Review of documentary "A Breech in the System" by Karin Ecker

Last month, I briefly mentioned the documentary "A Breech in the System". Karin Ecker, the filmmaker and mother featured in the film, contacted me to see if I'd be willing to review her film.

A Breech in the System:

Who's in charge of birthing my baby?

A new film by Karin Ecker

Edited by Sharon Shostak

http://www.abreechinthesystem.com/

This 40-minute documentary follows Karin's journey through the last three months of pregnancy and the birth of her first child. At six months pregnant, Karin moves from Austria to Australia and learns how to navigate through a new medical system. When she discovers her baby is breech at 36 weeks pregnant, her plans for a natural birth in an in-hospital birthing center have to be abandoned, as breech births are not allowed there. Pressured to have a scheduled cesarean at 38 weeks, Karin begins examining her options and realizes that she has to try for a vaginal breech birth. Never knowing until the last moment whether she will be allowed to make this choice, she continues to move forward, hoping that her choices are right. She feels torn between the support from her friends (several of whom have given birth vaginally to breech babies) and the rigid opposition to vaginal breech birth from the hospital system.

Karin's story unfolds in counterpoint with interviews of various people involved in Karin's pregnancy: friends, doulas, midwives, childbirth educators, family physicians, and OBs. They speak about the physiology and pathology of breech birth, about issues of informed consent and refusal, about the meaning and significance of pain, about a pregnant woman's need for support and information.

A third narrative line in the documentary is one without words--hauntingly beautiful images of pregnant Karin. We see her immersed upsidedown in a pool, gently cradled by her partner. We see her belly dancing on the beach, waving a veil that billows behind her. We see her underwater, motionless, wrapped in layers of transparent red chiffon, her eyes closed and her hands near her face--mirroring her baby's secret, watery environment.

A Breech in the System makes a strong statement about the "breach" in the Australian maternity care system by showing, rather than telling, the incredible obstacles one woman faced to have a vaginal breech birth in a hospital setting. In the end--and you can read more about this in the synopsis below--she was able to give birth vaginally by a stroke of sheer luck and coincidence. Not because the system in any way supported or facilitated her choice, her desires, or her autonomy.

This film is not a how-to instructional video of vaginal breech birth in a hospital setting. Nor is it an agenda-driven film striving to push vaginal breech birth as the best or right choice. Rather, A Breech in the System shows the complexity of the decision-making process for pregnant women, especially when their choices are outside those "the System" allows.

With the increased interest in vaginal breech birth from the SOGC, perhaps Karin Ecker would be interested in producing a companion video for physicians, midwives, and nurses. I envision this as an educational film consisiting of minimally edited labor and birth footage, along with voice-over narration from Karin explaining what was happening. Karin's birth footage is especially valuable because it shows upright, physiological breech birth in a hospital setting.

To purchase the film or arrange a screening, visit the documentary's website. The film can be downloaded for AUS $28.50, purchased in Australia for AUS $49.95 or internationally for AUS $49.95 (plus postage).

Trailer of A Breech in the System:


For an in-depth summary of the documentary, please read the synposis below.

Synopsis
The film is divided--organically, not overtly--into 3 main parts. In Part I, we meet the pregnant Karin and follow her journeys through the Australian maternity care system. She moved to Byron Bay, a seaside town in New South Wales on the eastern coast of Australia. Karin finds this beautiful, natural place at odds with the rigidity of the obstetrical system she will soon encounter once she discovers her baby is breech. Before this turning point in her pregnancy, however, she had selected to birth a hospital birthing center that felt perfect for her. The staff facilitated women to birth without medications (gas & air and morphine were available in the birthing unit, but rarely used). The center encouraged water births and provided large, spacious tubs for that purpose.

Even before her discovery of breech, Karin started questioning her maternity care. In Austria, women received ultrasounds every month, and they were seen as a very natural and normal part of pregnancy care. In Australia, though, people tended to view ultrasounds with hesitation and worried about the potential negative effects on the baby. She started wondering why one culture would see them so benignly, and another so suspiciously.

A newcomer to Australia, Karin was fortunate to have strong support system in Bryon Bay. The film features several of the women and men supporting Karin: her friend, support person, and camera person Sharon, home birth midwife Sue, friend and childbirth educator Suzanne, birth consultant Jayne, and Karin's partner. In addition, we meet Karin's GP (family physician) Dr. Marc Heyning and the OB who was on call when Karin went into labor, Indian-trained Dr. Geeta Sales.

Part II begins with the discovery that her baby was breech. At 36 weeks pregnant, her doula was feeling Karin's belly and remarked that she was fairly sure the baby was head-up. When the breech presentation was confirmed, Karin and her partner initially felt confident that the baby would turn. They tried almost everything to encourage their baby to move head-down: talking to the baby, inversions in water, yoga, homeopathics, and massage. Finally, as pressure was mounting for Karin to schedule a cesarean at 38 weeks--something she was not at all keen to do--they tried an external cephalic version. The baby turned, and after a 30-minute monitoring session, Karin got up to use the bathroom. She touched her belly and felt the baby's head back up near her ribs, and she knew it had turned breech again.

This moment marked the crucial turning point in Karin's journey. She almost succumbed to the cesarean, which was scheduled in just 4 days. She had a brief moment of relief that she wouldn't have to go through all the pain, all the laboring. But even during the version, when the baby was head-down and she was on the monitors, she remarked to the camera, "I wouldn’t want to have somebody I don’t know cut me open and lift my baby out of my body.” She realized that she had to try to have her baby vaginally. She simply could not agree to a scheduled cesarean.

Part III: With the medical system providing no options but a scheduled cesarean, Karin began digging deeper. She did not feel right about leaving the system entirely and birthing her breech at home--something her friend Sharon and midwife friend Sue had done with their breech babies. So she started looking for a back door, so to speak. She knew that vaginal breech birth was possible and had her friends' support for that choice. She felt the clash of two opposing mentalities: the natural environment she was living in, versus the medical system saying no, you have to do it our way.

When she met with the physicians at the hospital where she would now have to give birth, she found a small opening in the door. Initially, she was hoping to just convince them to let her go to full-term before scheduling the cesarean. During her meeting, they told her: "We’re not allowing you to have a natural birth. But we cannot force you.” She pressed further. "The midwives will definitely love you if you try for a natural birth," they said. "But no, we cannot support you." These mixed messages--no you can't, but yes you can--gave her the hope to at least try for a vaginal breech birth. She spoke with Sue extensively about what informed consent meant and her legal rights to not be bullied into making decisions.

The day of her scheduled cesarean, Karin called to cancel the surgery. She was expecting to be scolded over the phone, but the midwife on the phone was quite friendly and supportive. Karin went into labor on her due date, not knowing exactly what her plan would be or if she'd even be allowed to try for a vaginal breech birth. She arrives at the hospital with her friend and camera person Sharon. Sue, the homebirth midwife, had agreed to support her at the hospital and arived soon thereafter. Together, the three women held the space as they waited for the on-call OB to arrive. Deep in labor, Karin also had to deal with the anxiety of not knowing whether her wishes for a vaginal breech birth would be honored.

Finally, the OB, Dr. Geeta Sales, arrives. Dressed in casual street clothes and several gold necklaces, she learns of Karin's desire for a breech birth. How will the obstetrician react?

It is a moment of serendipity when Dr. Sales smiles and says...Oh, I've done lots of breech births! The tension in the room melts away. Sue and Sharon no longer have to protect Karin from the hospital. Instead, the staff--and physician in particular--are totally on her side. Dr. Sales, who trained and then practiced obstetrics in India before coming to Australia, is very comfortable with vaginal breech birth, which was the norm in India. She goes through Karin's birth plan line by line and is on-board with everything. Karin's wish to birth in an upright position gives Dr. Sales some hesitation, but when Sue assures her that the mechanism of breech birth is the same, Dr. Sales agrees.

Now it is time for Karin to surrender and give birth. We see Karin laboring and pushing in several positions: kneeling, standing, in the tub, side-lying, squatting. Loving hands and smiling faces surround Karin. The OB quietly explains to Karin's partner what to expect--the task is to simply wait patiently until the buttocks emerge.

Karin births her son's body in a kneeling, forward-leaning position. After the body has emerged, she is lifted into a supported squat/sit for the birth of the head. The birth of the baby occurs very quickly. Her son is quickly whisked to the resucitation table and given a bag-and-mask. In what is the most transcendent moment in the entire film, a naked Karin walks to the table, sobbing with joy, and caresses her son. The mother and baby are soon snuggled into bed together, naked and skin-to-skin. We see Karin taking in the enormity of what she has just done. As she and her baby nuzzle and caress, Sinead O'Connor's A Hundred Thousand Angels plays in the background. The first verse of the song goes:

Do you
Hear me calling you
The voice of a mother, a father and a child
Would you recognize the truth
Do you feel a love that's falling from my eyes

Every time I watch this part of the film, I cry. (This is coming from someone who did not cry when her own children were born.) It is that beautiful.

Karin explains that when she held her baby for the first time, the fear and trauma of the birth were all gone, wiped away. She experienced incredible happiness and relief that her ordeal was over. The documentary ends with Karin saying: "I felt there is nothing I can't do."