september mama

while i don't know for sure whether little mister is still breech or not, or what will happen with his birth, since i am doing all sorts of research on it i decided i should post my findings on vaginal breech birth for others who might stumble on this blog and need the info. i'm posting snippets of each piece just in case the links ever go dead (like they often do on gentlebirth.org, where i found most of this)!

ICAN says:

• Morbidity and mortality for breech infants and mothers is most related to inclusion and exclusion criteria adhered to by the hospital for determining mode of delivery, the competence of the attending physician, and the expectation of the mother rather than the mode of delivery.
• In general countries that perform more vaginal breech births have birth outcomes that are as good as or better than cesarean section outcomes. Countries that perform few vaginal breech births have birth outcomes that are worse than those for cesarean section births.
• In many countries breech vaginal birth has higher morbidity and mortality risks for babies, but the risk is still relatively low.
• Some of what has been typed as risk (e.g. low Apgar scores) is clearly not a long-term risk.
• Much of what has been typed as risk can be ameliorated by proper screening for vaginal birth.
• If you want to have a successful vaginal birth look for an old-time doctor or someone with a lot of experience with breech presentation.
• If you have a macrosomic baby or a footling breech cesarean may be better for you.
• To have a successful vaginal birth avoid induced or augmented labor and epidurals.
• If you are going to have a cesarean, consider having a scheduled cesarean without trial of labor.

source: ICAN fact sheet

recommendations for attendants at a vaginal breech birth:

Having excluded the above complications, the "normal" woman who at term has a baby in a breech position which shows no inclination to turn can, I believe be born easily and spontaneously, if the labour proceeds spontaneously and easily. Just like a cephalic presentation (head down), if the labour progresses and all is well, the woman is supported and cared for, the baby will be born. There is one major difference. Where in a cephalic presentation, labour is incoordinate, or lacks progress, augmentation is occasionally justified. I do not believe that there is any place for induction or augmentation in a breech labour. If a breech labour does not progress, this woman's body is telling us something, and we should listen. There is no emergency, there is no rush, this labour just isn't progressing, and this baby should be delivered by caesarean operation.

I do not feel that there is any place for either trying to push breeches through pelvises with oxytocic drugs or pulling them through with actively managed breech extractions. I feel that this management is what has contributed to giving vaginal breech delivery poor outcomes and such a bad name. In my experience, if the labour does not progress well and spontaneously, the baby needs to be delivered by caesarean operation.

...

Many women during their labour will adopt a hands and knees position. I find that this is the best position for the mother, the baby and the midwife. Some practitioners ask the mother to stand in an upright position. I am concerned that the placenta may separate too quickly in this position. When the mother is on her hands and knees the uterus appears horizontal and tipped forward. It seems to me that if the woman is vertical there may be some traction on the cord/placenta from gravity just after the birth and in the absence of a contraction. I do not have any evidence to support this theory but I feel that until I have evidence to refute it, I should not encourage women to give birth to breeches in a vertical position. It also seems that women will bend forward and assume the all fours position if not directed by us. We need research to help us in this area.

There is also some evidence that when the woman is standing, the birth can be too swift and the placenta can separate too quickly; assisted too much by gravity, it can arrive almost on top of the baby's head. So, I prefer the all fours position.

Old midwifery text books show that when a woman is on her back for the delivery the attendants lift the baby up by the heels, over the mother's pubis; when she is on her hands and knees this movement happens by gravity.

source: keep your hands off the breech

breech elective caesarean vs. vaginal birth:

So, what of the woman who is fortunate enough to be well informed and who takes the very unusual decision to remain 'naturally active' and give birth to her breech presenting baby in a supported standing squat? How much respect is such an 'informed choice' likely to engender? How much genuinely interested co- operation is she likely to encounter?

The general reaction from the vast majority of our maternity health professionals is very sadly likely to be at best unhelpful and at worst downright threatening. It is an indictment of our maternity services that if she steadfastly refuses to make the 'right' choice she is likely to find herself trying to give birth alone, unassisted, unsupported, surrounded by birth attendants oozing fear, with a ready-and-waiting operating theatre down the hall, complete with surgeon, knife at the ready, waiting for the errant patient to come to her senses.

Despite all the evidence pointing to the relative safety of natural active breech birth a mother can't possibly be properly 'informed' if she makes such a choice, can she?

source: breech caesarean operation vs. normal birth

midwife's advice on risks and ways to help avoid them:

Trauma and injury to the baby as a result of:
* normal swelling and bruising of the baby's presenting parts during labor and delivery
* delivery techniques and manipulations during the birth process causing fractures of the skull, neck, humerus, clavicle and femur
* spinal cord injuries
* damage to internal organs if the baby is grasped incorrectly.

Asphyxia due to:
* prolonged compression of the umbilical cord during delivery
* actual prolapse of the cord
* aspiration of amniotic fluid caused by breathing before the head has been born
* prolonged or hard labor.

Cerebral hemorrhage due to compression and rapid decompression of the head at delivery.

There is an increased need for resuscitation of the newborn who birthed breech as opposed to head first.

These risks may be minimized by some of the following techniques:

*Early detection and assessment of labor.

*Close observation and monitoring throughout the labor process.

*Intact membranes if possible.

*Client cooperation in delaying pushing efforts until complete dilation is achieved.

[check out her breech homebirth consent form!]

techniques for breech birth from the gentlebirth.org archives:

"MANA Conference--Chicago--Oct '94. This was one of the topics for a small group lecture. There was a physician there (can't remember his name) who brought a video of twin home birth. Second baby was breech. He put mom in knee chest position. He felt that since we elevate the trunk and thighs of a breech, after they have delivered, to keep the head well flexed, that turning the mother to knee chest would naturally do the same thing. And then just let the baby dangle with minimum support for body weight, it will come perfectly. Made sense to me."

source: midwife archives

movie trailer: a breech in the system:

source: abreechinthesystem.com

i found references to a supposedly wonderful book, Breech Birth Woman-Wise, by Maggie Banks, but it's not in the library database so i can't read it at the moment.

"The medicalization of breech has generated a high rate of automatic c-sections with no choice given to the birthing woman. While many studies and statistics have been accumulated for observational evidence, when women have not been given choice and cesareans have been performed on them, these statistics become merely circumstantial evidence. Thus 'uncontrolled observations…do not answer what might have happened if a different form of care had been provided.' "

and that's about it for now. i hope to add more info/links as i find them, if i find them.