Tuesday, December 04, 2007

Midwives and doctors talk about breeches

I have interviewed several midwives and doctors as part of my dissertation research, and I thought I would share these comments about breech births with you (with their permission). Both of the midwives quoted here are very hands-off; parents almost always catch their own babies, and the midwives try to be as invisible as possible during the birth.

Dr. Sarah J. Buckley gave birth to her fourth baby at home unassisted, a surprise breech. I haven't interviewed her yet (although I will be meeting her this spring!), but the birth story is worth reading.

"Sarah" practiced for a midwife for a while in two Midwestern states. She currently lives in a state where midwifery is illegal and has decided not to continue her practice. She has given birth in a variety of settings, from UC to hospital.
I have attended a few breeches and I have given birth to a frank breech of my own. Most of the time I think breech is a variation of normal but that it should be approached with respect. (The casual attitude some UC folk have about it bristles me a bit. Breech is like any other birth, you see a couple go well you have that honeymoon feeling, what's all the fuss? But if you ever see one go bad, well, it will stay with you a while.) I don't want to live in fear of the what ifs, but I do think it's important to respect the possibilities and be prepared to take responsibilities. I have seen enough to know that breech births have their increased rates of complications for good reason, probably the greatest of which is simple mishandling by caregivers. I think even well trained attendants tend to panic a little with breeches. They miscalculate how much time has passed and start maneuvers too soon. Dr. White advocated a serene labor (including semi recumbent [to prevent cord prolapse or premature urge to push] position for mom once the waters spontaneously rupture), a hands and knees position for breech birthing, and completely hands off approach. I am with him on that completely. I have seen the arguments for maneuvers and what not, and having seen a few breech births and watched even more videos, I can tell you his way is non-violent and so much more conducive to a good outcome. Basically I believe that if you follow those simple guidelines and you get a less than perfect outcome, well, there is nothing that could have been done to prevent it. While a cesarean will prevent entrapment and cord prolapse, it won't prevent a host of other issues for mother and baby. If the baby is breech because of a defect of some sort, giving birth by section will not change it. The stats are there...breeches are more complicated with or without section. So why have surgery?

Recently I've heard some UC folks make very casual comments about how easy it is to sweep an arm on a breech. Well, it often is, especially if the baby is small and the mama is roomy, has given birth before and is not in a panic. But, if the baby is full term, good sized it may not be so easy. Again not something to fear, but I think that one place where UC folks scare me a little is when you have someone who knows little about birth and there is this prevalent attitude of everything is normal, everything will be OK, don't say anything that might be negative or scary. But scary or not, birth is not a safe event. It is a life event and while most of the time it will all go just fine; sometimes it won't. I see it kind of like amusement park rides or getting on a plane. You're not going to tell somebody never to get on a plane or ride a roller coaster when we all know that it is generally safe and a good experience...but you wouldn't tell somebody that a plane crash or a roller coaster derailment is no big deal either. That's how I feel about complications. Not a reason not to UC, but not something to sweep under the rug and pretend scary stuff can't happen.
"Mary" is a practicing home birth midwife and shares these experiences with breech births:
I have had three experiences on my own. I had three within six months of each other. I had never before and never since had any. Weird. But I did learn that doing nothing and letting the mother rest as much as possible lying down are useful for the labor but not for the birth. Most of them did this and stood up right at the end when the baby was coming butt first. The one footling was in the pool, and the mom stood up at the last seconds for the head. I only helped one of them hands-on after the body. His arms were not coming down. The mom got to the edge of the bed and I supported him to hang, then reached around his back and pulled down each arm. The babies did fine though they needed a bit of work. One was 9 lbs and a first baby; he had some fluid to get out. But his cord was attached until hours later so I think that helped him. All the babies' cords were left intact. Always a good idea with any birth...I am a big Lotus birth advocate. Anyway, the others were fine except the footling one needed some rubbing up and a suck and blow over her mouth which her mother gave her. The other one came out wailing. I think it was strange to have three within such a short time.


  1. Very interesting, thank you for putting this up.

    I, too, was very turned off by the "Don't talk about anything 'bad' approach to communally educating each other on the UC Boards on MDC a few years back. Facts are not something to hide from or to be feared, information is our ally! I am grateful for this information as an aspiring midwife and mother.

  2. I've been at the Mothering.com forums since 2001 and in my experience those who have a pollyanna attitude about UC have always been in the minority. I agree though with Sarah that it can be upsetting to see. For me, it's knowing that if anything does go wrong, these very same people will come back and say, "UC is dangerous and bad and ruined our lives SO NOBODY ELSE SHOULD DO IT!" It makes me nervous for them -- because they aren't realistic about the risks -- and also nervous for the community, because it's only fuel for the fire that UC is inherently scary and stupid and morally wrong. I like to see people going into it because it is their ideal choice (not out of desperation,) under ideal conditions, with full knowledge of what can happen should complications occur, and at peace with whatever the outcome is. Of course, one would hope that anyone planning any type of birth would be making their choice in that way. It just feels especially important when one is part of a movement that is in a very precarious position legally and culturally -- even more so than midwifery.

  3. thanks for sharing this. since having my own footling breech home birth a year ago, i'm very interested in reading others' perspectives on breech birth. i just recently posted my birth story on my blog in case anyone is interested in reading it.

  4. Wow, a footling breech! Congrats.

    Off to read your story...

  5. thank you. :)
    i should have included the link:


  6. Linda, I love your description of how anyone planning any type of birth should be making their decisions!

    I had a term breech pregnancy with what was to be an attended home birth, but with the breech, my immediate choices became automatic c-section or UC. I think I can say I had full knowledge of what can happen in both scenarios; neither felt like the ideal choice for me and neither would have been under ideal conditions, and I certainly was not at peace with all outcomes. I just had this strong sense --call it intuition-- that this baby is not *meant* to be breech, that the whole scenario was unreal. It wasn't at all helpful to be told that breech UC is no biggie or no different from a vertex birth. (My personal birth ideal is hands off attended -- so you might wonder why I was asking for advice on UC forums except that I was running out of options.)

    I had no difficulty ignoring the more glib voices. As always, the most helpful contribution from UCers was not their know-how but their urging me to listen to my intuition.

    In the end, my intuition was correct: I didn't even have a breech birth at all.

    UC support groups are so full of contradiction because when it comes to birthing, it's not easy to provide good support to another mom while telling her that you don't know what's best for her and you don't have definite answers for her. I would call such a helper a good midwife! :)

  7. "it's not easy to provide good support to another mom while telling her that you don't know what's best for her and you don't have definite answers for her. I would call such a helper a good midwife!"

    Just curious here Judit...so are you saying that a good midwife *can* know what's best for a woman and have definite answers for her? Or maybe I'm reading your response the wrong way. Perhaps you mean that even a good midwife *can't* do those things--she can only encourage the woman to look inside herself for the answers?

  8. Yes, that's it: the latter. A good midwife is able to say she DOESN'T know what's best for the mom and that she doesn't have definite answers for the mom. Sorry about the confusing wording.


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