International Breech Conference: Day 2 continued

Friday, October 16, 2009

After the German physicians spoke, the morning concluded with two panels. The first panel, "Fear and Faith: The Breech Experience," was made of five women who had breech births. Almost all of them were forced/coerced/cornered into cesareans at some point. They spoke eloquently about their desperate search for a care provider. Of being told at the last minute that no one was willing to attend their baby's birth unless they agreed to a cesarean. Of being strapped down to a table, legs tied together and told they were killing their baby, pushing their baby out to the hips, then having the baby pushed back inside them and an emergency cesarean performed under general anesthesia. The midwife who attended Dio's birth was on the panel, and that last situation happened to her first breech baby. She's had three breech babies total, of five children. Hearing these women speak, and at times break down in tears over their treatment, was eye-opening for the physicians present. They tend not to see the back story of women's pregnancies and births.

Some notable comments from women on the panel:

• “Women get the birth that their trusted care provider thinks they ought to have.” Robin Guy
• “Women do not belong on the alter of obstetric convenience.” Robin Guy
• "Cesareans are not the root of all evil, the manipulation of the cesarean is what we struggle with."
• “When it’s the care provider’s lack [of skills or experience], it is not a choice.”
• "I tried to create choice for myself because my midwife was unable to provide it."

The next panel had five physicians (4 OBs and 1 family doctor) discussing "Challenges and Solutions for Offering Vaginal Breech Birth in the Hospital." Panel participants were: Dr. Stuart Fischbein of LA, Dr. Michael Hall of Colorado, and three Canadian physicians whose names I can't remember. The panel was moderated by Canadian midwife Betty-Anne Daviss, which was great fun, since she gave them some very challenging/uncomfortable questions. Some emerging themes: Canadian solutions won't work in the US, with our fractured, private system of hospitals and health care. For example, one of the Canadian physicians remarked that he's on salary and has an academic appointment, so there is absolutely no financial incentive for him to do a cesarean. There was widespread agreement that simulation will need to be a part of breech training in the 21st century. There was discussion of the pressures to practice a certain because of litigation. And two of the doctors mentioned that parenting was as important as being a doctor; at times the lifestyle of always being on call is hard for them and their families. I won't even try to summarize everything they said, but I will include this lovely quote from Dr. Hall:

"You can pull the breech into trouble, but the mother can’t push the breech into trouble.”

After lunch were another series of breakout sessions. Julie and I presented our research about women's experiences of breech birth. More on our conclusions later. Because I was presenting, I missed the sessions on simulation training, but I talked with other people who went. They said it was great, and the breech birth simulator can do hands & knees, not just on-the-back.

The last speaker was Ina May Gaskin. Her presentation was supposed to be about "Breeches at The Farm," but it was mainly a rambling, train-of-thought talk about birth. It would have been great as a story-telling session, but it wasn't appropriate in the context of a conference on breech birth with a mixed audience. I wanted to know more about how they do breeches and came away disappointed. I don't want to dismiss her important role in the renaissance of midwifery and home birth in the States, but her presentation was very disappointing. Julie leaned over to me and said, "No wonder doctors don't listen to midwives. They're not even speaking the same language!" Jane Evans' presentation epitomized the very best of midwifery, while, frankly, Ina May's was quite lacking. If I had been a physician, I would have come away from her presentation with a very poor impression of midwifery.

That said, I was interested to learn that The Farm midwives gradually came to use a kneeling or hands & knees position for breech. They used to do breeches with the woman sitting down, leaning back slightly, but now they have come to prefer all fours. They don't dictate this position, though, and some women will choose to move into other positions as they push the baby out.

Right after the conference, Julie and I caught a bus back to the airport. (I LOVE public transportation.) We got sent from kiosk to kiosk, and finally were directed to a check-in desk. At this point we were exactly 3 minutes past the cut-off time to check in for international flights. Julie was told by one particularly mean clerk that it was too bad, we'd have to miss our flights and stay overnight. Luckily I had Dio with me and he charmed the woman at my check-in desk and she let us through. It's nice to travel with babies!