Breech Birth

UK Midwifery Archives


These archives contain extracts from discussions held on the UK Midwives and Consumers email list, a discussion group for people interested in midwifery in the UK. Open to midwives, students, mothers, and anyone interested in improving maternity services in UK. Posts in these archives express the views of the individual authors, and not those of the Association of Radical Midwives.


Breech Birth


Midwives’ Views on Breech Birth

I have had six breeches last year, two of whom needed to be born by CS (caesarean section). One needs to distinguish between breech births – that is, babies born by the expulsive efforts of the mother, which in my opinion are safe, and breech deliveries – that is, babies born by traction by midwives and medical practitioners, which in my opinion are pretty dodgy.

We have reasonably good, safe caesarean section in the year 2000. We should use it for the breech births that do not progress spontaneously. If the labour progresses spontaneously, ie the contractions come oftener, last longer, get stronger, the cervix effaces and dilates, and the breech descends through the pelvis, the baby will be born. If this does not happen there is no place for augmentation – trying to push the baby through the pelvis with contractions driven by oxytocic drugs. Nor is there any place for trying to pull breeches through the pelvis with managed breech extractions. Labours that don’t progress are telling us that the baby should be born by CS.

..In my experience, if a breech presenting baby is too big for that particular woman’s pelvis, the presenting part does not descend and the labour does not progress. It is when we try to be clever and stimulate/augment the labour or try to do breech extractions that we get into trouble. Furthermore a big well grown baby has a big bum. The bi-trochanteric diameter is very similar to the bi-parietal diameter..

.. In my opinion, Epidural anaesthesia or any intervention is totally contraindicated in the breech presentation…

Mary Cronk
www.marycronkmidwiferyservices.co.uk


All-Fours for breech birth?

“I have some pictures from Practising Midwife of a breech birth where the woman was on all fours. Another midwife has asked if the weight of the baby hanging down at right angles would encourage the head to de-flex? “

The article and pictures she refers to are I think mine, and the question she asks is one that several people ask. The answer is no. The midwife supports the body once the trunk and arms are born and the head flexes spontaneously (or we can assist it by a finger behind the occiput tipping it forward and a finger in the babies mouth, or two fingers on its cheeks doing the same thing).

With the mother in lithotomy the practitioner swings the legs up, doing exactly what gravity does with the mother on all fours. Look at the pictures and play with a doll and pelvis and you will see what I mean.

Mary Cronk
www.marycronkmidwiferyservices.co.uk


Dear Mary,

I believe that you said that you thought there was a link between standing breech births and haemorrhage. If that is so, on what are you basing this? Is it from your own experience of breech births or from research? Why do you think bleeding may increase?

Ruth


When I have a few spare hours I will reply properly, But basically I do not recommend that a woman stands to birth a baby coming bottom first for the following reasons.

  1. Very few women will instinctively stand to give birth. Most will get down on the floor on all fours, and I feel that one should follow what most women will do without being influenced by anyone, particularly anyone with a French accent.
  2. There is some evidence from a study done at Kings a few years ago that the placenta separates rather too quickly with the woman vertical. I believe they had several poor outcomes from standing breeches so until I have evidence to the contrary I encourage women to be on all fours.
  3. The woman seems to me to be in better control of her birthing if she is self-supporting on all fours
  4. She will often start the birthing ie the emergence of the baby, kneeling up in what I think of as the prayer position (Christian) and then as the head flexes and emerges she will go forward almost into the prayer position (Moslem) I hope I have not offended anyone by using these religious explanations.

I do not know where the idea came from that I encouraged standing births – I have NEVER done so. Unless of course it is a head first birth and the woman definitely wants to stand, then I accept that this woman’s body knows best.

Mary Cronk
www.marycronkmidwiferyservices.co.uk


I was with a woman a few weeks ago – 1st baby felt head down on palpation when arrived on labour ward. VE 9cms, bulging membranes. Laboured in rocking chair, foetal heart fine. Waters went about 2 hrs later, clear. Urge to push gradually built up standing by bed, eventually chose to kneel on bed pushing for 1/2 hr then small amount of very fresh meconium. On looking at perineum a scrotum appeared hanging out of vagina.

Registrar informed, woman advised to try and breathe through contractions while assessing situation. Reassured that everything is fine with baby, foetal heart still fine.

Registrar arrived and told the woman it was a difficult situation as there were risks either way. If you go for c/s (which is the policy at this hospital for 1st babies) then we will have to push the baby back up. Or if you opt for vaginal delivery, we cannot guarantee that the head will not get stuck! So it’s up to you to decide.

All this while she is desperately trying not to push. Needless to say with that scenario in mind she opted for c/s under general anaesthetic as she had had no pain relief at all.

When I measured the baby afterwards, his head circumference was 38cm and so the staff felt justifed that this had been a good decision because that was a big head.

Donna


I got a bit confused here! With this wee lad being breech and then also being delivered by LUSCS, his head circumference would be bigger anyway, wouldn’t it?? i.e, no moulding.

I still thought that there was a degree of moulding with a breech birth? So, if this woman had birthed vaginally, then the circumference would have been smaller?

Brenda


Poor woman, having major abdominal surgery under general anaesthetic because of our lack of skill in helping her birth a baby presenting by the breech.

Her labour was obviously progressing very well and in my opinion would have continued to do so if she had been encouraged to get on with it in the position she had chosen.

If the attendants had got themselves a pint of beer or a large mug of very hot tea, faced the corner of the room, and drunk it slowly, the baby would have been born. If the buttocks were on the perineum the baby would have been born.

I have NEVER seen a ‘trapped’ head in a spontaneous breech birth. It is caused by breech extraction where the buttocks and body are delivered by the traction of the attendant and pulled down. Sorry, but this is bad midwifery and even worse obstetrics from a medical practitioner who is no doubt a good surgeon but does not understand his mechanisms.

Mary Cronk


I meant the staff who did the section were justifying it based on the head circumference. I hadn’t really thought about moulding occuring. To be honest I have never even seen a breech birth let alone helped with one so I didn’t really feel in a position to argue over the womans head. So I spent my time quietly talking to her and reassuring her that her baby was fine.

My humble opinion at the time was that everything would progress well but as soon as I informed the LW coordinator of the situation there was definite tension in the air and unfortunately this communicated to the woman. You could practically see her shutting down.

And although I had said yes to her query of “can the baby come out this way?”, this was not the impression she got from the medics when they arrived.

It was an awful situation for her to be placed in to try and make a decision like that at such a late stage with limited information.

I agree, Mary, it is very sad for her to have undergone major surgery after doing so well and it is due to the fact that skills are becoming less and less – and also the fear of litigation I assume (if the policy says c/s for primip breech and it is not done then someone has to justify why not.)

It made me want to revisit techniques of breech birth, but others at work said what is the point because we never do them!!

Donna


I have just had the pleasure of caring for a mum who had a baby in a breech position until 39 weeks. She came to see me the day after attending a hospital antenatal clinic whetre she was given the pros and cons of vaginal delivery vs caesarean section. She was unable to decide at that point and told them she wanted to go away and think about it. “Fine” said the hospital, “just give us a ring when you’ve decided” All very laudable except at the same time they pencilled her in for a CS on the 18th July.

We discussed the pros and cons further and she came to the decision that she’d attempt a vaginal delivery so that at least she could say she’d given it her best shot if it all ended in CS anyway. We also talked about acupuncture for helping to turn babies and all the different exercises that she was already doing.

Guess what? She came to clinic a few days ago and the baby was cephalic. Just think if she’d attended the hospital on the 18th for her pencilled-in CS – yes it was still breech on the 18th.

Nothing to do with delivery of breech babies I know but I am just so pleased that she went with her feelings about avoiding an unecessary CS.


There are midwives and obstetricians who prefer for breeches to be born in water. If you get a copy of the video of the Aquanatal Experience in Ostend, ( available from www.waterbirth.org) it has a lovely breech birth under water. The cardinal movements are beautifully clear, because the baby is being supported and kept warm by the water alone, so there are no hands obscuring the view. The warmth factor in and of itself would be an advantage over dry birth.

Angela Cross.


If you decide to have a vaginal breech birth, you may find that midwives and doctors are actually keen to help:

I’ve had my fare share of caring for women birthing a breech baby, usually undiagnosed (the only way they are ever “allowed” to do it). The first time, I was sitting waiting on the double bed in the ‘home-from-home’ unit.

Mum was on all-fours and the baby was out up to its umbilicus, when the obstetrician walked in at the request of a core midwife and said, “could we turn her over, I’ve never done it this way before”. I gave him a withering look and asked him to stay outside in case we needed his services. The core midwife was standing leaning on a forceps pack, and I shook and shook!

Outwardly calm, I watched in complete fascination as the baby smoothed his way into the world and sat on the bed with his head still inside his mum! All went very well.

One other that springs to mind is me being thankful that the baby was a boy – that was the only way I could tell it was breech to get the woman out of the pool in time! Had it been a girl, I dread to think! She had only one vaginal examination at 3cm and intact membranes. She later asked me what happens to women with diagnosed breeches. I told her the hospital policy, CTG, lithotomy, episiotomy, 15 people in the room, and she stated emphatically that she would labour in the pool again and blow the ******* policy!

Libby


Today I was to go to theatre to take a baby from section. I knew the woman from my community clinic, she is a multip, 39 weeks with an extended breech which she had wanted to birth vaginally. Unfortunately she was admitted the previous day with abdo pain and a s.h.o. (senior house officer – a fairly junior doctor) persuaded her to have a section (I’ll add here that she speaks very little English).

When I went to the ward to prep her for theatre she had obviously SRM’d (spontaneous rupture of membranes, ie waters broken) and was in established labour. I transferred her to labour ward and she was 7cm dilated (hooray, no section). The senior registrar (senior doctor) who was on was great and said that I could ‘deliver’ and he would supervise (I have seen a couple of breeches but never done one).

The woman cracked on, got to fully and the breech was descending. Then came a change of doctors, the breech is visible and the s.h.o. (who was the one who wanted the section) announces very adamantly that he wants to do it and then new senior reg goes along with this. It didn’t matter that I had known this woman for months, been with her throughout her labour and had it ‘cleared’ by the previous senior reg.

This may be sour grapes but he didn’t do it very well (Mary Cronk would have had a fit!). The breech was descending beautifully and it would have been a wonderful birth if hands were kept away. Luckily the baby was ok and the woman was fine. I just feel robbed as I had mentally prepared myself (selfish I suppose) but I was also upset that there was no discussion.

I feel very strongly that midwives should regain their skills in breech births and here was my opportunity. If the senior reg who was on in the morning had been there, I know he would have ‘let’ me have the lead. Thank you for listening.

Louise


Perhaps the doctors needed the experience of delivering a breech, as most of them end up with an elective section. At least she had a vaginal delivery. I have experienced a Doctor who insisted a woman was prepared for theatre when the breech was half hanging out!!

Vicky


A midwife who I tought breech birth to as a student, found herself about 1 year after qualifying in a midwives’ unit, half an hour away from a consultant unit, with a woman in second stage and breech presenting. She was perified, but she said that in her head she went through everything she was taught through simulation. She helped the mother give birth and everything was fine, with a good Apgar score!

Fortunately those rare emergencies, where the breech is advancing well, don’t generally cause problems. If only the obstetricians realised this!

In one hospital in which I worked, I assited several multipara breeches giving birth, without doctors present. I never had a problem. Then I moved to a teaching hospital where the Registrars were involved with the birth! Several of the babies had low Apgar scores. I’m convinced it was because they couldn’t keep their hands off!

Ruth



I am on nights at the moment so I have been a bit fuzzy and not chatting on the list but I was disgraced at what happened the other night….

A lady came in fully dilated with an undiagnosed breech, the little bottom was just peeping out! But the woman was a primipara, and I work in an obstetrically lead unit, so the midwife caring for the woman involved the Registrar, who obviously had no breech experience, and a C/section was performed!!!

I was so apalled but also felt so powerless, I could not support my fellow midwife or the woman since I have never supervised a breech delivery. I fear that I will never see a breech delivery and only have a chance to see breech extractions…..

Oh how I wished I could have turned into Mary (Cronk) and let that mother get into a kneeling position and let the babe find its own way out.

Anyway is the justification of a primip needing a c/s for breech since ‘we’ don’t know if the head will pass through the pelvis justified? I mean, a babe can be cephalic and have the potential for shoulder dystocia but that would mean we would have to section all women!

Any thoughts or advice for when this next happens……

Robyn


I too, was in a similar situation recently – a multipara with twins on board. The first twin was out – fine, but the second was breech and the Registrar’s ‘rummaging’ caused a prolonged bradycardia – result, section! I felt so powerless, I knew the theory, but didn’t feel that I had the authority to override the Reg. Later I found out that he had never delivered a breech and that was the reason for the section.

One thing I did learn from the experience, because it caused so much anguish to me, is that next time, I would act regardless. It all felt so wrong. I have to live with it now, it can’t be any worse than having to live with challenging a Doctor – win or lose!

Lynn


I tried to bring up this subject at a recent joint meeting ie different positions for birth — what was the response, I hear you cry?

Asked how we felt about women requesting to deliver a breech baby in a kneeling or standing position, the consultant obstetrician stated : “In my opinion the Mental Health Act is not used often enough in obstetrics!” and no further discussion was allowed!

Don’t you just love their enquiring minds!

Cate


I think we are amazing that we can even work with such closed-minded people!

However, in casual discussion with some other midwives, I start to hear worrying responses like….”well if the woman was a primip, I don’t think I would be happy her vaginally delivering a breech…” Why? “Because we don’t know if the head will pass through the pelvis”.

To that I stop the conversation and say, “Well, we don’t know if for a cephalic delivery that the shoulders are going to pass through the pelvis and we don’t do a C/section on every primip for that reason!”

Robyn


And for that matter, we never know if any baby is going to make it through that pelvis, but for sure, we can cut them out! I agree Robyn, this is a useless conversation. How about “the female pelvis was designed for birth”, and leave it at that.

Sue


Some months ago a friend of mine sought my help. She was pregnant with her fourth baby, which was in the breech position. All attempts to turn the baby were unsuccesful, so she was facing a breech delivery.

Previous births:
1) Vaginal breech delivery
2) Normal birth, head down baby, position semi-recumbent.
3) Normal birth, head down baby, all-fours position.

She dreaded a repeat of the first birth, which she hated, and very much wanted to deliver on her knees, as last time. So we looked at a number of articles on breech delivery—but little about active positions. Mary Cronk’s articles proved very useful (thank you, Mary).

We wrote a detailed birth plan, (as I could not guarantee to be available to be with her) On going into the hospital she met two very supportive midwives, and an unhappy doctor!! But she got her all-fours birth. Baby in excellent condition. Mum still elated months later!

I just wonder if any of you out there see many such births, and whether you know of any doctors(!) who would willingly support such a choice. ( our dr. was outnumbered by midwives and father of baby who adamantly insisted on compliance with the Birth Plan! But to be fair he did agree to the choice although he said that he was “unhappy”)

Pam, Midwife


I have only ever been at one footling breech delivery which was totally undiagnosed. Client came to deliver suite fully dilated on examination, membranes ruptured spontaneously, feet presenting. By the time reistrar arrived the client had delivered a healthy, if slightly shocked, baby who picked up very quickly. It was myself and a SHO (junior doctor) at delivery and, due to my wonderful training, I remembered what to do even though I had only seen one other vaginal delivery and that was a breech extraction of a second twin by a Registrar.

I think I was only qualified about a year. But I always remember the words of my tutors “HANDS OFF THE BREECH”. The woman delivered her baby and we handed the baby to her. Both the SHO and myself were reprimande by the registrar for “allowing her to deliver”. We were gobsmacked; both mother and baby were well. Were we supposed to have pushed it back up?

Rehana


I work with an integrated team of midwives and just a few days ago a colleague went out to a lady, first baby, having very good contractions. She had planned a hospital birth, but on vaginal examination she was found to be 9cms dilated. Presenting part difficult to define and rather high. Membranes still intact. Mum quite happy to remain at home as labour progressing so well. Waters then broke, and before long a bottom became visible!! Baby was born soon afterwards—needed a little help to breathe—but recovered rapidly. Mum and Dad and baby now very well. I’ts sad to reflect that if this had been diagnosed beforehand this would almost certainly have been a CS delivery.

Pam


What is breech birth like for the mother? Is it more painful than head-first?

I had a vaginal breech birth last week. Was absolutely wonderful – no pain relief, 5 hour labour, no tears and wonderful baby. Gave birth on all fours hanging on to an armchair for dear life. All thanks to a sympathetic consultant and midwife manager and a WONDERFUL independent midwife who I found the day before (when I was first told baby was breech!), and who was able to come into the hospital with me.

Sophie
Sophie’s Breech Birth Story


I have cared for a woman who has had two breech babies (first and second) and two head first babies (third and fourth) – her opinion: “Give me a breech baby any time!”

Maggie Banks
www.birthspirit.co.nz


My second daughter (of three) was extended breech presentation – I refused the epidural that the consultant was keen for me to have and in fact managed with my own resources, as I knew that I could. She was the biggest of my babies at 7lb 12oz (others were 6lb 8oz and 7lb 1oz) and the quickest, most intense labour about 3hrs from first contraction to baby born, very quick second stage.

I wouldn’t have said it was any more or less painful than the others, although the actual birth seemed worse, but I think this was partly due to the stress I felt – midwife telling me not to push until Registrar arrived, staff insisting on Lithotomy position and virtually lifting me round from where I had been relatively comfortable on my knees leaning on the back of the bed, and what seemed like a huge wait between birth of body (wriggling away from the moment she was out) to birth of head. Sounds really negative but I didn’t and still don’t view it as a bad experience at all – was just so elated to have done it on my own in spite of the doubting Thomases, didn’t think to argue at the time about Lithotomy but would if in that position (ha ha) again. Could have done without the episiotomy too, but otherwise no pulling or manipulations on the part of the Doc – just caught her as she fell out really!

Family joke is that she wanted to have her feet ready to hit the ground running and she has been on the go ever since – now 8yrs. She still delights in demonstating extended breech position and telling people “I was born like this” – is very bendy and flexible now!

Andrea R, midwife


Breech Birth Photo Story

There is an amazing photo-sequence of a vaginal breech birth at www.birthdiaries.com/diary/47vbirth.htm with a commentary on what the doctor is doing. Mum is on her back for the delivery so that the doc can ‘do’ things – I’d be interested to hear from Mary C and any other midwives experienced in breech birth about your views on this. All went well during the birth and the baby was 8lb 11oz. I am very impressed that the mother felt able to let people take photos and to post them as nowadays many people just don’t seem to see breech birth as a real option.

Because there are lots of photos on the page above, it does take a while to load. I suggest you click on the page, then go back to read your emails for 5 minutes!


How do you feel about the amount of handling the baby had? This was very much an assisted breech and while I do not wish to be accused of criticizing the Doctor, I wonder about the handling because we were taught ‘hands off a breech until you can see the back of its head’ and this baby seemed to be doing fine without assistance before the assistant assisted(???) Lovely story too.

Debs


Definitely a breech extraction which the baby survived.

It certainly does NOT sound like a breech “birth” to me it sounds like a breech “delivery”, or the extraction by a clever doctor of a baby presenting by the breech. The outcome may well have been good but I suspect that it was good despite the efforts of the deliverer.

It is this that gives vaginal breech such a bad name. If the deliverer had had a problem it would have been a different outcome. I still feel that birth by the propulsive efforts of the mother has better outcomes than delivery by traction exerted by a deliverer.

Independent Midwives attend quite a few Breech births and we are in the process of auditing our practice.

Mary Cronk


Velamentous Cord Insertion?

Even more interesting is the mother’s birth story - www.birthlove.com/pages/stories/breech_of_faith.html. She was not happy with the doctor’s insistence on a supine position for birth, but she had nobody else who would attend her for a vaginal breech. It turned out that the baby had a velamentous cord insertion, and she wonders if that was why the baby stayed breech. Does anybody have any thoughts on this?


Oddly enough…

Earlier today, I supported a woman having an elective CS for breech presentation (failed ECV, largish baby). Her placenta also had a velamentous cord insertion – plus *very* thick, relatively short cord.

I suppose it could well make a difference.

Hannah, uk midwife


Breech birth USA Style, not for the squeamish. I am not going to comment except to say, do you wonder that American women are so scared of birth?: www.geocities.com/HotSprings/Spa/9786/breechvag1.html


Ugh – those pictures are awful. I have Maggie Banks’s Book “Breech Birth, Woman Wise” and I can 100% recommend it. It is a ‘how to’ book, and has some lovely vaginal (hands off) pictures. Its available atwww.acegraphics.com.au/product/book/bk511.html - order from the UK or Australia.


I had a friend who was expecting a baby, her fourth child, who insisted in staying in the breech position. She used it in her birth plan, and—it worked wonderfully— the baby was born quite spontaneously, as a breech, in the all-fours position. She was given wonderful support by midwives on the delivery suite. The doctor was not so sure–but my friend’s husband was insistent that this was how their baby was to be born, bless him, and so the doctor was able to witness a beautiful and un-interfered with birth in the breech position. The baby was born in excellent condition, and is still making good normal progress. She’s a super little girl!

Pam, midwife


I’ve attended five woman with breech babies, most of them born in hospital due to policy of the organization I work for.

The first was a woman having her third baby, breech discovered at end of first stage, 42 weeks, 10lb frank breech.

Another having her second baby, also breech discovered at fully, footling breech, home within two hours of birth.

Another 40 year-old woman having her first baby, had ECV which turned the baby, but she was determined to come out breech and turned back. Long labour vaginal delivery, frank breech, with the obstetrician using breech maneuvres.

Another primip frank breech who labored and pushed well, delivered vaginally in theatre (due to last minute panic of med staff when breech was on view she was transferred to OT, unnecessary).

Footling twin breeches delivered ten minutes apart, mum standing for first and kneeling for second.

All of the babies were fine, despite most of the mums being coerced into the lithotomy position.

Lynda


Are UK midwives trained to attend breech births?

On the subject of midwives and breech babies – yes we all know in theory how to do it, or more to the point how not to do it, but obviously this isn’t the same thing as being experienced and confident about it – if I was going to have a breech baby at home I would want to be sure of having an experienced and confident midwife, not someone who was basically unhappy with the idea. As we all know it is becoming more and more difficult to find such a person as those of us recently qualified have very little opportunity to gain this sort of experience. I work in a unit that is (relatively) vaginal breech-friendly, where Docs are mostly very happy to support midwives in gaining experence of breech births,and we also have some teams with pretty high home birth rates ……yet I think you would be hard pressed to find many midwives in our unit who would feel 100% happy about attending a Breech birth at home.

Andrea R, midwife


Many midwives have never seen a woman give birth to a breech baby but rather have seen them ‘delivered’, ‘extracted’ or simply go straight to a Caesarian section. I do not agree however that midwives are not taught the skills of breech birth. Our programmes in New Zealand (and I am sure in UK also) cover this, as up to a quarter of breech babies are not diagnosed as such until labour, thus the midwife, wherever she works, can be faced with the need to facilitate breech birth. The universal problem is breech birth has become highly medicalised – not surprising when all birth has! However – you and your midwife may like to check our website www.birthspirit.co.nz for a critique of the Term Breech Trial and information about my book “Breech Birth Woman-Wise”.

Maggie Banks
www.birthspirit.co.nz


All midwives in the UK are taught to assist a mother in giving birth to a baby presenting by the breech. They also learn all the manouvres that may be required.

It is a requirement of the ENB that to qualify a student must have either assisted in breech births or simulation of breech birth. So it is always simulated, because some students may not have the chance to assist in one. I know simulation is not quite the same, but midwives I have taught have never had a problem when they have unexpectedly found a baby presenting by the breech in 2nd stage of labour.

If one understands the principles of the breech birthing process, the midwife should be able to assist the mother. However, fear of the ‘unknown’ and fear of litigation plays a big part in what midwives are prepared to take on today.

Ruth


Strictly speaking midwives are trained to cope with a baby deciding to come breech as long as it’s an emergency!!!!! Which is why most midwives will assume that they cannot do one – ie breaking their code of conduct. Having said that there are midwives out there who have done them.

Before I joined our team I know they had a breech birth at home because (I think) after discussion with the obs the woman decided that there was no way she would get a breech birth in hospital, only a breech delivery.

If you are having consultant-led care, discussing it all early sometimes helps. Rumour has it that in another local unit a woman who told the Obs that she was giving birth to her breech baby on all fours resulted in the consultant spending hours with a doll and pelvis working it all out!

I’d strongly recommend ‘Breech birth – Woman wise’, it’s a book that lives in my car in anticipation of the day of having a breech birth at home – the piccys are great.

Cate


I’ve only ever seen one breech delivery, undiagnosed, admitted pushing, with no obstetric notes as she was only visiting friends in the area. I was a very green student, and it was the horrendous scenario of every man and his dog on LW (labour ward), including me, being sent in to observe this 34 weeker being dragged out, and running out again.

Thought I was going to get another chance the other day. PG (primigravida) booked for elective section came in at 04.00 2 days before c/s with a vague history of irregular tightenings all evening and night that had got a bit stronger in last hour, and she just wanted checking over. As she was contracting 1:4 on admission and looking at her face appeared to be in active labour I examined her. Membranes bulging, cervix about 7-8cms.

The registrar, who happened to be a very well-informed locum, was informed but was busy with another woman. He suggested giving her Entonox for now and he would be in shortly to discuss pros and cons of mode of delivery. Settled the mum to be into a room went out to get some paperwork and came back to find the SHO consenting her for a emergency c/s. When I tried to talk to the woman about a vaginal delivery she looked horrified and said ..” but I thought that was the point of a c/s because I wasn’t allowed to go into labour and deliver a breech as it is too dangerous..” I found it really difficult at this point when she was in pain and distressed at what was happening to try and explain things to her.

Unfortunately the Reg was tied up for a while longer and anyway his SHO had reported back to him that the woman wanted to go ahead with the c/s, so he ended up meeting us in theatre. I thought it was such a shame as it didn’t feel a particularly large baby. She turned out to weigh 5lb 5oz and Dad told me they had been warned she would probably be small.

She did however have a short cord around her neck twice so whether this was the reason for her settling in a breech position and/or whether this would have necessitated an emergency c/s anyway we will never know.

It’s very frustrating when the consultants have a policy of elective c/s for breech in PG (and pressure on MG too)

Donna


I have a interesting story of an antenatal class client. 1st baby. Waters went, no contractions. Admitted to hosp for observation. Husband sent home. Contractions started strongly. OA mother 6cm dilated, but baby ?breech. Taken to delivery suite, scanned. Confirmed frank breech. Husband called back to hosp. Couple told the best outcome for the baby would be achieved by a C/S. Mother in transition by the time this happened. No foetal distress noted.

I just found this all a bit sad really. They were one of those couples who desperately wanted the “natural” birth experience. They are happy at the moment with what happened. But I just wonder, if it was progressing so well, despite the anxiety this mother must have felt, then surely this baby stood a reasonable chance of being born vaginally?

They have a healthy baby, but her dreams of a natural, low tech. birth will be very hard to fulfil now.


Difficult Breech Births

Two posts on the Ob-Gyn forum, from obstetricians who had handled difficult breech births:

From: http://forums.obgyn.net/ob-gyn-l/OBGYNL.0007/0731.html

I had a case a week ago on Wednesday. Patient is at term with previous term normal vaginal delivery. A (previously undiagnosed) breech is found at 6cm in rapidly progressing labour.

Senior resident diagnoses footling but by then she’s 8cm. I am called. Couple are keen to avoid CS and in our unit there is no blanket ban on footling breech vag deliveries (strikes me there is no need to debate that as in fact it has no real bearing on the problems of this case).

She is progressing so quickly that when I see her I think she is probably fully dilated. I suggest we move to theatre and put in a spinal. Aim for vag del (vaginal delivery) but set up for CS. This all happens very quickly, but spinal is not easy and has to be abandoned because breech is now crowning.

The breech delivers without traction and no real maternal effort to just beyond the umbilicus. There is then no further descent at all.

Lovset’s manoeuvre failed – the trunk wasn’t really low enough, nether shoulder was in the pelvis.

I was unable to get above either shoulder to bring one down. Traction was ineffective, as was maternal pushing.

At this point I had the partner taken outside and asked for a GAB.

Under GA (general anaesthetic) it was almost as difficult. I was, though, able to disimpact the left arm. In the meantime I had instructed my senior resident to start CS. Patient was still in lithotomy. Once uterus was open we could not deliver the head. This was despite pushing up on baby, forceps, putting legs down.

Accordingly I got my SR to help me push the remaining nuccal arm down across the fetal face & chest so that I could disimpact it below. Then I easily delivered the head by MSV.

I should point out that this was not a problem of footling breech coming through an incompletely dilated cervix. The cervix was definitely fully on vaginal and abdominal examination.

The problems was of two nuccal arms in a good sized (3.9Kg) breech.

There was concern about this being due to a decision to allow vaginal delivery. IN fact if we had decided on caesarean delivery the same sequence would have happened. She would have been taken to theatre. The anaesthetist would have failed to have got the spinal in before the breech delivered, the arms would have been misplaced.

My understanding has really been that nuccal arms arise as a result of traction and stimulation of the baby and don’t occur if management is hands off – I may be wrong!

Any comments?

Needless to say the babe was born assystolic and was resuscitated including adrenaline to restart the heart. Cord pH was 7.174 – obviously not really reflecting fetal status as the cord was occluded for most of this time.

I was very frank in my conversations with the parents and warned about HIE CP etc.

Baby has done really well. He did not fit. He has been cardiovascularly stable. He was taken off ventilator after < 24 hours. He commenced feeds today (aged 48h). He seems possibly to have a mild brachial plexus injury but no bony problems. He is somewhat bruised!

I think I have had a very near miss and don’t want to repeat this experience for a long time!


Another very difficult breech delivery resulting in a dead baby is discussed at http://forums.obgyn.net/ob-gyn-l/OBGYNL.0007/0880.html. The discussions are graphic and may be upsetting.


Comments from the UKmidwifery list on these two cases:

First, congratulations to the practitioners who are being so frank about the tradgedies that have occurred. Jane Evans, me and several other Independent Midwives have helped women birth babies presenting bum (or Foot) first and reading these accounts I felt so sad that they didn’t know to ask the woman to get on to her hands and knees when the presenting part was at the vulva AND DO NOTHING ELSE. Or they could get a pint of beer, a theatre stool, sit on the stool facing a corner of the room and drink the beer s-l-o-w-l-y.

Forgive me for seeming facetious but that is exactly what the Consultant Obstetrician who taught me about breeches used to say to his students, to emphasise that most of the problems with breeches were iatrogenic. If the baby is too big, the labour will not progress and a CS is indicated. If you pull any of the baby down you are asking for trouble and often get it….

…Just a little appeal from a fussy old bat who has attended many breech BIRTHS but has rarely delivered any of them. PLEASE could we stop talking about breech deliveries, when what we mean is enabling the woman to birth her baby by her expulsive powers. It is by trying to “deliver” babies presenting bum first that we cause problems. Occasionally we need to assist the woman….

I have some very good slides and pictures about breech births which I am happy to show to people and discuss the issues around breech presentation. Incidently Jane (an independent midwife) has just helped a woman birth her breech presenting baby at home. When Jane arrived the second stage was in progress, woman on all fours. Footling presentation, sacro posterior. Jane watched as the feet emerged, the bottom and trunk rotating as it desended and emerged, and then the arms and shoulders. The head flexed and was born into Jane’s and the mothers hands. Baby weighed 5K (11lbs) perineum intact.

Mary


Although Jane is a wonderful midwife – she did not need ANY ‘skills to perform’ for this wonderful breech birth. As in most births, the body will function perfectly if left well alone.Jane is skilled in the art of doing nothing.

Breech birth is not a pathology although there may be underlying pathologies that predispose a baby to present breech. Breech presentation in itself ought not be considered a malpresentation, if only the obs would catch up with their “skills” (read lack of training and confidence to not utilise every “skill” in the book)and reading of evidence based practice!

‘Hands off the breech’ is the golden rule that I was taught and when you leave your hands off your eyes will be able to tell if you actually do need to help with rotation or flexion of the head. Modern medicine would have us believe that to birth this baby vaginally would be an impossibility for any woman and with the fear driven intervention that would ensue this would be a self fullfilling prophecy.

Tania


I was involved in a horrific undiagnosed breech birth experience, (only midwife, midwifery unit, 20 minutes ambulance journey from ‘help’). Maybe l’m just being sensitive, but the body doesn’t always get it right, or was it me just being a c**p midwife; am I not so skilled in the art of doing nothing? The body was born and the head got stuck. He lived for 36 hours. I used to love looking after a women in labour, now I live in fear of what may come through the door.

C


I’m sure you’re not a crap midwife. I also feel for your dismay & fear that such a distressing thing should happen. I hope that being involved in helping women have good births will help to lessen your fear,( as it has my own when births have been difficult, as they sometimes are).

As far as nature always being right & it being possible for all breech babies to be born vaginally with a ‘good’ midwife’. How can that be true? With breech babies nature tells us when it isn’t going to work out – the labours themselves don’t go as planned, may need augmentation or the breech may need pulling & tugging when these things happen nature is saying that a caesarian is needed. Unfortunately, in your case the breech was undiagnosed & there was nothing you could do.

I too have seen a breech birth go terribly wrong, but I have also seen breech births where everything was wonderful. Like cephalic births there will always be breech births that may need intervention even though the majority may not.

Heather


When you are involved in birth, sooner or later a baby will die. It may be through something the caregiver could have /should have/ would have done if they’d known or it may have been something no-one can account for. The phrase “there but for the grace of god go I” is very apt here.

I am not saying that breech birth carries no risk. I could also never imply that any birth carried no risk. One birth I can comment on was a woman whose labour was entirely normal and heart tones were fine. When the baby was born dead with the cord round its neck, the enquiry could not find any lapse of care nor any cord/heart rate patterns that indicated there was a problem. Heart tones had been taken about 2 minutes before birth and were normal and documented. I am willing to bet that all my sister midwives in the room continued to re-live their fear every time they attended a birth for quite some while, despite debriefing and psychological help.

A practitioner with different birth experiences may well be horrified at any woman choosing to birth at home, no matter how low risk she was, because they will have seen things that scared the trust out of them. I am thinking here of OBs who see high risk and unusual things all the time and never see normal births. Once you have seen it with your own eyes,no ammount of randomised controlled trials will change that.

If a woman is diagnosed as having a breech presenting baby prior to birth there are guidelines to gauge whether she is a candidate for a breech birth.it will take into account whether she has already birthed(proving the pelvis) , effacement, dilation and station (how far down has this baby already gone), baby’s expected size and gestational age of baby. There is a point system rather like the Bishops score for cervical ripeness. This info can be found in Oxhorn and Foote “human labour and birth” in the breech section for those interested.

Tania


Many years ago in Oz I gave birth as a “primigravida breech” in six hours. It was one of the easiest things I’ve done physically.

As the pp (presenting part) appeared before the midwife expected it to (I had to get on a buzzer and tell her the baby was coming and I couldn’t stop pushing) she went pale and called out for emergency help. They all rushed in and threw my legs into stirrups and starting shouting at me to stop pushing, my daughter was halfway out at this point! The attending staff made it into a side-show, they made it out to be a drama, brought in heaps of medical students to watch as well….. So emotionally I was completely assualted and I still sadly meet women having not dissimilar experiences today… Wish I’d had her at home with a midwife who knew what to do gently.

Midwives are wanting to do all sorts of odd things like amniocentesis and ventouse these days. I would prefer to reclaim midwives attending breech births as part of the range of normal instead of calling in doctors. We need to get our priorities right and the code and rules changed that affirm our capabilities in real midwifery not undermine them- not just doing breeches in an emergency. Or promoting technological expertise as the only way forward.

K-A


The most recent message from K-A stirred many memories with me, as it resembles my experience of the breech birth of my second daughter.

Approaching the birth the midwife asked me if I would allow students to witness the birth, I obviously looked horrified because she quickly followed the request with the statement “you can say NO, you know”, which I did. At the time I felt that 2 midwives, a registrar and a paediatrician were more than enough witnesses. Since then, and particularly since I have started midwifery, I have qualms about having refused since I now know what a rarity a spontaneous breech birth is, and think what a wonderful learning experience it could have been for junior obstetricians.

I clearly remember telling the midwife “one good push and this baby will be out” and being told, ” no, you have a little while to go yet, you are only 9 cms”. Next contraction brought overwhelming urge to push (I had refused to have an epidural), and baby’s bum advancing rapidly. I was virtually lifted into lithotomy position! I had been on all fours on the bed, and really couldn’t have changed position at that stage by myself. Reg came running in just as breech was emerging.

Afterwards I was so elated at having birthed my baby without epidural or forceps, the way I wanted to. And I had great emotional support during pregnancy and labour from several brilliant midwives. My daughter (now 7yrs) loves to hear her birth story about being upside down, and delights in telling people “I was born like this” demonstrating the extended breech position with her feet alongside her ears!

Andrea


It is fine and commendable for midwives (and doctors) to be encouraged to watch a breech birth, providing they understand what they are watching. If they watch the birthing of a breech in the manner described by Mary Cronk in Modern Midwife (and the AIMS journal) all to the good.

If, however, they watch the perversions of “normal” which are imposed on most women expecting breech babies i.e. on their backs, feet in stirrups (probably having had an epidural) and an attendant manipulating the baby, they are unlikely to understand that there is a better method.

Having said that, what we need is a randomised controlled trial of the Cronk method of birthing compared with what most doctors (and probably most midwives) consider to be a “normal” breech delivery.

Re trials of breech birth:

Where is the evidence that a footling breech is not ‘a reasonable position’? I have just seen Mary Cronk’s latest collection of photographs of the birth of a footling breech. What a tragedy that most women appear to be browbeaten into having a caesarean section or an obstetric delivery.

I have lots of anxieties about doctors and midwives doing vaginal breech deliveries. We have already criticised past studies because instead of a vaginal breech birth the baby is subjected to continuous electronic fetal monitoring, the mother is prone and the baby is manipulated. Will this study offer women the Cronk birth approach? If it does not, prepare yourselves for consumers who will say that we still do not have the kind of breech study informed consumers want and the arguments about breech births, deliveries and caesareans will continue.

Beverley Lawrence Beech
www.aims.org.uk

See also:

Midwifery Skills needed for Breech Birth by Mary Cronk


External Cephalic Version

When is the optimum time for ECV to be carried out?

Best time for an ECV is usually 37 weeks, but it can be done in labour.

Sara


In our Trust, External cephalic version is usually performed at 37-38wks and position confirmed with a scan. The baby is then monitored for about an hour and the woman sent home.

Antenatal checks are made weekly untill she delivers to ensure that the baby stays cephalic. There is a scan done initially to check the baby’s position, and to make sure there are no problems, eg low placental site, that might be causing the baby to adopt this position in the first place. The placental site is usually diagnosed from an earlier scan, though.

Ann (Team Midwife)


In some cases women await spontaneous labour and then, if the baby has not been turned beforehand, external version is attempted, and if that fails then they can choose either to continue with a trial of labour or to have a section.

Here’s some backup for that:

Acta Obstet Gynecol Scand 2000 Dec;79(12):1083-5
Intrapartum external cephalic version of footling-breech presentation.
Kaneti H, Rosen D, Markov S, Beyth Y, Fejgin MD.
Department of Obstetrics and Gynecology, Meir General Hospital, Kfar-Saba, Israel.
BACKGROUND: External cephalic version is attempted prior to the onset of labor. Women who present in labor with footling breech presentation are usually delivered by cesarean section. We present our experience of external version in women in labor.
MATERIAL AND METHODS: External cephalic version was attempted in thirteen patients in labor with footling breech presentation with the breech out of the pelvis.
RESULTS: The procedure was successful in twelve of the thirteen patients. Ten of them delivered vaginally. There were no maternal or neonatal complications.
CONCLUSIONS: It may be reasonable to attempt external cephalic version in patients in labor prior to performing a cesarean section.
PMID: 11130092 [PubMed - indexed for MEDLINE]


While ECV has a place, it is not always the right thing to do. How about the baby who is in the breech position because the cord is short? Or the baby who has a congenital abnormality – they don’t all show on scan – and who has taken up the breech position because it is right for that baby?

We should, alongside offering ECV, be ensuring that midwives and medical practitioners learn the (not too difficult) skills of assisting women to birth their babies who present by the breech -and knowing when these babies need to be born by surgery, ie CS.

Mary Cronk


From Breech to Brow -lots on turning breech babies, with photos of cephalic version in progress.
(www.obgyn.net/pb/cotm/9810/cotm_9810.htm)


Breech presentation and home birth

My baby is currently presenting breech, and I am booked in for a home birth. There is obviously still time for it to turn, but if it doesn’t, my midwife says I am no longer permitted to have a home birth.

Is this the case? Are there any independent midwives who would consider breech birth insufficient grounds for a hospital transfer?


Nothing makes me more angry than a midwife or a doctor telling a woman that she will not be permitted to xxxxxxxx. It is not within their remit to permit anything. The decision where to have a baby rests ENTIRELY with the mother. The midwife or doctor may ADVISE, but a mother is not obliged to take that advice.

If the midwife feels that she is not competent to help the woman birth by the breech I suggest that you write to the Director of Midwifery informing her that you intend giving birth by the breech at home and you expect her to provide you with a midwife who is experienced at facilitating this. If there are no midwives in her team able to do this she can arrange an extra contractual arrangement with an independent midwife whom, I am sure, will be interested in providing the service.

Beverley Lawrence Beech
www.aims.org.uk


It all depends on your midwife’s experience, the position of the breech and how big your pelvis is. Is this your first baby?

I am a midwife and attended my first breech in hospital in 1982 or 83 in London. The first few were in hospital and the first one I attended at home was not planned for home (long story). Anyway, I now have sufficient experience to know which women could do it at home and which would be ill advised to stay there. Find out your midwife’s experience and what her back-up arrangement is.

I have always done breeches at home with 2 midwives in attendance. Make sure your pelvis has been checked carefully so that you know it is big enough to accomodate the after-coming head. Very rarely, a baby sits breech because the pelvis isn’t big enough for the head to engage there. Overall pelvic capacity is important.

I attended my niece’s birth last week and the day before the baby was head down. Her first baby and I was a 2 hour drive away. When I arrived her cervix was fully dilated and she was ready to push. But the baby was breech. In America it would mean an automatic cesarean if we transferred to hospital and I told her that. I also told her the risks. She was inclined to stay home. Her final question was, “What would you do if this was you?” My immediate reply that with my pelvis (very small) I would transfer, with her pelvis (normal sized and she was carrying a small baby) I would stay home. She stayed home and I called 2 other midwives who helped. Lauren Holly, 6 lb.s 2 oz. was born well and is fully breast feeding with her mother making an excellent recovery. I did need to do a small episiotomy. I haven’t done one of those since 1981 so it was not a light decision. But it was the right one and she is healing fine.

Good luck on your birth, however and wherever it happens.

Cheers, Melody (midwife in the US)


In the UK women have the legal right to give birth at home. If a woman chooses against medical advice to birth at home health professionals are bound by law to attend her. This usually means that a midwife attends her, sometimes with an ambulance at the door, or other heavy pressure from local medical professionals. Few women are willing to take this kind of a stand.

Breech presentation is considered high risk by most medical professionals. On the other hand many midwives would say that breech presentation is a variation of normal labour, and not an abnormal situation. Most are agreed that it is preferable to give birth to a breech baby in hospital, given the higher likelihood of resuscitation being needed, but there are situations where transferring the woman from home to hospital might be riskier, either for emotional or physiological reasons.

As an independent midwife, I will discuss the implications of breech presentation carefully and in depth with the woman, giving her clear options for care. Usually this begins with efforts to encourage the baby to turn head down, and we have a good success rate with this. If she decides to go for a hospital birth I will try to make arrangements for the kind of care she wishes, although this may not be easy, and I may not be successful. If she decides to stay at home, or if the baby turns out during labour to be an undiagnosed breech, we would go ahead and deliver the baby at home if this is what the couple wishes, as long as good progress is evident all through and baby and mother are both in good condition. If there is delay during labour, or a complication arises, we would transfer the woman to hospital – with her consent, although I can’t imagine that she would refuse. There would be no problem about an NHS hospital accepting any labour transfer, whether from an independent midwife, an NHS community midwife, or a GP.

In the unlikely event that a woman refused transfer, I would document it all in the notes, contact the supervisor of midwives for support, and continue to care for her to the best of my ability.

Other UK midwives may have different opinions and perspectives on this, but this is my ha’pennyworth!

Melanie


I have all round midwifery experience – and believe in empowerment/safe practice. No I have never undertaken a breech birth at home – I would attempt if that is what the mother wanted – would not like to unless had exceptional near to hand back up!

Lorraine


There are independent midwives who will attend you at home and who have experience with breech birth. They also may be able to help you with turning the baby.


See also:

Independent Midwives Association 
Listings of independent midwives across the UK.
www.netcomuk.co.uk/~pvan/ima.html


There is an excellent and reassuring book called ‘Breech Birth Woman-Wise’ by Maggie Banks, a New Zealand midwife who has great experience with breech birth at home. It can be ordered through ACE Graphics and costs $36.00 Aus or £15 sterling excluding postage. They have branches in the US and Australia.
The Acegraphics website is www.acegraphics.com.au

Maggie Banks’s website, with more info about her book:
www.birthspirit.co.nz


Term Breech Trial

Term Breech Trial Collaborative Group, Lancet 2000; 356: 1375-83
Concluded: Planned caesarean section is better than planned vaginal birth for the term fetus in the breech presentation; serious maternal complications are similar between the groups.

BBC News article on the Term Breech Trial

The article about the breech study from the BBC says that caesareans are safer for babies, and that “There was no difference in outcome for the mothers in both groups. ”

I have to say that I’ve a gut reaction against such a blanket statement, and against anything which supports surgery as the choice for many women – so maybe I am not being fully objective in my comments, but a couple of points spring to mind:

1. ‘no difference in outcome for mothers’ – what, so those who had caesareans are not going to be higher-risk for all future pregnancies, then? And their future babies won’t be at increased risk of abrupted placenta, uterine rupture, etc, after all?

2. What sort of vaginal births were these mothers having? Actually the study does talk about this. But basically, you can bet that few of them were having the Mary Cronk treatment. Many of the mothers were induced or had their labours augmented with syntocinon, had epidurals, or had forceps deliveries.

Interesting stats: when the time came for birth, 1.8% of babies in the planned caesarean group were actually cephalic, but 3.7% in the planned vaginal birth group were cephalic. Presumably that was because c/s was planned for 38 weeks & some babies turned after that. Only around 20% of mothers in either group had external version attempted.

Angela, mother


“It says that caesareans are safer for ‘breech’ babies.”

Interesting thread. From a student’s perspective though, perhaps vaginal birth isn’t the safest. Seems they are so rare no-one is learning how to do it; both midwives and obs do not get enough experience in them. I for sure will feel less able to offer a homebirth, for example, to a woman with a breech for the simple reason that the chances are I won’t observe one and there’s a high possibility that I won’t get to help a woman deliver one. I certainly wouldn’t feel happy about my competence as things stand presently. Books are all very well, but no substitute for experience.

More worrying still that the midwifery literature regarding registration as a midwife demands we be competant in midwifery skills. Is a vaginal breech still be classed as a midwifery skill, or does it now fall under the ‘complications’ umbrella? The thought of being presented with an undiagnosed breech fills me with dread for the simple reason that very few of the midwives at my place of practice have seen or done one and so there is no one to teach me.

Jackie


This study is flawed in that it is basically comparing breech delivery with CS and NOT individualised care and breech BIRTH, ie baby born by expulsive efforts of mother positioned on her hands and knees.

I personally feel that there are several flaws in the Term Breech paper.

1. There is no mention of the position of the woman during the second stage – does she choose her own birth position or is it imposed on her by her “deliverer”?

2. The deliverers are medical practitioners

3. it compares breech “delivery” which to me indicated that there was traction from the deliverer

It is interesting to note that the nearer the practice is to midwifery, and not obstetrics, the better the outcomes for vaginal breech.

The outcomes are short-term; no mention of the long term sequalae of Caesarian, and no mention of how it feels to return home following major abdominal surgery to look after new baby, maybe two toddlers with probably no domestic help. A partner who cannot get time off his job. You live on the 4th floor of a block of council flats with no lift and have to get the double buggy up and down the four flights of stairs. If you leave it at the bottom it will get pinched. Think about it, those who feel that a CS is no big deal!

Independent Midwives in UK have built up quite a lot of expertise in assisting women to birth their breech presenting babies.

Mary Cronk
www.marycronkmidwiferyservices.co.uk


Commentary on the Term Breech Trial, by Maggie Banks, midwife and author of “Breech Birth Woman-Wise”.

See also Maggie Banks’s website,
www.birthspirit.co.nz


I went to a meeting to discuss the term breech trial with doctors at our hospital, anticipating a lengthy, one sided statement regarding c/sec and breech going hand in hand, and instead we were treated to “there is no evidence either way and all women should discuss having a vaginal ‘delivery’ and be told the pros and cons of all forms”. Came away thinking no wonder our vaginal breech rate has gone up!

Docs present admitted to not being able to do ECV and then suggested that maybe one of them should go off and get some training or sort out a way of giving women a choice as a neighbouring trust has a doc who does. Added to 3 of the docs picking up ‘Breech Birth Woman-Wise’ to have a look – I am in a deep state of shock!

Even the mention of an upright position was not met with suggestions of bringing the mental health act into use! And epidural was not seen as a necessity!

Cate


The subject of our weekly lunchtime meeting on the unit today was Breech presentation. In our unit we have Consultants and Registrars who are experienced in and generally supportive of Vaginal Breech deliveries. The Term Breech Trial, which published last year, came up and it was interesting to listen to a bunch of Obstetricians pulling this research apart.

Not sure I can remember all the criticisms, but some points from Obs were:

Couldn’t understand how they came out with such poor neonatal outcomes in Vaginal Breech group – questioning how experienced were the people conducting the delivery? Surprised that induction or more particularly augmentation of labour was allowed in trial protocol, also some criticism of statistical analysis which rather went over my head I’m afraid.

There were other comments made by the midwives present at the meeting similar to those we’ve discussed on this list before. I was just interested to discover that our Obs didn’t like the trial results much either!

I wonder how this paper has been received elsewhere – I had the impression from friends who work in another unit that the Obs at their unit had embraced the findings (that C- Section had better neonatal outcomes with no difference in Maternal outcomes) wholeheartedly, delighted to have been given just the ammunition they had been waiting for to try to put a stop to vaginal breech deliveries altogether.

Andrea


Obstetricians in my unit have embraced the trial wholeheartedly, unfortunately, and now actively encourage all women to undergo a caesarean section for breech. They do understand that this research is flawed but endorse it anyway. Soon no one will be left who can safely deliver a breech baby.

Anne


Links to other sources of information:

On this site:

Planned Breech Birth at Home by Lynda Cantillon

Assisted Birth – not Assisted Delivery by Debby Gould

Midwifery Skills needed for Breech Birth by Mary Cronk

Commentary on the Term Breech Trial, by Maggie Banks, midwife and author of “Breech Birth Woman-Wise”.


On other sites:

Turning Point for the Breech AIMS article on turning a breech baby.

<p”>Why are Some Babies Breech? (AIMS)

 

Breech babies - AIMS article on caesarean operation versus normal birth

The Baby’s Breech – Now What?
(www.geocities.com/momcare/breech.ht)

US Midwife Archives pages on breech
(www.gentlebirth.org/archives/breech.html)

Photos of a doctor-assisted vaginal breech delivery from the USA
(www.birthdiaries.com/diary/47vbirth.htm)
The mother’s birth story which accompanies the photo diary
www.birthlove.com/pages/stories/breech_of_faith.html

Sophie Snell’s natural breech birth story, from the UK
(www.homebirth.org.uk/sophiebreech.htm)

Breech extraction with episiotomy and forceps - graphic photos.
www.geocities.com/HotSprings/Spa/9786/breechvag1.html

From Breech to Brow -lots on turning breech babies, with photos of cephalic version in progress.
(www.obgyn.net/pb/cotm/9810/cotm_9810.htm)

Heads Up - a mother’s website, all about breech birth.
( http://members.home.net/ibirth/ )


AH updated 3 June 2001


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One Response

  1. Charlotte
    Charlotte | | Reply

    I am 39+1 and my baby is frank breech. It is my first child. We had been told at 36 weeks that the baby had turned head down, then last week it was confirmed by scan that this was wrong. My husband and I had to see a ‘consultant’ at the hospital we were going to have the baby in.
    The natural water birth I have so longed for went out the window and the ‘consultant’ made it very clear that I was irresponsible if i did not choose to book in for a C-Section. I don’t understand why first time mothers and fathers have to be pressured into something they don’t want. Is it better for the baby this way because as far as i can tell (from a selfish point of view) it sure as hell isn’t better for the mother. I want to best for my baby of course but I cant help wishing that they would give me a chance to let my child be born naturally rather than extracted from me in a cold hospital theatre under glaring lights.
    Would it be a good idea to go with what we have been told to do or will it help our baby a little if I wait until i go into labour spontaneously before having my child ripped out of me?
    Any advice would be very welcome at this stage, i feel miserable!

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