Confidence, competence, and preserving breech birth at home

Just a few days after my review of Karin Ecker's documentary "A Breech in the System," Australian midwife Lisa Barrett posted the story of a breech home birth she attended (watch the birth video here). Both women's stories are remarkably similar. Originally planning to use in-hospital birthing centers, they are told their only option is a planned, pre-labor cesarean when their babies turn breech. Both women go through great lengths to encourage the baby to turn, including an attempt at ECV. Both find encouragement and support from home birth midwives, even though neither one plans a home birth. Both plan a natural breech birth "in the system."

The woman whom Lisa attended had settled on a hospital birth with Lisa attending and supporting her. However, once she went into labor, her plans changed. (Read the story, linked above, for the surprising conclusion.)

I admire Lisa for her generosity in helping this woman at the last minute. In fact, when Dio was breech and I was wondering what I would do, Lisa invited me to come stay and birth with her. I was floored by her offer. At that point, we had not yet met in person, so she only knew me from my online presence. Lisa's the invitation meant so much to me during that time of upheaval and uncertainty. Fortunately, Dio turned vertex and I did not need to consider traveling halfway around the world.

One problem with preserving the art of breech is that of numbers. Very few obstetricians, let alone midwives, have attended a significant number of vaginal breech births. However, a birth attendant needs to be both confident and competent in attending breeches. Confident enough to stay calm, to keep their hands off the breech,  and to know their limits. Competent enough to have seen and dealt with the rare but serious complications of breech birth, in addition to a sufficient volume of "uneventful" physiological breech births.

I feel strongly that we need to preserve not only vaginal breech birth, but also vaginal breech birth at home. In today's obstetric climate, it is often the only place where a woman can avoid a cesarean for breech. And even if she can find an OB willing to attend a breech birth in a hospital, a woman often faces an uphill battle for an undisturbed, peaceful birth. Lisa's client commented on the advantage of giving birth to a breech at home: "Being at home meant we didn’t have to negotiate for a normal physiological birth without intervention – it was assumed because there were no problems." Not all women wanting a vaginal breech birth will chose to do so at home, but losing or outlawing that option would mean a great loss for women's autonomy and their ability to choose what is best for their babies and their bodies.

Lisa's client ended her story with these remarks:

I’m so grateful that I was able to have a natural breech birth without panic or fear. The birth of our daughter was such a fantastic, positive experience and it saddens me to think that women are led to believe that breech birth is always dangerous or even impossible. As a woman in the public hospital system, I became a black sheep because I questioned their policies and their underlying evidence and refused to accept their way as the only way. I was too much trouble and was effectively turned away. The only reason I was able to birth naturally was because I was lucky enough to find a midwife who believed in birth and believed in me and because I have a like-minded husband who supports me. These things don’t necessarily guarantee anyone a birth free from intervention, but they certainly give the birthing woman a say as to what happens to her baby and her body, placing her at the centre of the decision making process – which is exactly where she should be.