Wednesday, November 28, 2007

Breech babies

So, what do you all think and know and want to discuss about breech babies? I personally haven't experienced this, but I found out after the film and big discussion with the Mamas on my trip that this is fast becoming a dying art form, no longer even being taught in Medical School, and is in danger of becoming totally obsolete besides among grassroots mouth-to-mouth midwives and UC Mamas and of course, self educating online which has risks in many people's eyes.

I was taught through all that I read that breech presentation was a normal variation of birth. Ina May Gaskin wrote my first midwifery text, Spiritual Midwifery, and this book is still my bible as far as so, so many things. There are easier and more tricky breech presentations, depending on which part of the baby is presenting first (feet, butt, etc) but it does occur, and so what are women to do if this is now (yet another) CSECTION red-alert trigger?

My own Mom was born breech, (vaginal) and I remember this being something I was familiar with from a very early age, the idea of non-head first babies!

Here's one little thing I was looking at today, but of course there is tons out there. I am open to discussion from all sides of the issue, as always!


mm said...

My first child turned to breech during labour... it was a mess. One foot out, other leg flexed (could see his knee in my abdomen) umbilical cord everywhere... yet, I am told to this day that if I'd believed in myself and fought, I would have been able to birth him vaginally.
I'm still angry about the c/s. I'm still angry at people who tell me over and over how easy breech babies are to deliver.
I've seen some great outcomes for vaginal delivery breech babes, and some pretty devistating ones... I guess it depends on the mom, careprovider and babe.
I can tell you that personally, I was always terrified for the next babe to be in a vertex position... makes having that hbac so much easier to attain! *our Province has issues with home breech birth, hospital, fine... home not so much, lose your licence type of thing!
Three doctors in our city 'do breech births'. The midwives have the surprise ones on occassion from what I hear. But no... the college does not train the ob docs to do them... =(

Andrea said...

I haven't experienced this, but what drives me crazy is that it's a one-size-fits-all c-section solution. That, to me, is just not good medicine. Shouldn't every instance of a breech baby be judged individually? And if a care provider isn't experienced with vaginal breech deliveries, shouldn't they admit that this makes them a substandard care provider for a breech baby? And shouldn't a woman who would like the OPTION of a vaginal delivery be referred to someone with experience, rather than being categorically denied?

In a perfect world, of course, of course. If nobody knows how to handle it anymore, there's no option there, anyway. And then there's the issue of legality. My midwife told me she was trained to do them *just-in-case* and very much wanted the experience, but it's illegal for her in this state to knowingly deliver a breech baby. She once was back-up for a woman delivering at home whose baby turned breech the night before he was born, and they were required to call EMT's. Of course, when the EMT's arrived, they had no idea what to do with a breech delivery, and basically had to wait downstairs while the midwives, who did know what they were doing, handled the delivery.

It's really asinine here -- those who know how (DEM's) aren't allowed unless there's no other way, and those who could in theory (OB's, etc.) don't know how.

Kelley said...

The whole medical birth community makes me want to go screaming around pulling my hair out in frustration. The commenter's last words ("those who know how (DEM's) aren't allowed unless there's no other way, and those who could in theory (OB's, etc.) don't know how.") say it all perfectly? Well said.

Rixa said...

I find the near-extinction of vaginal breech birth very distressing. Basically most obstetricians have NO IDEA how to attend 3-4% of all term births, except to cut the woman open and extract her baby. That, to me, is pretty shoddy training.

The midwife I apprenticed with attended breech births, including one set of double breech twins. I am not sure they knew both babies were breech beforehand; the second baby required a lot of resuscitation but all turned out well after that. She wasn't comfortable with footling breeches, but was fine with frank breeches.

Vaginal breech birth in most hospital settings frankly scares me, because I would not trust most people to be able to keep their hands off and let things occur on their own. One thing I've read a lot from those experienced in attending breeches is that you absolutely do nothing to augment labor and no epidurals.

I chatted with Dr. Mayer Eisenstein of Chicago's HomeFirst about breeches. He attends them, but less frequently than he used to because he said if he does too many home breech births, he risks losing his hospital privileges. Anyway while we were chatting he mentioned something he'd learned from another very experienced doctor (I think Dr. White but am not sure on that), who had noted that if a woman is a certain station by a certain dilation (again, can't remember the specifics...will have to email Dr. Eisenstein on this one), the birth will always go smoothly. If the woman is not at a certain station by that dilation, it doesn't mean that it won't go well, but the inverse had always proven true. Now how's that for confusing! I need to get accurate info and update you on this. said...

I think Rixa got it: "Basically most obstetricians have NO IDEA how to attend 3-4% of all term births." And yet these are the people to whom almost every woman in the country entrusts herself during childbearing years.

The particularly frightening part of the lack of breech training is simply that every breech mom-baby pair will not "make it" to a hospital that is staffed and at the ready for surgery (nor will every breech be known at the time of labor). I feel sorry for (and am frightened for) those moms, who birth with an untrained, scared attendant who has a better chance of hindering and endangering the pair than (s)he does helping.

Leigh said...

Joy, you likely know how I feel about breech birth. Seeing as both of my babies were comfortably (Frank) breech during most of my last trimesters, I feel as if some babies definitely prefer to birth feet/butt first. Who are we to decide otherwise? For me, after two successive breech births, I feel that is indeed a variation of normal.

I had a C-birth for girl #1 (transport) because she seemed to kinda be stuck. I still feel confident that I could have birthed her at home.

I made the decision early in pregnancy #2 that I'd lovingly accept whatever means/method of birth this baby decided and that baby would hopefully be born at home. She was Frank breech too and knowing that, I worked with a close friend in the birthworld to educate myself on birthing a breech. The birth went just as we'd plan with zero intervention ("hands off the breech" approach)save for checking heart rate and 20 seconds of blow by O2 afer she was in my arms. Born at home!

Yes, it was intense but baby was healthy and vibrant. I know no other way to birth babies - a vertex baby seems out of the question. HAHA.

I am all for natural methods of turning a breech. I tried ALL of them. And yet, in the end, I believe baby will turn if they are inclined. Mine were not. And we must trust their inherent, primal wisdom.

Rixa said...

I just spoke with Dr. Eisenstein and typed up what he told me on my blog.

Anyone had experience with this?

Kelley said...

Dr. Amy just commented on a breech post on Rixa's blog, and I tried to call her out on how dumb her logic was. She has countered, and I don't know enough about breech births to know if what she is saying is true or not. Could somebody help me out? I don't want to respond to her unless I have my facts straight because she seems nasty enough to happily rake me over the coals. Even so, it sounds like she is pulling out the worst possible stats she can find. Is she right?

Rixa said...

Don't try to argue with her. It's not that everything she says is a lie; it's just typical technocratic beliefs, emphasizing the dangers of breech and the benefits of cesarean.