on the mechanisms of breech birth. There are other chapters on how to diagnose type of presentation by touch, interventions (maneuvers), and how to perform but full & partial breech extractions.

To reflect today's increased interest in upright breech birth, I have rotated some images to keep the maternal spine consistently upright.

















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