The dance of breech

In Jennifer Block's Pushed, she discusses the disappearing art of vaginal breech birth, and the small groups of physicians and midwives going to extraordinary lengths to learn those skills--often halfway around the world--and bring them home to the communities they serve. This excerpt describes the characteristic movements women often make when birthing breeches (if, of course, they aren't restricted in their movement or positions.)

Jane Evans is about to catch a breech baby. The woman she's attending is on all fours, and the baby's buttocks are emerging: one cheek, then the crease demarking two; then one chubby leg plops down, then the other. The baby--a girl--is now dangling from her mother. "Most women left to their own devices will get on hands and knees," Evans explains, clicking to bring up the next slide. "The baby needs to turn its pelvis, which is really hard to do if mum is on her back." We next see her gloved hands gently bringing one of the baby's elbows down, then the other. "Remember, you're assisting progress--you're not pulling," she says. More of the baby hands gree--she's jerking her knees up in midair. Evans explains the mechanics at work; the head needs to be flexed chin-to-chest to be born safely. There are maneuvers an attendant can use to facilitate this; one is to reach up with a finger, find the baby's mouth, and draw the chin down. But here, the baby is doing it herself. "What happens when you lift your knees?" Evans asks rhetorically, as members of the audience bob their hands. "You drop your chin to chest." She clicks to the next slide. The mother has now sunk to chest and knees, butt to ceiling, with arms extended as if supplicating before royalty. "When the baby hits the G-spot, mother drops to the floor and goes Muslim," says Evans. Laughter in the audience. She grabs a skeletal pelvis and fetus doll off the podium, modeling how on supplication, the mother's pelvis pivots around the baby's head like a visor, setting it free. "And look," she says, moving to the next slide. "The baby practically slides out."

Evans is a British midwife who has been in practice for 30 years...We are in a low-lit auditorium at the Women's Hospital in Vancouver, British Columbia, and she is teaching vaginal breech 101. Not to the doctors at the hospital, though. Like nearly all obstetricians in North America, they no longer attend vaginal breech birth, instead performing a cesarean section. Evan's audience is mainly midwives from the United States and Canada who have come for a 2-day conference on the subject. Evans has flown in from England; Maggie Banks, midwife and author of Breech Birth Woman-Wise, has come from New Zealand; physicians from Belgium, Germany, Norway, the Netherlands, Australia, and across Canada have come to present research. Evans is introduced by Philip Hall, MD, the Manitoba perinatologist and professor of maternal-fetal medicine, who bemoans the current standard of automatic cesarean. "Can't we offer something better to women? Can we do anything to turn the tide?" he asks.

So aren't you just about dying to see this in action? All this talk of babies flexing their legs, of mothers supplicating earthward...but it's hard to imagine without ever having seen it. Guess what? There's a great photoessay from Evan's midwifery group The London Birth Practice showing a footling breech with Evans herself in attendance. We see the mom going from hands and knees to butt-in-air to release the baby's head. The baby flexes its arms and legs, just as Evans had described. You can read the mom's birth story here.

Anne Frye's Holistic Midwifery Vol II: Care During Labor and Birth explains the process of vaginal breech in meticulous detail on pages 933-971. She includes several illustrations of the dance of breech. Below is one set of illustrations, drawn from photos of the birth.