Last spring, I had the pleasure of meeting Dr. Mayer Eisenstein, a physician who has attended home births in the Chicago area for several decades with HomeFirst. He worked with Dr. Gregory White, also with HomeFirst and author of the manual Emergency Childbirth used by police officers and EMTs.
While we were talking, Dr. Eisenstein told me of a simple criteria for predicting whether or not a vaginal breech birth will develop difficulties. He learned this when he was a young physician from Dr. Frank O’Connell, who was a senior obstetrician at St. Francis Hospital in Evanston, IL. Dr. O’Connell learned it from his father, also an obstetrician, who had worked as the Chair of Obstetrics starting in the late 1950s or early 1960s.
Rule #1: If the presenting part is at a positive station at 5 centimeters dilation, there is an overwhelming probability of an easy birth, irrespective of what part is presenting (foot, knee, butt) and irrespective of parity. In other words, it is just as true for primips as for multips, just as true for footling breeches as for frank (butt-first) breeches.
Rule #2: If the presenting part is at negative station at 5 centimeters dilation, there is a significantly higher probability of a difficult birth, irrespective of the presenting part or of parity.
These criteria are more accurate in predicting easy births than in predicting difficult ones. In other words, a women may still have a straightforward birth when the presenting part is at negative station, but it is just much more likely that difficulties will arise.
Dr. Eisenstein and some of his medical students reviewed over a decade of their records to see if this held up with the breeches they had attended. In over 100 breech births they had attended, the rule held true in all the cases.
Dr. Eisenstein added that it should be blatantly obvious at 5 centimeters that the presenting part is at positive station (this does not include zero station, only true positive station). No guessing.
Dr. O’Connell’s father also had another rule: “The sign of a good obstetrician is how few cesarean sections they do.” I like that one!