Thursday, May 04, 2017

Obstetric blinders: Overlooking the obvious solution to breech because "modern" women do not birth upright

With my nose deep in old articles about breech, I came across this gem: In 1970, two English obstetricians described the Bracht maneuver for an article in the ANZJOG. Note this section immediately following the mechanisms of assisted breech delivery and preceding the Bracht maneuver:
Spontaneous Breech Delivery:

If one closely observes a spontaneous breech delivery an entirely different course of events is seen.

This phenomenon may best be observed in quadruped mammals which deliver standing up, or in the apes which deliver squatting. This latter situation was employed by the midwife of the middle ages using her delivery-stool, and up till the present, parturient woman of the Bantu tribes squat on their haunches, the trunk bent slightly forwards (Botha, 1968). The Polynesians revert completely back to our evolutionary forebears and are delivered lying over a cross beam with the pregnant abdomen downwards thus dispensing with the need for any manipulative interference in the delivery of a breech presentation.
Despite these observations, the authors next describe the "modern" approach that use the Bracht maneuver as a substitute for gravity.
With the modem mother in the dorsal position the breech presents with the sacrum directed laterally and the buttocks are born with the bitrochanteric diameter in the anteroposterior diameter of the pelvic outlet....Ignoring the pull of gravity, the spiral motion of this compact form continues upward and forward until the baby’s back lies directly against the mother’s symphysis pubis. (153-154)

The solution lies right before their eyes, yet the authors cannot see it due to their obstetric and cultural blinders. The authors note that upright, leaning-forward positions eliminate the need for obstetric maneuvers to deliver a breech baby. The weight of tradition, cultural superiority, and "modern" obstetric practice hinders these obstetricians from seeing spontaneous breech birth as anything but a quaint, historical footnote. Not a lesson to be learned nor a reason to change obstetric practice.

How much else have we failed to learn due to the blinders that we wear?

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