I find myself more prone to anxiety and worrying during pregnancy, and more this time compared to last pregnancy. My logical brain knows that fretting about a baby's positioning at 30 weeks gestation is fairly pointless, and that the vast majority of breech presentations resolve themselves by term. But does that make any difference to my emotional self? Not really! Here I am, knowing all of these things and having reassured many other women about breech presentations, and I still can't stop fretting about the future: what if the baby stays breech? what would happen then? what would I do?...
It's not that I am worried about a vaginal breech birth per se. I feel quite confident that I could give birth to a breech baby, and I have read extensively about the controversies surrounding breech management. But I am quite afraid of birthing a breech baby in the current medical & legal climate. Going into labor with a breech presentation would mean the following for me:
- No continuity of care, as my midwife cannot attend a breech at this time. She really wants to add breeches and twins to her practice in the next five years, but she does not have enough training yet to attend a breech birth.
- A last-minute desperate search for someone to attend me, or a last-minute unassisted birth with no midwife backup. I live about an hour away from a very large city with a total metropolitan population of 1.7 million. There may (or may not) be one or two physicians who still attend breeches. There used to be more, but almost all of them have stopped attending vaginal breeches, some of them against their will. My midwife used to work as a L&D nurse in a large tertiary hospital in that city, and she said they used to do vaginal breeches all the time until a change in medical opinion declared a vaginal breech to be malpractice. She remembers one OB letting off the F-bomb because he was so upset he'd have to start doing c-sections for all breeches. She knows of a few physicians who, although they currently don't officially do vaginal breeches, might be able to attend a woman if she into labor on a day they happened to be on call and insisted on a vaginal birth at the hospital. She'd have to know that this option even existed and who to ask for, of course.
- Or, if I wanted to stay at home, I could try to find a direct-entry midwife who has skills with breech births. There are one or two, but there is a complicated back story that makes me more hesitant about that option. In brief: my midwife's third baby was breech. She was abandoned by those midwives the day before she went into labor because of the breech presentation, leaving her to do it on her own.
- A massive amount of stress and worry, because I could not simply carry on with my birth plans. Instead, the days or hours leading up to the birth would be characterized by extreme upheaval and uncertainty. And there's still no guarantee I could find someone willing to attend a vaginal birth.
- And of course, if I did go to a hospital and manage to find a doctor to attend me in this hypothetical situation, I wonder if that would be a very good setting for a vaginal breech: unknown physician, probably a lot of anxiety and fear, unknown amount of manipulations or interventions in the process. Not a very good setting for a smooth vaginal breech birth. The best possible atmosphere for a successful vaginal breech birth is one that is the least disturbed, one with low levels of stress and adrenaline, one with laid-back hands-off providers with lots of skill and experience seeing physiological breech births. Basically the opposite of what I would be able to find if I found myself faced with a breech presentation at term.