Wednesday, April 16, 2008

A hands-off breech birth

Lisa Barrett (a UK-trained midwife now living in Australia) recently wrote another post about breech birth, with an amazing video of a totally hands-off footling breech birth.


  1. Beautiful, beautiful, beautiful!! Thank you SO much Rixa and Lisa and the sweet family for sharing this! I've never actually seen a breech birth (go figure, I work in a hospital). This was so amazing!

  2. That was simply the most amazing thing I have ever seen.

    I want to thank you for this blog. I have a lovely 5 month old daughter, sadly I went into the hospital thinking I could still have the birth I DESERVED and wanted and ended up with pitocin, an epidural, a 2nd degree tear that didn't heal right and I am going for a surgical consult at the end of the month to repair it.

    I will never give birth in another hospital again.

  3. AAAAAAAAAAAHHHHHHHHH!!!!!!! That was completely wonderful!!!!

  4. Thanks Rixa for getting this to a wide ordinance. I am sad that we have so much fear surrounding breech. It is really like any other birth. Some are amazing and some need help. Pity we can't see it as such.

    Love your blog it is comforting to know that all over the world there are people who believe in birth.

  5. Isn't it true that some women are better candidates for breech birth than others? If you are condoning breech birth. Encourage woman to get all the facts. All the statistics. Remember if you don't know both sides to an argument, you don't really know the argument.

  6. And I have seen a few breech births in the hospital. Especially the second twin is a good candidate. Also one of my Doctors has recently done a vag breech because the Mom came in fully and pushing. Some other Doctors would have C-sectioned her but he thought "Baby will be out by the time I get into the OR." He was right?

  7. Isn't it true that some women are better candidates for birth than others regardless to which way up they are.? Women I birth with are up to date with all the facts surrounding birth and all the research. You are 4 times more likely to die and so is your baby with a birth head or breech with an experienced practitioner. I don't think that doctors DO any birth, women birth babies.
    Remember if you come from a position of fear it won't matter what the argument is.

  8. sorry I left out the vital word Ceasarian section from my previous post.

    Just to add. Condoning is a patronising word. I support women in their choice of birth. Check the NMC circular on the woman's right to homebirth. It backs up the woman's rights, and the midwife's duty to support her.

  9. "You are 4 times more likely to die and so is your baby with a birth head or breech with an experienced practitioner. I don't think that doctors DO any "

    Where are you getting this statistic? Also You are in Austrailia and I am in New England. Things are different. Very different.

    The word Condoning is not a condesending word. You are adding meaning to my words that I am not intending.

    " Women I birth with are up to date with all the facts surrounding birth and all the research."

    Lisa with all due respect I feel this is hard to believe if you cannot get your hands on a research paper as you had told Doctor Amy. And you needed to be told the difference between a screening test and a diagnostic test. If we have 95% false positive, we don't use that test.

    My question was not meant to insult you or make you defensive in your practice. I am concerned about Homebirthing Breech babies and wanted to know what you tell the mother about risk involved? I want to know what you think about the risk involved.

    Just telling me "My woman are fully informed" does not tell me what they have been told and that is what I am asking.

  10. This is a different subject but I think you'll find Dr Amy said it was meant to be inaccurate in her comments.
    here they are
    "To recap, claiming that a screening test is not highly accurate is simply stating the obvious. They are designed that way deliberately, and they are designed that way for a very good reason. It is the diagnostic test that must be highly accurate, not the screening test"

    Only the abstract of the paper she mentioned was free the rest was for pay only in Australia, please pass it on if you have a copy. it said 75% detection rate which is 25% miss rate and they had a 5% false positive. I think the article in the paper,(and not me personally as you seem to suggest) said 40% were missed. Seems to be pretty accurate to me.
    I don't need to be told the differences in any test. It is hardly my fault if Dr Amy loves to insult people. Looks like you do too.

    All birth is a risk. Obviously clients who chose homebirth are well informed. Women who decide to birth a breech at home are totally aware of risk versus advantage and so am I. I think that there is less risk with a physiological birth than there is with a medicalized birth. I also think if a breech labour is not progressing it is better not to try and medicalise it in any way but to have a c/s as the last resort.

    I don't feel defensive of my practice in any way. Have you ever been to a breech homebirth? Saying the women I birth with are fully informed is enough, that is unless you are some nurses board official that I don't know about.

    It is always different to hear the medical perspective on birth. I had no idea that personal degradation was part of this blogger system.

    Sorry that you think I've made up the c/s risks here are some links
    A quick summary by Olubusola Amu, Sasha Rajendran and Ibrahim I Bolaji,
    BMJ 1998;317:462-465 ( 15 August )

    "Caesarean sections are not without complications and consequences. Maternal risks in the short term include haemorrhage, infection, ileus, pulmonary embolism, and Mendelson's syndrome. The prevalence of hysterectomy due to haemorrhage after caesarean section is 10 times that after vaginal delivery, and the risk of maternal death is increased up to 16-fold.

    As a midwife yourself it's hard to believe that you would put 100% faith in a doctor, but have little or no faith in a midwife who births quietly and gently with women however they wish.

  11. change the course of this discussion momentarily here... I would like to highlight those words of encouragement Lisa had for the mom; as well as point out the whole atmosphere of quiet calm. It does mean a world of a difference for the likelihood of a good outcome. (No, I don't have studies that show this so take it or leave it.) Practitioners who work in mainstream settings, understandably, view births like this with a sizable baggage of skepticism. So I just want to say: the serenity is beneficial, the trust (as manifested by hands off) is beneficial, the intimacy between caregiver and mother is beneficial, the mother's confidence is beneficial, her being fully conscious, mobile and perceptive of all the sensory input from her body is beneficial for a good outcome. I believe Lisa when she says that her clients know the consequences of potential catastrophic complications of breech birth; with the benefits of excellent support and hands off breech, her mothers have the best possible odds that they won't occur, and with that, they can be fully informed to decide whether the risk for them is acceptable.

  12. " Obviously clients who chose homebirth are well informed. "

    This is not obvious to me when I meet women who have been at home for 3 days ruptured, have a temp of 101.4 and pus coming out of their uterus. But I do seek to understand what drives them.

    My goal here is not to change your mind. Perhaps you can enlighten me. That I would be grateful for. I ask for studies and research because that is what I base my interventions on. What you base your interventions on may be intuition, it may be shamic chanting. I don't know unless you tell me.

    I don't doubt that in Austrailia you " are 4 times more likely to die and so is your baby with a birth head or breech with an experienced practitioner. "

    This I don't base it on any scientific evidence. I base it on the horrific surgical techniqe many of my coworkers have seen in Austrailian Hospitals. In your case you may very well be better off at home than in the hospital.

    However, if I make a claim, a medical claim, I should be able to back it up with where I got that information. Even if you give me a text by Ina May Gaskins, at least I then know where you are getting your information. And don't you think my patients deserve to know where I am getting my medical information? I think they do.

  13. If you have ever met a woman with ruptured membranes for 3 days and puss coming out of her uterus I would be interested to get in touch with her!!!!

    Even though I no way endorse what happens in Australia. ( It's not my home country) I understand from the figures that the section rate is lower than it is in America. Where exactly did your co worker see these horrific things?

    As a homebirth midwife I don't do interventions. I have been a midwife for over 20 years. I am wondering why I would need to quote Ina May or is it I have to write a book to be heard and understood. Or be 70 years old. Better still I could be a General Practitioner, specialist in nothing.

    If I ever make a medical claim I'll let you know but up to date I have only ever made midwifery claims. Medical claims are for medics.

    As I said in my previous comment. I missed out the section bit. It should have read you are more likely to die from a section than from a normal birth head down or bum down. That is not just in Australia but anywhere in the world. Developing countries obviously being the worst.

    The onus is not on me or anyone else to educate you but for you to educate yourself. As a midwife being "with woman" is you title and your role. To hold the space and protect her from harm.
    Your language is harsh, you see women as patients and feel ownership on what you would allow or disregard. It's not research and evidence you need but a look at humanity.

  14. Okay everyone, enough arguing here. Let's focus back on the original video, which, as Judit commented, was pretty fantastic. I agree that if you're going to do a vaginal breech, that is the best possible way to do one.

    Lisa, the c/s rate in Australia is about the same as the US's. I think the 2006 rate in the US was 31.1% but I'd have to look it up again to be sure. If anything, I think it's actually slightly higher in Australia.

  15. Your right, sorry Rixa. I looked up the stats The state one is 32.9% and the Australia wide was more difficult to pin down but seems to be 31%,

    The post is great and the video was a total delight.

  16. Thanks for passing that on. What a wonderful birth to see! Amazing!!


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