Sunday, June 28, 2009

Breech: what to do next?

From Robin Guy, co-founder of the Coalition for Breech Birth:
Dear friends of CBB,

Well, here we are. Women's voices are finally getting heard -- the Society of Obstetricians and Gynaecologists of Canada has issued new breech guidelines that above all, advise that women need to be offered the choice of vaginal breech birth. What is the most important about these guidelines is not the nitty-gritty of candidate selection and techniques of delivery, but rather that they have tackled the ethical issue of forced surgery and come down firmly on the side of not obliging women to have surgery they neither want nor need.

Here is a link to the new guidelines and commentaries (please especially read Andrew Kotaska's commentary).

For those of you not in Canada, this is a great opportunity to approach your own organizations and present this example of progressive movement towards recognizing women's autonomy over their own bodies and ownership of their birthing.

So one battle is won, but the next is beginning. The guideline change will offer those doctors and midwives who were willing to catch, but afraid of professional censure or litigation, the excuse they need to start catching openly and helping to train their colleagues. The SOGC is also launching training initiatives that will help the care providers currently in school to gain these skills and graduate competent to include vaginal breech in their practice.

However, as always, the real change must come from us. The real change must come from women and their families expecting better care. Expecting to be offered unbiased informed choice discussions and for our choices to be respected and supported. Expect referrals to competent attendants when our own midwife or doctor legitimately doesn't have enough experience to safely catch our breech babies.

Please. Tell your friends what has happened. Shout it to the rafters. Watch for the International Breech Conference registration announcement (it will be October 15-16, in Ottawa), and do whatever you can do to be here.

Let's make some noise.

Blessings, Robin


  1. I think the SOGC changes are such a critical first step and of course I am thrilled this is where we are headed.

    However, I teach prenatal at the ottawa hosp and none of the Ottawa Hosp. Dr's are able to follow these guidelines because they are not yet trained. The few that are able to catch breech are rarely willing to be on call for women in labour. I've been told to tell couples in class nothing has yet changed regarding breech birth.

    Naturally, this change in practice is a bit hard to swallow for me since I did have breech babies - and even though I was 10cm dilated when I showed up at the hosp, hosp protocol followed current SOGC guidelines - no vag breech births of twins. It feels wrong when our choices are restricted by arbitrary protocols that we KNOW don't make sense. *sigh*

    Work is still to be done.
    I'm looking forward to the conference.

  2. Simulation lab has gotten so real to life that we have dolls that deliver babies. Does the Doc even need to practice these skill on a live birth? They also could start out by doing breech deliverys on the second twin. That may be a less stressful situation for them. I am in the USA and many of my Docs up until recently would do a breech 2nd twin no problem. Recently they have started refusing to do that.

  3. I wonder when they get this training going if I could go to Canada to learn breech skills, and then have any kind of leg to stand on to offer breech vaginal delivery to good candidates? I'm trying to imagine ACOG coming out with this kind of statement and offering retraining in breech techniques, but I'm not seeing it happen.

  4. Oh, it makes me so mad that we will ADMIT this and yet little is done to change the mindset and practices of thousands of OB's and midwives. I just read a post on a board I belong to that went "I had to have an unexpected c-section because the baby was breech". I always want to respond with my breech birth story but I don't because I know it will only help to make her feel 'less than' somehow.

    Midwives still have breech knowledge but I don't know many OBs who will be seeking them out to learn, for sure.


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