Tuesday, August 29, 2017

A physiological breech birth in Brazil

This gorgeous upright breech birth is worth the time to watch. The mama had originally planned a home birth, but transferred in labor to a hospital due to breech presentation. I loved watching the OB's face as she is sitting at the foot of the bed. I imagine she is thinking "Best. Day. Ever!!!"

For a faster sneak preview, start the player at 6:15. You'll see the baby following all the cardinal movements of an upright breech:
  • Body rotates from transverse to facing straight towards the attendant ("tum to bum" as they say in the UK)
  • Legs go on forever, knees look turned almost inside-out, and then plop out 
  • Chest crease or "cleavage" indicates arms will soon follow
  • Baby does a tummy tuck once to release its arms and once again to flex its head
This all happens so quickly that the filmmaker put the birth in slow motion.

Here is the Google Translate version of the birth, taken from the YouTube page:
Thayla was born on a rainy Sunday in May 2017. The initial plan was a home birth, but she was breech (with her butt down and her head up), so it was recommended that she be born in a hospital. The family stayed at home accompanied by midwives Paula Leal and Silvia Briani of Mamatoto team and doula Thais Olardi, until her mother, Thais, was 7 cm dilated. In this hour they went to the Hospital and Maternidade Sepaco where, after a short time, Thayla was born in a totally natural way, without any intervention, in a respectful and humanized way. In the hospital the family received the support of the obstetrician Camila Escudeiro and the neonatal pediatrician Nicole Martin.

It is with great generosity that the family opens up their intimacy and discloses the video of the birth of Thayla. Parents believe that good stories deserve to be told and that it is indeed possible for pelvic babies to be born naturally. The biggest message that Thais leaves to all mothers is: "Believe in yourself, believe in the strength and perfection of your bodies!"

Clareou Films took great pleasure in following this story and is flattered to share with you a story of faith, determination and a beautiful happy ending!

Congratulations to the dads and thank you for sharing this special moment in your life with other families! Welcome, Thayla

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Saturday, August 26, 2017

Why do I care about breech so much?

This letter explains why I want vaginal breech birth to remain a viable option for all women. It was originally written to a member of the Coalition for Breech Birth Facebook group and shared with permission. (I added paragraph breaks for readability.)


Hi F___, I found your posts that had the hashtag "forcedcesareans." I searched it because I feel like very few people understand the pain I'm going through. I had a forced c-section because my baby was frank breech. I knew vaginal was possible, and that it happens in many European countries (hospitals too). I live in WA, and as anywhere else in the US, hospitals don't allow vaginal breech. I felt completely trapped, I wanted to run away before the scheduled surgery but I couldn't because I've been showered with scare tactics by the doctors.

The day of the surgery was a complete nightmare and I was in shock and scared the whole time. I felt like dying while the needle was entering my spine. "When you'll see your baby it won't matter", they said. And it didn't for a couple of minutes, because I was drugged and tired of fighting over what was no longer my pregnancy. But then I stopped taking opioids (I had to have an unmedicated birth... I didn't want anything like that! I wanted at least to go into labor...), the pain became less intense and anger grew inside of me.

I still feel angry and I feel like it's growing everyday. I still have flashbacks that some days are very frequent. And I feel angry and desperate and lost. They all knew. Everyone knew I absolutely did not want this. I cried at every appointment since the word "breech" was mentioned. I cried every day in between, and after, especially as the physical pain was decreasing, leaving space for more anger. I do not trust hospitals anymore. I hate my body now. I was loving it. I was loving my pregnancy until then. Now I feel like half a person. I have a baby but I didn't give birth. And no, I didn't. Every time I hear someone who's never had it done say "it's the same, a friend of mine had both vaginal and cs and she said there's no difference!" I get angry. I hate everything about it.

I don't trust hospitals anymore, at least not for birthing. When they saw I was in despair they kept repeating me next time I cod go for a VBAC. They were already planning my next pregnancy, exacerbating the feeling that what I was living wasn't my pregnancy anymore, and the next one too (the hospital being more TOLAC friendly than VBAC. What a joke.). They also made me feel inadequate because my baby was too sleepy from my opioid-tainted colostrum and she lost 11% of her birth weight, telling me I had to integrate with formula as my nipples were also sore.

I'll never forget what a horrible thing was done to me, all because of hospital policy and the lack of expertise. Because of their limits I had to be sliced open, had my baby removed from my body before labor even started, leaving me deeply traumatized, emotionally and physically broken, afraid of my own body and worried about my future pregnancy. I will have to report the surgery even if I will have to go to the dentist, reminding me every time that my bodily integrity is gone forever. All because my baby was head up.

Sorry for the long message... I just need to communicate how painful and horrible it is to prevent a woman from doing something so natural that her body needs. It messed up my psyche and I feel anguished about surgical birth unless strictly necessary. Thanks for reading... ❤️
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Thursday, August 24, 2017

The Tsovyanov maneuvers for frank and footling breech

I discovered two maneuvers for assisting frank and footling breeches while wading through PubMed literature on breech from the 1950s. I've never heard of anything like it before. It was introduced by N.A. Tsov'ianov in the Russian medical journal Sovetskaia Meditsina in 1951 in an article titled New method of conduction of labor in breech presentation.

Tsov'ianov (also spelled Tsovyanov) apparently introduced two maneuvers. Maneuver I was for frank breech presentations; maneuver II was for footlings.

I'm having a hard time finding details about these maneuvers, since all of the articles are in Russian and the references on PubMed do not include abstracts. However, I did find this website about breech pregnancy and birth written hosted by Ternopil State Medical University in the Ukraine and written by I. Kuziv. A friend of mine living in Russia, Katerina Perkhova, sent me the illustrations.

Here is Kuziv's summary of the "Tsovyanov I" maneuver for breech breech babies:
The manual aid by Tsovyanov I in frank breech presentations.

The aim of the manual aid: to prepare the maternal ways to the delivery of the head and shoulders and to keep the normal attitude of the fetus.

In the frank breech presentation the fetus extremities are flexed at the hips and extended at the knees and thus the feet lie in close proximity to the head. The circumference of the thorax with the crossing on it arms and legs is larger than circumference of the head and the after-coming head deliveries easily.

The technique. The aid begins after the delivery of the buttocks. The obstetrician’s hands are applied over the buttocks, the thumbs placed on the fetus sacrum and other fingers on the legs. The doctor gently supports the legs to avoid its flexion. If the normal attitude of the fetus is keeping the head deliveries easy.

It appears that the attendant holds the legs against the torso, keeping the feet near the head for as long as possible.

Here is Kuziv's summary of the "Tsovyanov II" maneuver for footling breech babies.
The manual aid by Tsovyanov II in footling presentations.

The aim of the manual aid: To perform [convert?] the footling presentation to the incomplete breech and to prepare the maternal ways to the delivery of the head and shoulders.

The doctor covers the area of the vulva with the sterile napkin and puts up resistance to the delivery of the feet. The feet are flexing and the footling presentation becomes incomplete breech presentation. Than the delivery manage as in incomplete breech presentation.

I think the author means that this second technique converts a footling presentation into a presentation where one or both hips are flexed. "Preparing the maternal ways" refers to creating a large enough diameter in the fetal presenting parts for the fetal head to pass through easily.

Thoughts? Comments? Are the Tsovyanov methods still taught in Russia, the Ukraine, or other countries in that region?
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Wednesday, August 23, 2017

Physiologic breech birth workshop with Shawn Walker in Toronto

The Association of Ontario Midwives is sponsoring a physiological breech birth workshop with Shawn Walker on Sep 11 & 12 in Toronto. Participants can attend a 1- or 2-day session.

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Tuesday, August 08, 2017

Please participate in the "Birth On My Terms" project

From the Birth On My Terms Project at Texas A&M University:
Were you coerced, forced or pressured to have a procedure(s) during labor and birth? Such procedures may include: epidural, episiotomy, induction of labor, augmentation of contractions, IV medication or fluids, cesarean section, Pitocin, antibiotics or other medications, electronic monitoring, movement or lack of movement, or pushing position.

If so, we would be interested in learning about your experience.

We are conducting a study that examines the experiences of women who have been forced or coerced to have a procedure, including cesarean sections, during labor or birth. If you have had such an experience and are willing to share your experience, please click on the link at the bottom of this post. You will be directed to our secure and confidential survey site. The survey will include questions about you, your reproductive history and questions about the pregnancy, labor, and birth that involved a forced or coerced procedure(s). Participants will also be asked about any consequences of having the forced or coerced procedure. Completion of the survey is expected to take about 30 minutes. Participants names will not be used in any publication of results. To access the Spanish version of this survey, follow the link bellow and select the language option in the top right corner.
For more information, contact:
Theresa Morris, Associate Professor of Sociology
(979) 862-3193


Survey Link: https://tamu.qualtrics.com/jfe/form/SV_0HeWuF8x3FLKX41

**Feel free to share with those you feel would like to participate**

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