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In June of this year, the Society of Obstetricians and Gynaecologists of Canada (SOGC) released updated clinical practice guidelines for the vaginal birth of a breech presentation. After a review of available research comparing outcomes of breech birth via the vaginal route with breech birth via c-section, the society's Maternal Fetal Medicine Committee reached the conclusion (among others) that "[c]areful case selection and labour management in a modern obstetrical setting may achieve a level of safety similar to elective Caesarean section."
For Canadian women and their doctors, this means that the c-section is no longer the default standard of practice for breech births in hospital settings. Could this lead to changes in the way breech presentations are handled in the US?
Read the updated guidelines in full at: http://www.sogc.org/guidelines/documents/gui226CPG0906.pdf
— Society of Obstetricians and Gynaecologists of Canada, "Vaginal Delivery of Breech Presentation," June 2009
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The medical professional's reluctance to deliver the breech baby is well founded. Based upon their experience, this delivery is fraught with danger. How can we expect a physician to handle the unusual delivery when he has not been trained to allow the normal delivery?
Indeed, complications may ensue in the process of labor and delivery, and in no way do I wish to disallow them. Yet I believe that many of these complications may be avoided with competent knowledge of the mechanics of the breech labor and appropriate delivery technique.
Physiological reasons for breech presentation:
- Prematurity
- Placenta previa
- Hydrocephalus
- Multiparity
- Hydramnios
- Uterine abnormality
- Tumors or fibroids
- Multiple gestation
Other than these obvious physiological reasons for breech presentation, I believe the baby chooses the position that is most comfortable and that will guard him against oxygen deprivation. For example, I have delivered three breech babies who had complete knots in the cord. If they had been born vertex, they may have suffered hypoxia or been stillborn. Also, it is not unusual to find that the placenta, though not a previa, is somewhat low-lying (most often delivering Duncan), which leads me to wonder if the baby assumes the breech position to avoid the greater weight of his head pressing against the placental site, thereby reducing oxygen flow.
When considering a vaginal breech delivery, it is imperative that the mother is emotionally stable, has a high degree of confidence in her body as well as in her midwife, and has a high degree of motivation. In attempting breech delivery, excellent communication and cooperation between the mother and her birth attendant are crucial. Allow extra time for a careful discussion with the parents so they will know what to expect.
— Valerie El Halta
Excerpted from "Normalizing the Breech Delivery," Midwifery Today, Issue 38
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Q: I broke my tail bone during delivery of my first daughter 27 years ago. I still have pain when I get up from sitting on a hard chair and in some other situations. It was very painful for a long time, and was well over a year following the birth before I was able to get up off a chair without gritting my teeth or gasping in pain, and I have a strong pain tolerance.
My daughter weighed 9 lb 6 oz. Would a different position have helped during birth? I gave birth to my second daughter on my side rather than on my back.
— Anne
SEND YOUR RESPONSE to mtensubmit@midwiferytoday.com with "Question of the Week" in the subject line. Please indicate the topic of discussion *and the E-News issue number* in the message.
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Q: What do you think is the primary fact that causes women to fear, or not trust, birth?
— Anonymous
A: Fear mongering from the press and medical establishment. Lack of options. Difficulty connecting with natural birth support networks.
Nine essential elements to achieving the birth you desire:
- A deep conviction in your ability to birth
- At least one person who shares this conviction to support you through the entire journey
- Birthing with practitioners who are committed to birth rights, compassionate and normal birth and motherbaby-friendly standards of practice
- Taking responsibility for your physical and psychological well-being and preparing yourself
- Avoiding birth conversations with people who don't share your conviction
- An ability to sort through or tune out all the conflicting and fear-based information and advice which bombards pregnant women
- An ability to say NO
- An ability to explore the unconventional
- Patience
— Birth India
www.birthindia.org
A: In lots of discussion with friends and patients, I think it comes down to two main things: we have always been taught that someone knows our bodies better than we do (we abdicate choice) and that pain is BAD! In most cases, pain is a sign that something is wrong, your body is trying to tell you that you need help in some way. Whereas in birth, this is turned upside down, pain is good! It lets you know where the baby is and what stage you are at, whether the pain is uterine contractions or the cervix opening, and we can use that pain to guide us rather than being afraid of it. So the pain in this instance is a good pain of stretching and opening and allowing.
— Maryellen, Chiropractor
A: The ravage of civilisation, including the breakdown of village and extended family, and the sick influence of authority (patriarchal, religious, medical). Without village and supportive sisterhood and elders, the girl and maiden do not see, or become close to, or learn of, older mothers birthing—and so birth is unfamiliar, scary. With men seeing women as inferior, priests telling us the body is evil, and doctors telling women they know better, women are in an unsupportive world. The overwhelming pressure of our unbalanced culture is causing women to fear and distrust birth.
— Bruce Mitchell
A: I don't believe it is a "fact" at all that causes women to fear birth. Nor do I think that it is one particular story or piece of information.
Instead, I believe it is the compounding of negative stories from those around us, combined with scary images of birthing in the media and negative information from caregivers. The very people who ought to care about our birth experience—friends, family, midwives—are often the same people who undermine women's confidence. Advising a pregnant woman to have an epidural tells her that you do not believe that she is strong and made to do this. Suggesting that an induction be booked, just in case she goes significantly past her due date, suggests her baby and body do not know how to birth. Telling her that she has the same body as her aunt who had a c-section goes against trusting her body.
A wonderful term for these sorts of statements is "practised doubt." Birth in North America is a magnet for practised doubt.
Each of us needs to look at how often we introduce doubt to any girl or woman who might one day birth a child. Statements that introduce doubt in women's abilities to birth manipulate women to be less than we are. Instead we need to be affirming how perfect our bodies are and how beautifully they function, from periods to pregnancy to birth, breastfeeding and beyond.
— Jennifer Elliott, B.Ed., HBCE, CH, CD (DONA)
A: I believe the main reason that women fear birth in this country is because of a lack of natural birth examples to follow. The best way to lead is by example. Where are the examples of mothers giving birth with other women by their side, nurturing them, caring for them? Where are the examples of loving, supportive spouses learning pain management techniques to help laboring mothers? Where are the examples of health care professionals creating a supportive environment for a natural, unmedicated birth? The examples, mentors, teachers, spouses and health care professionals are few and far between, especially in America.
In my childbirth experiences, both personal and professional, there was and is an overwhelming lack of mentorship and nurturing that new mothers-to-be receive from other experienced mothers. Women need more first-hand examples of women giving birth naturally or unmedicated. Women need more first-hand examples from women with experience in helping women have natural, gentle pregnancies and births. The reason for this paucity of leadership by example is multi-faceted. I believe it started with medicalized birth beginning in the 1960s, and even before. Birth became categorized as a medical condition and even diagnosis wherein women required hospitalization. Birth was no longer a natural state and certainly not a rite of passage for women. Women, amazingly after 50 years, are still being robbed of their basic civil rights by not even being allowed to birth and care for their child in the manner they see fit. In many states we are unable to have homebirths, professional midwives, or even use birthing balls or choose which way we lie down to give birth. For example, I drove two hours in order to receive care from a midwife, in a facility that allowed me to use a birthing ball, give birth without laying supine and in stirrups, and actually stay with my baby the entire duration of my hospital/clinic stay. It is amazing that women still put up with having our rights stolen away. In this case, and I can say this because I am a part of the medical establishment, it is time for women to take back their right to birth.
So, as medical intervention has increased, fewer examples now exist of women who are giving birth without medical intervention. I had no personal examples to bolster my courage and strength while I was pregnant with and gave birth to my sons, and I daresay none of the mothers I have worked with or are friends with had many or any examples either. Women need to, arm in arm, take back their right to birth and help each other give birth. It is only then that we can dispel this false, fear-based mentality and alarmist attitude surrounding pregnancy and birth that, in my opinion, the medical establishment has needlessly and firmly rooted into the American landscape of maternal and child health.
In the future I imagine a beautiful flowering, blooming, blossoming, organic, natural garden of new mothers and experienced mothers, together with their caring supporters, giving birth in all of its beauty, magnificence, and mystery. This portrait, not the current one that has been hung for far too long in the collective gallery of mother's minds, is the portrait of birth that needs to be repainted in America.
— Ginger Garner, Physical Therapist, Professional Yoga Therapist, Childbirth Educator and Women's Health Specialist
Responses to any Question of the Week may be sent to E-News at any time. Write to mtensubmit@midwiferytoday.com. Please indicate the topic of discussion *and the E-News issue number* in the subject line or in the message.
We are looking for your best massage- and touch-related "Tricks of the Trade" for an upcoming Midwifery Today issue. Send your tips with "Massage Tricks" in the subject line to: mgeditor@midwiferytoday.com
The Ottawa based advocacy group Coalition for Breech Birth (CBB) will host the International Breech Birth Conference at the Bronson Centre in Ottawa, October 15 and 16, 2009.
On the heels of new guidelines published by the Society of Obstetricians and Gynaecologists of Canada (SOGC), the International Breech Conference will bring together a community of experts and consumers from around the world working toward the restoration of breech delivery skills to maternity care providers.
The CBB is thrilled to announce a high profile line-up of speakers at the International Breech Birth Conference including world-acclaimed obstetricians, midwives, researchers and others who have assisted women and tirelessly defended their right to vaginal breech delivery. Invited experts hail from Canada, the United States, Germany, Australia and the United Kingdom. Special guests include the legendary American midwife Ina May Gaskin, author of Spiritual Midwifery and Ina May's Guide to Childbirth.
Local speakers include: Dr. André Lalonde, Vice President of the SOGC; Dr. Robert Gagnon, an obstetrician from Montreal; Betty-Anne Daviss, acclaimed researcher and Ottawa midwife; and Dr. David McCoubrey, an obstetrician who delivers breech babies at the Montfort Hospital which has already reinstated vaginal breech birth protocols. Additional speakers include prominent chiropractors, naturopaths, and consumers with insight into breech birth.
Fees are on a sliding scale, making this conference exceptionally affordable for consumers, while offering educational credits to participating obstetricians, midwives, nurses, chiropractors, naturopaths and doulas.
Registration is now online at: www.breechbirth.ca
— Coalition for Breech Birth
www.breechbirth.ca
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