My original comment:
In a hypothetical scenario where every community had access to vaginal breech birth in a hospital, I might be more inclined to find Jonie’s proposal reasonable. But in our present situation, banning breech at home = forced cesarean for almost all women. This topic is particularly relevant to me, since I just organized a vaginal breech training workshop with a Canadian OB who has done 300-400 vaginal breeches and a Canadian midwife who has trained in a German clinic that does mostly upright (hands & knees) breeches. I was disappointed but not overly surprised that all participants were out-of-hospital providers. Unless some radical changes occur to bring vaginal breech birth back into the hospital setting, I think the future of breech birth will be at home. Interestingly the midwife we brought down was more hesitant about breech in a home setting (she has done them in both home and hospital in the past, but now only does breeches in hospital, in part to help train residents and OBs in the dying art) than the OB was.Dr. Fogelson replied:
So should the practice be continued at home even though there is no skilled provider present? Does attending a course give one adequate experience to provide breech birth?And I wrote this:
I think the political issue of breech birth availability should not be addressed by providing the service in a suboptimal environment. I feel the same about VBAC.
A skilled provider is obviously optimal in whatever setting a breech birth happens. I’m just saying that there are women who would rather have a chance at a vaginal birth even in less than optimal conditions (i.e., with someone who hasn’t done a large number of vaginal breech births), rather than be forced into surgery.Come join the discussion--especially if you've had a breech baby (at home, in hospital, by c-section or vaginally).
I don’t think anyone was expecting this workshop to be the only training they needed to safely attend a breech. You’ve got to start somewhere, though, and simulation training with an experienced OB and midwife is a good place to start. Many of the participants had attended surprise breeches at some point in their careers and wanted more training for when/if that happened again.
I would love to see vaginal breech birth become common again in a hospital setting. But I don’t think that banning it in a home setting is the right approach. (This will further drive breech birth underground, as women either go unassisted or hire unlicensed midwives to be able to have a vaginal birth.) I’d rather find a solution that expands, rather than contracts, choices and that doesn’t limit women’s autonomy.
THANK YOU! I fully support your position and your efforts. Having personally given birth to a surprise breech at home, this issue is very close to my heart.
ReplyDelete"I would love to see vaginal breech birth become common again in a hospital setting"
ReplyDeleteWhy? Does bringing birth to the hospital really "expand" a woman's autonomy? Does birth in a hospital, traditionally, give many rights to women? Or does it traditionally control birth and the woman and the baby? Before we go bringing birth back to hospitals, maybe the way birth is carried out in the hospital should be changed.
"A skilled provider is obviously optimal in whatever setting a breech birth happens"
and who decides who is skilled? And how many is a "large number of vaginal breech births"? so that must disqualify any woman who wants to homebirth unassisted? And why is that "less than optimal"
I think a lot of things are being inferred by your verbage that are way off base. Especially the theme as of late that women who homebirth are often backed into a corner with no other option.
~confused
3rd child was a surprise vaginal home breech birth. Thank god I was home. I think with adequate training breech should not be considered such a scary topic. More women should be allowed to give birth their way without going underground.
ReplyDeleteOMG... Can we have a pic of your precious tiny ones? I need one to help me swallow this huge and never ending set of breech pills.
ReplyDelete(Not that I don't think vaginal breech is awesome...)
Pretty please... with sugar on top...
I might cry...
My second child was going to be my VBAC baby. As 36 weeks approached he was still breech. Policies in our area would have forced me to have an ECV at the hospital or accept my fate of a repeat csection. Unacceptable options from my point of view. I consulted with my midwives and they agreed to provide me with the information of someone who was willing to do a breech VBAC.
ReplyDeleteOne afternoon while watching my older son play in the playroom I was enjoying one of my usual spinning babies dot com positions when I decided to try to see of I could nudge the baby around. After about 3 minutes of gentile nudging while in a mostly upside down position I felt a quick shift in baby's position. When I stood up I felt what was unmistakably the head deep down in my pelvis.
Elated, I went to grab some juice to get baby to move, in part to confirm his changed position and also to check to see if the move had compromised his chord. He kicked me square in the diaphragm.
I went on to have my VBAC, but if the option to deliver breech at home didn't exist and my home ECV didn't work I would have been forced right out of options.
My blog moved to http://talesoffruitandcake.wordpress.com
As a woman who was bullied into her 1st CS for breech (without even being made aware that baby could be turned) and bullied into another CS for no apparent reason this post really hit home. Becuase if I choose to have another child my ONLY option for VB is to be at home. If the baby is breech then I *may* be quite out of options aside from UC.
ReplyDeleteThat's bullying for you. It doesn't help anyone. Women have the right to CHOICES, HB with breech (or any other 'complication') is one of them.
This discussion is incredibly premature and full of many unconfirmed presumptions. I think that all pregnant women and maternity "care providers" need to look at their fundamental beliefs before they look for "solutions".
ReplyDeleteFor example, way before they can be expected to make informed and non manipulated and fear based decisions; people (especially the pregnant mothers themselves) need to consider their preexisting beliefs and considered answers to the following assumptions and questions:
- A breech birth is a variation of a normal and natural birth presentation or is it a birth "complication".
- Whether or not (based on your answer to the first question) you think that a baby's position "needs" to be detected at all during pregnancy?
- Again dependent on your answer, should women actively try to "turn or spin" their baby, is the infant in a certain position "for a reason" and is it better for babies to turn on their own rather than be "assisted" when the mother is "alerted" to their position?
- Do you know all of the methods there are for assisting changing a breech position? Do you have a personal hierarchy in which yo would consider "trying" them? Are all/most/any of the options readily available to you in your area?
- Should a breech vaginal birth be managed at all? Does the unnatural and unsupportive birth environment make uncommon variations of birthing even more difficult then they would be in an optimum mammalian/biologically instinctively selected one?
- Finally are breech births a symptom of our modern detrimentally mega convenient and overly sedentary lifestyles? Can a breech be prevented completely through consciousness, education, frequent natural movement and natural living etc?
I would be far more interested in hearing both mothers' and maternal "health care providers'" answers to these questions rather this distasteful rehashed power play for control over the "delivery of babies".
I'm a first time mom and my baby was breech from 29 weeks. We were planning a home birth, but our midwife and back up OB do not attend breech births at home. We viewed breech as a variation of normal, but not a particularly helpful variation from a birthing perspective. We therefore tried everything we could find to get our baby to turn, including everything from the spinning babies website (except moxibustion - not sure why), and three attempts at ECV, including one with two docs working at the same time. When that last ECV failed to budge the Bean, we decided enough was enough and to leave him be - still hoping that he would turn to make for an easier birth.
ReplyDeleteWe were fortunate that our OB is experienced in vaginal breech birth. I went into labour naturally (and fast) and pushed for 3.5 hours in the hospital, but with just my midwife and husband present. For the first 2 hours 45 there was a lot of progress, but we then got stuck. No matter what position I pushed in, the Bean couldn't get his butt cheek round. On the advice of my OB, we moved at that point to a cesarean birth. Would I have done the same thing at The Farm or somewhere else where c-section was less possible? I don't know. Maybe with another 3 hours of pushing I could have got him out. Or maybe we both would have died. I am at peace with the decisions we made.
Oh, and Michelle - I'm an athlete. I ran throughout my pregnancy up to 36 weeks and was still walking between 20 and 30 miles a week until I went into labour. Definitely not sedentary.
Back to the original question. 3% of babies are breech at term. The majority of those are healthy babies with healthy mothers, and vaginal birth must be an option. Having a skilled provider is the key - in my view it doesn't matter whether it is at home or in the hospital. I think this question has to be tackled as one part of the medicalisation and emergency-isation (if I can put it that way) of birth as a whole.
Sorry to go on for so long!
Michelle- I like your list of questions very much; I think they are very relevant to the discussion. Here are my thoughts, as a doula, childbirth researcher, and aspiring midwife.
ReplyDeleteNo, I do not think that breech births are "normal". We know that they are more dangerous that vertex, and that MOST babies will flip head-down, as this is certainly the optimal position for birth. I feel that mothers should be very alert to the position of their babies, whether breech or posterior, and try to identify if there is a reason in the mother's body that the baby is in a less-than-desirable position. Chiropractic care has been the most effective; I personally feel that EV's are not the best option, as the reason why the baby is in that position in the first place is not being addressed. At the spinning babies workshop that I attended, Gail Tully mentioned that in some countries, breech births are unheard of. I feel that the number of breeches that we have in developed nations is probably a result of lifestyle, or diet, or both of these factors together.
I guess my belief is that although the birth process is exquisitely and perfectly designed, women's bodies are not perfect, and much of the time, our lifestyles and diets are not optimal, in childhood, adulthood, or pregnancy. These factors absolutely affect our ability to give birth efficiently, whether we believe it or not. I am a fan of Weston A Price's Nutrition and Physical Degeneration, written back in the 30's, and he noted that native peoples living on native diets had very easy pregnancies, uncomplicated births, and robust babies. As soon as members of those populations abandoned their native diet, their health and their ease in childbearing left them. Pretty interesting stuff. I don't think he commented on breech babies, though. He did mention the large pygmy babies, though :)
I had a planned breech home birth. Despite weeks of trying everything to get her to turn, she would not. Licensed midwives can not legally attend breech home births in Utah so my midwife asked a very experience unlicensed midwife to also attend my birth. I am happy to report that it went off without a hitch. No one even touched my baby but me as she was born. I was kneeling in the birth pool. It could not have gone more perfectly.
ReplyDeleteI will be forever grateful for the lay midwife who agreed to attend my breech birth. I'm grateful that she is experienced and willing to go unlicensed so that she can serve more women. I strongly believe that many, many breech babies can be born vaginally and we NEED more care providers who are trained and experienced and willing to attend breech births.
I had so many people think I was taking undo risk to have my breech baby at home, but I knew I had an experienced attendant and I knew that when left alone, most breech babies are born without issue. I also just felt strongly that it would all be fine.
Joni's letter says "Though midwives study the mechanism of breech birth in texts, workshops, and lectures to enable us to respond to an undiagnosed and rapid breech birth, it is important to recognize that because breech occurs so infrequently, supervised hands-on training in skills necessary to facilitate such births is not commonly available."
ReplyDeleteThe same could be said for shoulder dystocia...how many midwives from all walks of life/routes of entry received hands-on, supervised training in resolving a shoulder dystocia? How many OBs did? And yet all are expected to know the maneuvers and act when the situation warrants to assist motherbaby safely.
The "suboptimal environment" for breeches and VBACs *IS* the hospital, at least in most places.
ReplyDeleteMost hospital personnel are not trained in the safest and most optimal choices in breech birth ("Breech Extraction") and they have so many ridiculous limitations on and interventions in most VBACs that it really is NOT the safest place to give birth for women in these situations.
I absolutely welcome more hospital providers being willing to attend vaginal breeches and VBACs and VBAMC, since most women still birth in hospitals. That choice MUST be there.
But until they can be sufficiently hands-off and quit interfering so much when it's not needed, I would consider the HOSPITAL to be the "suboptimal environment" for many cases.
My first son was breech (failed attempt at version) and we ended up with a c-section when I went into labor on a night my ob was out of town (he was the only one in our area with experience in breech vaginal deliveries, all other doctors were scared of us and were worried they would be on call when I went into labor so we had to sign special papers accepting responsibility for going against medical advice and also agreeing to c/s if our doctor could not be present. Now, I am 37.5 weeks pregnant with my second and she is breech. I have tried everything to turn her: chiropractic, moxi, acupuncture, tilt exercises, and just today, a version--baby started showing distress so they stopped). Talk about discouraged. Plus, I am traveling 2 hrs away to even attempt a VBAC (they don't do them in our area) and now am scheduled for c-section on 15th of aug (unless she turns on her own or I go into labor before). Anyway, that is my experience, and it's all frustrating. I am willing to try a vaginal breech birth, but there is no support and there are NO providers (I don't even know any midwives) who will attempt it. I try not to get stuck in the "why me?" cycle, but it can be hard. We are open to life and repeat c/s are not ideal.
ReplyDeleteThis is so interesting to me on both a personal and professional level. While I went to nursing school with the intention of becoming a nurse midwife, I got sidetracked and ended up as a neonatal nurse practitioner in a NICU. In the last few weeks, we have admitted 2 severely brain damaged infants delivered breech at home. Both had prolonged head entrapment. Now, granted, one was delivered by a parent with no experience, but the other used an lay midwife which is illegal in our state.
ReplyDeleteI have 2 comments here. This is for the midwives in the community. At what point would you arrange transport with a primigravida, under 5 ft woman, with a breech delivery? Would it be when you realized she was breech, when the head was stuck or after the baby failed to respond to resuscitation?
My second comment will probably make people mad, so I apologize in advance. Here I go...I don't understand how any parent made a choice that benefits them over what is good for the baby. I think it is purely selfish to take such a risk. I know I see the bad outcome, but to see babies wracked with seizures, and a meaningful life snuffed out in those few minutes between health and brain damage is heartbreaking. The line is so very, very thin. I know I couldn't live with myself if my choices led that such a result.
- A breech birth is a variation of a normal and natural birth presentation or is it a birth "complication".--It hold more risk for delivery, but I see it as a variation of normal.
ReplyDelete- Whether or not (based on your answer to the first question) you think that a baby's position "needs" to be detected at all during pregnancy? I think it's helpful, yes.
- Again dependent on your answer, should women actively try to "turn or spin" their baby, is the infant in a certain position "for a reason" and is it better for babies to turn on their own rather than be "assisted" when the mother is "alerted" to their position?I think the mother should try to turn the baby using natural methods; if that doesn't work, she should be assisted by a competent provider.
- Do you know all of the methods there are for assisting changing a breech position? Do you have a personal hierarchy in which yo would consider "trying" them? Are all/most/any of the options readily available to you in your area? Yes and yes. I have tried, I believe, every last damn one of them to no avail.
- Should a breech vaginal birth be managed at all? Does the unnatural and unsupportive birth environment make uncommon variations of birthing even more difficult then they would be in an optimum mammalian/biologically instinctively selected one? I wouldn't say managed, but it is nice to have someone who is aware of the way things should go. Should the baby get stuck, it's nice knowing someone is there who can help. Same with a vertex baby. If all goes well, little to nothing should be done by the attendant.
- Finally are breech births a symptom of our modern detrimentally mega convenient and overly sedentary lifestyles? Can a breech be prevented completely through consciousness, education, frequent natural movement and natural living etc? I really don't believe so. This is my second pregnancy with a breech baby. My lifestyle during both pregnancies have been drastically different. For my first, I was at a desk job all day. For this one, a stay at home mom of an active 18m old. Much better diet the second time around. I do some exercise as time permits. Different circumstances/activity level, same outcome.