Turnabout on Breech birth–talk is cheap

All day today I’ve received emails, telephone messages and Facebook notes letting me know that the Society of Obstetricians and Gynecologists of Canada have had a change of heart about vaginal breech birth.  The article in the Globe and Mail lets us know that the 30,000 Canadian women who undergo major abdominal surgery to have their breech babies have been given a raw deal. 

There is an obstetrician in Ontario, Mary Hannah, who has been the source of much of the wrong headed “research” that has led to the out of control rate of cesareans world wide.  Ms. Hannah was behind the study that said babies should be induced at 41 weeks gestational age.  That study was found to have major methodology flaws.  Now, we know that the breech study by the same woman is also bad science.  I would like to see the S.O.G.C. issue a press release that Ms. Hannah will not be allowed to publish in a scientific journal ever again.  She’s got a great deal of karmic debt load for causing so much unnecessary suffering in the world with her two multi centre controlled trials.

In obstetrics, the first rule has to be “Mother Nature is probably right”.  After all, Mother Nature has been doing birth for a very long time and doctors have only come into it relatively recently.  When these studies are so counter to what Mother Nature has been doing for millenia, they have to be suspected of being flawed in the methodology.  The fact that doctors and midwives march blindly along righteously cloaked in “evidence based practise” without questioning the wholesale surgical nightmare is hard to believe.

I cannot get excited about this latest epiphany of the medical profession.  The fact is that doctors feel good about being aggressive with birth.  They don’t like the unknown and they don’t like things wild.  The context of hospital treatment is to “control” the birth.  A controlled breech vaginal delivery is not a pretty thing to watch.  Through the 1980’s, I had a friendly obstetrician who would “allow” breech deliveries.  He would bring the woman in to be induced with a foley catheter placed into her cervix (a balloon at the end of the catheter would be inflated with saline solution to provide an irritant to the cervix).  The induction was done because he didn’t want the breech baby to get too big.  When the woman started to have sensations, he would get an I.V. into her arm so that he could get Pitocin running when she was pushing (didn’t want an arrest of contractions once the body was out).  Most of those breech births involved him cutting a “generous” episiotomy and introducing Piper’s forceps into the vagina  and onto the baby’s head to pull the head down.  Just recalling it all makes me sick to my stomach.  Those poor babies would usually come out with the placenta on top of their heads like a tam.  One little boy was resuscitated for over an hour and has severe cerebral palsy. The mother, too,  would have to recover from the episiotomy and that was brutal.

What was the alternative?  I had no experience with breech birth and I didn’t want my client to have a cesarean and have her childbearing future tainted forever.  Breech cesareans are not a pretty sight either.  The head can be trapped and forceps are needed to extract it from the abdominal incision.  Another boy has cerebral palsy after a cesarean done by a resident who had a terrible time getting the babe’s head out.  We didn’t have the internet back then, either, so I didn’t have access to all the great midwives who have published their ideas and photos of breech births. 

It’s different now.  I now have experience with breech birth and I’ve gathered really good information and tricks of the trade.  A home birth with a breech baby is a whole different kettle of fish than a hospital “breech delivery”.  Not every breech baby can be born safely by the vaginal route and, if a hospital is truly needed, a cesarean is a good option at those times.  The majority of healthy women with a breech presenting baby, however, will fare better staying away from hospital procedures.

If the S. O. G. C. is serious that it wants Canadian women giving birth vaginally to their breech babies, they’d be wise to hire an international team of midwives to show the doctors how it’s really done in the home setting.  Mary Cronk (England), Lisa Barrett (Australia), Ina May Gaskin (U.S.A.), Maggie Banks (New Zealand) and Patti Blomme (B.C., Canada) are the ones I’d like to see heading up that team.  When I see those women on the ground in Canada, I’ll get excited about the chances of Canadian women having vaginal breech births. 

Breech

13 thoughts on “Turnabout on Breech birth–talk is cheap

  1. I am afraid I have to agree with your feelings on this. I read the article yesterday, and i have to say that the last thing I felt was excitement. During my last pregnancy not three months ago I fully dove into the birth world and the further I went the more upset I got. Apart of me wants nothing to do with the whole scene because most of the time I feel helpless to how backwards most every bodies thinking towards birth is. But then I speck with you or read something you wrote or someone who follows your thinking and I want to jump in all over again. I guess what I am trying to say is we have so far to come before things can be right again that its hard to get excited about anything . . .

  2. I agree. There aren’t many OB’s out there who have a clue on how to assist a breech birth. I don’t think they will call on the experienced midwives unfortunately 🙁

    Having said this, this new statement does open doors to moms expecting breech who want to home birth. Hopefully more and more midwives will be able to assist those births and more and more moms will be able to stay home 🙂

  3. I think you are wise to withhold excitement until it is seen whether this recommendation is followed, and how. Just the idea of ‘management’ and the rush to train OBs is, I think, suspect, since as you say nature knows best and does birth so well if left watchfully alone. I’m not so sure those breech births to come will be left watchfully alone.
    I was one of those 30,000; I had an elective section for my 1st baby six years ago because he was frank breech. I have mixed feelings about it, obviously, especially since this SOGC announcement. Perhaps we should plan some sort of kidnapping/forced major abdominal surgery/evil laughter revenge for Ms. Hannah? 😉
    I’m so very glad I was able to have a midwife attended VBAC last summer. It healed many things in me that were in pain as a result of that first, surgical delivery. To deliver and to be delivered of–world’s apart, in my experience.

    Thanks for this post.

  4. I had my twins at home just a little over a year ago. We went into labor with both babies breech. My daughter, Claire, was born complete breech with just a little foot in the vagina preceding the rest of the ball that was feet, thighs, skins, and butt cheeks! It was a bit more difficult to push her out and she was born very quickly once I got that ball of body out so needed some suctioning and a little O2. Otherwise, it was straightforward and pretty easy all things considered. Her brother flipped vertex (posterior! ACK!) to be born. My midwives were very hands off and allowed me to push her out on my own. It was a delightful experience!

  5. “After all, Mother Nature has been doing birth for a very long time and doctors have only come into it relatively recently.”

    I love this line!

  6. I agree with you,in that I can’t see many practicing OB’s running out to get retrained in breech birth delivery.It is difficult for many to admit they don’t know something. Also we all know they are gods ( can you taste my sarcasm?) – so who would they learn it from, not midwives, that’s for sure. I would love to see the skilled birth attendants teaching the doctors how to properly receive a breech baby. But then I would love to see them learn how to receive a baby properly at all!

    Most doctors won’t deliver a mother in anything but a lithotomy position, nor admit that any other position for birth could be preferable. How could they accept the variations that are needed to make a breech birth sucessful?

    I hate to say it, this is a lot of talk on the part of S.O.G.C., but most women will still be sectioned for breech babies.

  7. My wife birthed our second daughter breech at home, after 8 hours of uncomplicated labor (the same length of labor I had with my vertex second baby and it was her first birth), she got into the water, stood up, Indi came flying out into my arms butt first and we went to bed.
    Much easier than any hospital birth.
    We attempted an ECV (were slightly wary of this but Danny wasn’t comfortable UCing with her first breech birth and it took us forever to find a midwife who attends breech births here. Of course when we did find a midwife to attend the birth she was out of the room the whole time and didn’t touch either Danny or Indigo at all) and in the hospital before they even attempted to turn her they were telling us how many breech babies had died in their hospital, how Danny should be booking in for her c-section right away and shouldn’t listen to me because a wife and doula is not an obstetrician trained in ‘delivering’ breech babies.
    They felt threatened by us because we were informed and making valid points.
    Those obstetricians were attempting to ‘help’ these babies out, with pain meds, forceps and episiotomies rather than letting women listen to their babies and either guiding their own babies out or letting their babies just fly out.
    Danny had a minor tear that healed easily by itself and she felt great after the birth.
    I believe babies who insist on being born vaginally breech are born that way for a reason.
    Indigo had a very short umbilical cord which is said to ‘encourage’ breech presentation. We personally interpret this as the breech position being the safest way for her to be born with a short umbilical cord.
    ECV, acupressure, acupuncture, chiropractics and OFP did not turn her and in the end we were glad as her birth was perfect and natural and beautiful.
    Sorry if this is a bit all over the place, been up with sick kids for ages.

  8. Thank you for posting this. I don’t think you are wrong in the least. As a Canadian mother and student midwife who refused a scheduled cesarean for a breech baby in 2006 (who despite all the odds turned vertex at 40 weeks, something only my midwife told me was possible) I am glad to see the reversal in position… but only if it’s going to be backed up by people who actually know how to let breech babies be born. I know a woman who had a horrific vaginal delivery of a breech baby in the late 1950’s and still carries the horror with her to this day… breech should be a variation of normal, not something requiring cutting into the mother as a matter of course.

  9. Thank you for such an educated post, once again Gloria. While I feel that the protocol is a small step in the right direction.
    I have my doubts many will take the time to either train or change their practice, it is only a recommendation.
    As far as I know they recommend continous foetal monitoring, and recommend vaginal b reech only in cases when the baby is full term, neither early nor late. It will still be a managed birth with all the trouble it brings.
    See you on Thursday, I am sure we will talk about it some more.

  10. Gloria, thank you for making comment on this turn about.

    I will still caution women about birthing under OB with a presenting breech. Just because there is a reversal in attitude that is reseach based…it does not mean the OB you have will come through for you when you present in labor.

    Understanding how to safely birth a breech will still remain the responsibility of the mother. Until we have women like Maggie Banks and Mary Cronk leading the way with “how to” we will still breeches born with he mothers being told “what to do” and not “follow your instincts”.

    Patti Blomme perinatal RN, mother to 5 (2 born breech).

  11. Most obstetricians (and unfortunately too many midwifes too) don’t have experience on assisting a vertex-head down fully natural and physiological birth, how can we expect they will assist a breech birth?
    Of course, it’s good news anything that officially moves away women from the OR at the moment of birth, but there is still a long, looooong way to go through.

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