Tag Archives: baby

Unplanned Cesarean Birth. A warrior’s path.

tor-019.jpgCaesarean birth is not everyones first choice when planning the type of birth we’d like. For many women it is the very last type of birth they’d opt for. So when we are faced with our least favourite choice, the thing we’d worked so hard to avoid, our worst fear, what do we do? How can we cope with the disappointment of a birth that’s so far away from the birth that we’d dreamed of that it resembles a nightmare? What went so dreadfully wrong, and who can we blame for this travesty? As a midwife and mother who’s first baby was born by unplanned caesarean I’d like to explore these questions further.

A less than ideal birth?

Why does a less than ideal birth have to mean less-than? Could our less than ideal birth leave us feeling less than complete? If our bodies apparently failed to give birth, or we didn’t get to do the things we’d planned to do when greeting our babies, is there a sense of failure? I certainly remember feeling that my body had failed to birth my first child, and that I’d somehow failed to be there for her immediately after birth. These are very common but totally irrational thoughts as we try to make sense of how our plans went so wrong. There must be someone to blame, and that someone must be me. But our brains must be so confused at this time, as I was obviously not slacking by needing a life-saving caesarean, then haemorrhaging and being unconscious for hours after. Where does that self-blame come from? Wherever it comes from it is misplaced in the case of unplanned caesarean.

How can we even think that we are to blame for things going wrong? I can joke about it now, as it’s approaching 23 years since my baby and I nearly died. I can see rationally that my caesarean was a life-saving measure, and that my daughter shows no signs of the early neglect she may have suffered. But do you know what? It still hurts to think of those lost hours when we were not together.

Best laid plans

Like many women I’d prepared for a homebirth, but of course I knew as a midwife that anything could happen. It just wouldn’t happen to me, as I was so well prepared. I watched all my plans evaporate when labour didn’t progress and I transferred to hospital for analgesia and augmentation. A catalogue of nightmarish scenarios ensued, and my baby was found to be presenting by the brow (forehead, instead of the back of the head coming down first). Of course trying to force a malpositioned baby through a pelvis for hours is never a good idea, so my body haemorrhaged after my caesarean and I was returned to surgery. Postnatal depression inevitably ensued, marring a majority of our first year together. It just didn’t make sense. I’d done everything so right. How could it go so wrong?

 Are birth plans worth the paper they’re written on?

I’m not sure one can actually plan a birth, knowing that birth is inherently unpredictable. I think writing a birth plan is a good exercise in looking at and discussing your birth preferences with your birth partner. It can also be a useful communication aid for your midwife to read whilst you are busy birthing and not able to fully express your wishes. Beyond this it is of very limited value. If you do write your birth preferences down please just write on just one side of A4 paper, use bullet points, and try not to be too outcome orientated. What I mean by this is do not write “I am having a homebirth, vaginal birth” etc as these are never guaranteed. Its fine to write “I hope I’ll have a homebirth” or “I’d prefer x to y if I require pain relief” or how you’d like to spend the first moments with your baby if possible. Please do keep it short though, as I’ve heard doctors joke that women with long, inflexible birthplans are bound to need medical interventions! So plan all you like, but your baby may have an entirely different plan of it’s own. I do believe that all babies do their best to come out the way we have planned, but some get stuck, some run out of energy, and if left to a natural conclusion some babies and women would not survive the birth process. Nature doesn’t always get it right despite our best efforts, and timely caesarean surgery saves lives.

Less of a birth=less than a woman?

Why should we feel “less than” if we’ve accepted life saving surgery, albeit unwillingly? As a midwife I see so many different types of birth, and not one has more worth than another. All women are strong, beautiful and powerful in their birthing. This transformational state has equal value whether it is long or short, painful or ecstatic, vaginal or abdominal, surgical or physiological. Each birth brings forth a baby as well as the birth of new parents who need to start their parenting journey in an empowered way. It is a true rite of passage, where we are presented with obstacles and challenges, so we can discover how courageous and strong we really are. When women are well supported in their births they get to see their strengths and triumphs, and start their journey to parenthood in a joyful way. Without support and explanation they may be left feeling disappointed or even traumatised by such an unplanned outcome.

So how can we lessen the impact of unplanned caesareans and enable women to feel strong and empowered in their birthing? It’s important to have continuity of midwife, or a doula if possible. Research has shown that continuity of carer leads to better outcomes. Women can empower themselves by learning assertiveness phrases and asking for everything to be explained, so they are in charge of the decision making. They can organise 2 good birth supporters, who will support their choices, and be able to help practically as well as emotionally after an unplanned outcome. Women will need opportunity to debrief their birth with their care provider after unplanned caesarean. And as care providers we have a duty to help women understand and integrate their birth experiences. Unfortunately most women don’t have continuity of midwifery care, but all midwives and doulas can help a woman after unplanned caesarean birth. We can do this by listening, by witnessing their story without interrupting, then by answering their questions. We can believe them and validate their experiences, letting them know they made the best choices possible (being a professional means putting aside our personal opinions). We can congratulate them on their intuition, bravery, endurance etc, for giving it everything they had and then some, because of course every woman does. Don’t forget to mention her beauty and dignity in birthing, her graceful acceptance of the inevitable, and big up her support team too.

That woman is a birth warrior, she has done battle with nature and her worst fears, she has bravely laid her body down on the theatre table and has said “cut me open for the sake of my child’ risking her own life to save her unborn baby. She then returns from her battle triumphantly holding her reward, her baby, and should be welcomed home as a returning Hero. How can this warrior’s birth ever be seen as less than?

Conclusion

As a midwife I’ve had the pleasure to see empowering and ecstatic, planned and unplanned caesareans. I have personally had a vbac so also know the joy of vaginal birthing too. All births are great opportunities for us to grow and become more than we ever thought possible. This is a process of growth not lessening, so let’s treat it as such, and celebrate all birthing women as the birthing Goddesses they are.

Birthing from Within Birth Preparation Weekend

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Saturday 18th and Sunday 19th April 2015  In Glastonbury

I am so pleased to be once again running this popular workshop in Glastonbury with my partner Jady Mountjoy. Working with stories, art and practical techniques this 2 day workshop will prepare you for your journey to parenthood.

  • Prepare for birth as a Rite of Passage.
  • Understand the power and life-long impact that “birthing from within” offers all participants in birth.
  • Co-create holistic prenatal care that is informative, transformative, and builds a foundation for birthing in awareness in our birth culture, whatever the birth location or outcome or events of the birth.
  • Prevent or minimize emotionally difficult births (for parents and professionals) through compassionate, honest preparation.
  • Honour and use the power of Birth Story telling and listening.

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Held in studio of the innovative Red Brick Building, Morelands enterprise Park, Glastonbury, BA69FT directions here

The cost of our workshop is £70 per person or £130 per couple. There are concessions if unwaged. 

 

I first learnt about birthing from within when I bought Pam England’s book and was so impressed that I signed up to train as a birthing from with mentor.

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  • Childbirth is a profound rite of passage, not a medical event (even when medical care is part of the birth).
  • The essence of childbirth preparation is self-discovery, not assimilating obstetric information. The teacher (mentor) is “midwife” to the parents’ discovery process, not the expert from whom wisdom flows.
  • Childbirth preparation is a continually evolving process (for parents and teachers), not a static structure of techniques and knowledge.
  • Parents’ individual needs and differences help determine class content.
  • Active, creative self-expression is critical to childbirth preparation.
  • The purpose of childbirth preparation is to prepare mothers to give birth-in-awareness, not to achieve a specific birth outcome.
  • Pregnancy and birth outcome are influenced by a variety of factors, but can’t be controlled by planning.
  • In order to help parents mobilize their coping resources, it is critical for childbirth classes to acknowledge that unexpected, unwelcome events may happen during labour.
  • Parents deserve support for any birth option which might be right for them (whether it be drugs, caesarean, home birth, or bottle-feeding).
  • Pain is an inevitable part of childbirth, yet much can be done to ease suffering.
  • Pain-coping practices work best when integrated into daily life, rather than “dusted off” for labour.
  • Fathers and birth partners help best as birth guardians or loving partners, not as coaches; they also need support.
  • For parents, pregnancy, birth, and postpartum is a time of continuous learning and adjustment; holistic support and education should be available throughout that period.
  • Childbirth preparation is also parent preparation.

To book your place please contact me on 07939247462 or email joy@birthjoy.co.uk.

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The Third International Breech Birth Conference. Washington DC November 2012

Robin Guy
Heads Up breech birth conference

I was lucky enough to be invited to lead a workshop at this years International Breech birth conference.

My qualifications are that I have been lucky to work with Breech birth expert Mary Cronk MBE as an Independent midwife. We attended several breech births together and thus I started to learn breech birth skills. Our midwifery clients alowed us to take photos of their births for teaching purposes, and these have further added to our knowledge as we studied the many and varied ways breech babies are born.

My workshop was entitled “Arse Backwards” as my journey to learning breech birth skills started with the most unusual births. A double footling, a foot then knee, a foot and extended leg, VBAC breech birth – all at home, were marvelous to attend and record, to share with other health professionals and women expecting breech presenting babies. Unfortunately I do not have permission to share these photos on-line which is why Mary Cronk and I travel the country (and abroad) sharing the stories and skills of breech birth.

My presentation told the story of how I learnt breechbirth skills, and how important it is to share these skills with others, to give women the option of skilled birth attendants at their breech birth. I took along video footage of Mary Cronk sharing her wisdom which was very well received.

I also learnt a tremendous amount at this conference which will aid me in the future care of women planning spontaneous breech birth.

I hope to have time to write up the highlights, but until then check out the brilliant Rixa Freeze’s blog

Association of Radical Midwives monthly discussion group.

This is a local group for the support of peaceful pregnancy, birth and parenting. Hosted by Joy Horner, radical midwife, mum, lecturer and some day writer. Inspired by the Freedom For Birth film I am determined to impart information about human rights in childbirth, facilitate discussions, and to support women on their journeys to parenthood. You don’t have to be a midwife, a radical, or a female to attend. All those with an interested in women’s rights and experiences in pregnancy and childbirth are welcomed. These stimulating monthly discussion groups are designed to encourage experience sharing and debate, accompanied by tea and cake. All welcome. Donations for refreshments welcomed as 50% given to local charity Towards Tomorrow Together.

2013 Meetings at my house 7:30pm-9:30pm:

Thursday 8th August – Birth rights and choices.

Tuessday 3rd September – Waterbirth evening.

Thursday 3rd October – Postponed due to midwifery commitments.

Thursday 7th November – Am I allowed? how to get the best from your pregnancy, birth and postnatal care experiences.

Thursday 5th December – Blissful, ecstatic or orgasmic birth?

Please phone or text 07939247462 prior to attending the meeting to confirm date and location details. I am a practicing midwife so there is a chance I would have to reschedule a meeting if attending a birth.

Please note that although children are welcome they are your responsibility at all times, as I do have free-roaming teenagers, lurcher and elderly cats.

The Association of Radical Midwives are midwives, student midwives and others in the UK committed to improving the maternity care provided by the NHS. We strongly believe that all women have the right to a service tailored more closely to their needs, and a sympathetic attitude on the part of their professional attendants.

We are primarily a support group for people having difficulty in getting or giving  sympathetic, personalised midwifery care, and those who wish to provide good care. A few of us are working independently outside the NHS, in order to offer a more woman-centred,one-to-one, style of practice, which at present is not widely available within NHS maternity services.

In the mid 70s, the majority of pregnant women in UK had labour induced by artificial rupture of membranes (ARM) around the date they were “due”. These initials were used when the group needed a name, using the dictionary definition of “radical”, (roots, origins, basics, etc.) which aptly described the basic midwifery skills which they hoped to revive.

Held in our homes in Somerset, the group meet monthly to share skills and knowlege to empower women to have the best possible maternity care experience. Phone me or e-mail me at joy@birthjoy.co.uk for details of the next meeting.

Taunton Birth Forum 4th September 2012

I was delighted to have made it to The Taunton Birth Forum this month as I have had such a busy Summer I have missed a few. It is always a pleasure to See Eleanor Copp and her husband Simon and learn from the speakers she invites along.

This month was a real treat with speaker Katherine Ukleja teaching about the embryonic face. katherine is a Cranio Sacral Therapist, teacher and lecturer. She has also undergone prenatal and birth training with Ray Castellino.

Katherine started off explaining how human babies are born immature compared to other species, and how this means we are dependent on our parents for our basic needs (warmth food etc). Babies are reliant on face to face contact which enables their brain to develop. The baby’s “social nervous system” allows babies to pick out a human face and mimic facial expressions (such as sticking their tongue out) within minutes of birth. This allows baby to engage with parents and communicate it’s needs, as it is helpless otherwise. Through this social engagement and play the baby’s nerves learn to “self regulate”. The baby’s face is a major form of communication, and the helpless baby relies on parents being able to read it’s facial expressions.

Now the technical part

The embryonic stage of development lasts until 8 weeks. during this time all body structures are present and just develop further beyond that point. At 3-5 weeks of development the baby’s face begins to develop. It develops between the brain and the heart in a series of folds that used to be called gills, as they resembled those of fish.

The face is where the internal and external world meet. the outer world covered by the skin of the face, and the inner world of the body, with entrances at the mouth and nose. Exteroception being the sensitivity to stimuli originating outside the body and  interoception being sensitivity to stimuli originating within the body.

The structures of the face and head develop in the mesoderm (the middle germ layer of an animal embryo, giving rise to muscle, blood, bone, connective tissue, etc).  when the mesoderm is compressed it forms cartillage and when it is stretched it becomes membrane. Bone then develops from the cartillage. The base of the skull is formed from cartillage and are less moveable than the upper cranium. The cranial nerves develop in the folds of the embryonic face and make up what is known as “the social nervous system”. The cranial nerves supply the facial muscles, help babies orientate their heads towards their parents, and alow them to identify the human voice over background noise. The nerves that control expression are very important to humans. As adults we read facial expressions to tell if another human is safe to approach.

One branch of the cranial nerves, the vagus nerve, supplies the heart and lungs. it modulates the heartrate, enabling enough blood to supply the brain. It also allows baby to coordinate sucking, breathing and communicating. The cranial nerves exit the head at the base of the skull.

Because of our large brains our babies need to be born relatively immature. To enable passage through their mother’s pelvis the upper bones of the skull develop seperately and can move over each other (moulding) during the birth process to navigate through the pelvis.

 

As baby travels through the pelvis it moves under it’s mother’s pubic arch, and at this point there is potential for the nerves to be compressed or overstretched. This is more likely in instrumental births like forceps, ventouse and caesareans where traction is applied to the head to pull the baby out. There is also a possibility of this if the baby is pulled out by the head during a so called normal birth. (Note from Joy: in the normal birth process there should be no pulling on the baby’s head!).

If these nerves are dammaged the baby can suffer feeding problems, pain from the injury, impaired hearing and facial expressions. Cranial nerve injury can also affect arousal of the vagus nerve with increased heartrate, inability to sleep and colic. All of these injuries affect the baby’s ability to communicate with it’s parents, and their empathy with their baby. A traumatised newborn baby feeling fear cannot use the “fight or flight” mechanism, so develops a self preservation behaviour of freezing or playing possum. This makes communication even more difficult.

Babies need to communicate face to face from birth as eye contact and empathy encourage brain development. Playing with babies and sharing joy increases dopamine and oxytocin production in the baby, which increase brain growth. In babies the right half of the brain develops first. This ensures emotional strength develops before intelligence. The stimulation of the right half of the brain is important in the first year after birth, as without stimulation these areas can atrophy. A well developed brain leads to empathetic behaviours in the child rather than antisocial ones.

It is a survival mechanism for babies to be able to communicate. Babies read the emotional tone of their carers. If parents are unhappy then the baby will be unhappy.

What I’d like to share from what I learnt is that:

  • Babies are born very immature and depend on us for their survival.
  • Babies are ready to communicate with their parents from the moment of birth.
  • The birth needs to be gentle to avoid dammage to the cranial nerves.
  • No pulling babies out by their heads!
  • If a baby’s nerves have been dammaged he may be less able to feed or communicate his needs.
  • These injuries can heal with time but craniosacral therapy can help.

Thank you for sharing your wisdom Katherine. xx

MAMA Conference 26th and 27th April 2012

Birth Joy (C) 2011

I have just returned from the fabulous MAMA Conference in Troon, Scotland, organised by the brilliant Cassie MacNamara.

Mary Cronk MBE had been booked as a speaker but had recently suffered a bereavement, and asked me to talk on her behalf about breech birth. These are big shoes to fill! I decided I could not teach about breech birth, but could provide a presentation paying Homage to all I’ve learnt from my mentor,  and great friend Mary Cronk.

With Knees shaking and voice quaking I took to the stage. It was an emotional moment as I knew I was only there because my learned colleague was at a funeral that very same day. I paid Homage to my mentor by showing photos of breech births which have been kindly shared by families who’ve births we’ve attended. Each breech birth taught me more and more about the skills needed to safely attend breech births. I hope Mary’s wisdom and teachings shone through my presentation. It was certainly well received!

Mary Cronk MBE (right) and Joy Horner (left) 2011

Here is some of the feedback I’ve received:

Met you at the conference, and was very inspired by all you shared with us on your breech experiences!”.

It was so wonderful to hear you speak at the MAMA conference. It really was incredibly inspiring and I just know Mary would have been so proud of she could have seen you speak. Many thanks for sharing your wisdom.”

Joy I would like to send my congratulations on yesterday’s presentation. You did Mary proud, and yourself, and I am sure that you will effect change in the NHS, they are very lucky to have you!”

I must have done something right as the organisers have invited me back next year!

The highlight for me was sharing the stories privately with the wonderful Ina May Gaskin. What a privilege to speak on Mary Cronk’s behalf, and to be able to discuss breech birth with Ina May Gaskin.

Ina May Gaskin and Joy Horner 2012
 

 


The Joy of birth

Has anyone ever told you that birth can be pleasurable or even pain free? It may be a very strange concept to women bombarded with stories of painful or traumatic birth. As an Independent midwife I rarely see women needing pharmacological pain relief, the main reasons being that they feel safe, loved and respected. They know and trust their midwife and know the sensations of labour are not to be feared. When a woman feels safe and supported throughout childbirth her biological functions can work as they were designed to. Her body produces complex coctails of hormones, endorphins and oxytocin to bring forth her baby in joy and triumph.

The strong sensations of childbirth are actually signs that our body is working well. The discomfort alerts us to the start of labour so we can move to a place of safety and gather our birth supporters around us. As the baby moves through our body it instructs us how, and when to move, to paricipate in the intimate dance of birth. As sensations change they let us know that we are making progress, and to assume a birthing position. The sensations of the expulsive stage enable us to work with our body and baby to give birth. These signals are more likely to be perceived as painful if the birthing woman is unsupported, scared, disturbed, or interferred with. Most women with good support manage labour with self-help techniques, love and their own determination.

I am of course referring to healthy women, experiencing full-term spontaneous labour, with a baby in the optimum position. If a labour is induced or augmented with artificial drugs, if a baby is in a really unusual position, or if an instrumental or surgical birth is necessary, then pain can be more difficult to manage.

The secret to an enjoyable birth experience is preparation, good labour support, and Oxytocin. Oxytocin has been called the love hormone as it is produced when we fall in love, or make love. It is very important in childbirth as it makes the uterus contract, enhances maternal behaviour and enables the letdown reflex in breastfeeding. Oxytocin is a very shy hormone though. It is hard to produce oxytocin in stressful situations.

The same environment which is conducive to making love is also advantageous in childbirth. Can you imagine having to make love in hospital, with bright lights, little or no privacy, unfamiliar staff wanting to watch, examine, time and chart every move? It would be very hard to mainain that loving feeling, let alone reach orgasm.

Oxytocin production is enhanced in an environment of trust, privacy, love, tenderness, darkness and emotional and physical comfort. As normal labour progresses it is normal for a woman to become more inwardly focussed, and less inclined to commumicate. The thinking parts of her brain need to not be stimulated as she enters a different state, sometimes referred to as being in “labourland.” If a woman is disturbed during active labour the flow of oxytocin can be interrupted.

According to wikipedia “The word oxytocin was derived from Greek  oxys, and tokos, meaning “quick birth,” so you can see its advantages!

Of course, if medical management is really necessary it is still possible to give birth in joy. Loving support, being in charge of the decision making process and sending love to your baby throughout, can make all the difference.

See the films below to see how joyful birth can be.

 

French woman enjoying giving birth – one of the best films of enjoyable birth I’ve ever seen.

Ecstatic birth –  shows the heights of pleasure some women can experience in labour.

Elephant birth – rather dramatic but worth watching just to see the power of birth and maternal instinct. Continue reading The Joy of birth

“Am I allowed?”

A woman this week asked me one of the things that make me want to get on my soapbox about assertiveness and women’s rights.  What she said was “are you allowed to give birth to a breech baby?” My response, as ever, to this type of question is “it you who allows or disallows your care providers to do anything to you or your baby. Nothing can be done to you or your baby at home or in a hospital setting, without your consent. You are a mentally competent adult making rational decisions about your care, and you, more than anyone, has the best interests of your baby at the foremost in your mind”.

The Nursing and Midwifery Council (NMC), that govern all practicing midwives, provide information to midwives and nurses on the issue of consent:

“Legally, a competent adult can either give or refuse consent to treatment, even if that refusal may result in harm or death to him or herself. Nurses and midwives must respect their refusal just as much as they would their consent”.

The problem may lie with the allocation of power and responsibility in maternity care. Midwives and doctors are in a uniquely privileged position to be able to serve women at such a vulnerable time in their lives. We train long and hard to amass knowledge to help those we care for, but we should not use this to control or coerce women into what we think they should do. We are after all “Professional Servants” (Mary Cronk). We are there to serve the families we care for, but it is also our professional duty to inform them of any risks associated with their choices. The Nursing and Midwifery council (which regulates all midwives and nurses) has rules and codes of conduct advising us how to support our clients such as:

1. You must treat people as individuals and respect their dignity

2. You must not discriminate in any way against those in your care

3. You must treat people kindly and considerately

4. You must act as an advocate for those in your care, helping them to access relevant health and social care, information and support

5. You must respect people’s right to confidentiality.

6. You must ensure people are informed about how and why information is shared by those who will be providing their care.

7. You must disclose information if you believe someone may be at risk of harm, in line with the law of the country in which you are practising.

8. You must listen to the people in your care and respond to their concerns and preferences.

9. You must support people in caring for themselves to improve and maintain their health

10. You must recognise and respect the contribution that people make to their own care and wellbeing.

11. You must make arrangements to meet people’s language and communication needs.

12. You must share with people, in a way they can understand, the information they want or need to know about their health.

Point number 2 was obviously not read or understood by midwives who attended a woman’s home birth. The woman was from a particular religious group and her partner was from a different ethnic group. The woman phoned me as a result of midwife harassment in her current pregnancy, and in telling me her previous birth experiences said the midwives at one of her previous births had made racist remarks! I was livid and asked if she had complained – no she hadn’t! this is so wrong on so many levels I don’t know where to start! Harassing heavily pregnant women, and going against their wishes in labour is not acceptable but racism from a so called professional is a disciplinary offence. I gave the woman information and advice to make written complaints about current and previous problems, and gave her AIMS contact details.

Another part of our rules concerns consent:

13. You must ensure that you gain consent before you begin any treatment or care.

14. You must respect and support people’s rights to accept or decline treatment and care.

15. You must uphold people’s rights to be fully involved in decisions about their care. 

16. You must be aware of the legislation regarding mental capacity, ensuring that people who lack capacity remain at the centre of decision making and are fully safeguarded.

17. You must be able to demonstrate that you have acted in someone’s best interests if you have provided care in an emergency.

Whether your care provider will like or dislike your choices should be no concern of yours. I personally don’t like junk food, but understand that some people know the risks of consuming it, and still chose to do so. I may offer education about the risks, but wouldn’t dream of telling people not to do it just because I don’t like it myself. This applies to many areas of midwifery care, for example if you are told you are not allowed to give birth at home it would be good to ask if there are specific risks you need to be aware of, before thanking your health professional for their opinion, informing them that you will consider what they’ve said very carefully and let them know you will let them know your decision in due course (Taken from Mary Cronk’s assertiveness phrases). Consider how your care provider would actually be able to force you to do anything against your will (sadly, women have informed me of social services being used as a threat in some circumstances!).

REMEMBER: You do not have to ask permission to do anything which concerns your own body or your baby. Politely question your caregivers, do your own research then take responsibility for your choices! Your body, your baby, your choice!

See also:

Mary Cronk’s assertiveness comments on Angela Horn’s great homebirth website

AIMS the Association for the Improvement in Marternity Services has a great website and provides telephone support for anyone having trouble finding good maternity care. Please consider becoming a member or making a donation to their good work. x

All rights reserved. Copyright Birth Joy 2011 (C)


Breech Birth

Breech birthBreech birth is a very complex subject which needs in depth discussion with your care provider. I am lucky to have worked with one of the UK’s most experienced breech birth midwives, Mary Cronk, learning what I can about these unusual, but not abnormal  presentations. I have attended several breech births and taught alongside Mary Cronk, and Shawn Walker. I am happy to provide information and birth support for those carrying a breech presenting baby.

The Breech Birth Network run study days for health professionals and others wishing to learn more about spontaneous breech birth. This is a different set of skills to those needed to “Deliver” a breech baby which is a hands-on medical technique. Spontaneous breech birth is a hands off birth which can be facilitated by experienced midwives. The Royal College of Midwives consider this a normal type of birth.

Although breech is a normal presentation it carries additional risks compared with a head down birth. Breech babies are often born swiftly and spontaneously, but sometimes manouvers or surgery are needed to ensure baby is born safely. For this reason I recommend hospital birth with experienced care providers for breech presenting babies.

There are many things you can do to encourage a breech baby to turn see the brilliant spinning babies  website or the very funny pregnant chicken blog. The majority of babies who present as breech in pregnancy will turn head down by 36/37 weeks. If baby has not turned by 36/37 weeks of pregnancy you may be offered an External Cephalic Version (ECV) in hospital.

This ECV video  shows the technique used. The success rates (aprox 50%) vary with practitioner, whether it is your first baby, type of breech, how much fluid, size of baby etc. There is a small risk (1 in 200) of the baby becoming distressed during the procedure and needing immediate delivery by caesarean. More information is available here.

Breech babies can of course be born vaginally, but some doctors recommend caesarean surgery to deliver breech babies. Those doctors are probably basing their recommendation on the flawed Hannah trial (also called the Term Breech Trial or TBT) results. The TBT study seemed to indicate that babies born vaginally had worse outcomes than those born by caesarean, but when the outcomes were looked at 2 years later there were no differences in outcomes for the babies, but there are differences for the mother recovering from abdominal surgery. There have been many studies since, such as the PREMODA study (reported on at the 2012 breech birth conference) which show no differences in outcomes for breech babies born vaginally or by caesarean section. It is very important that you have a skilled midwife or doctor caring for you whichever type of birth you have.

The information and criteria which doctors use to determine who is a good candidate for sucessful vaginal birth can be found here. Please bear in mind that this green top guideline was published in 2006 and there has been lots of research done since then! I attended the International Breech Birth Conference in Washington DC in November 2012 and am eagerly awaiting the data soon to be published by Dr Frank Louven and his team in Frankfurt. See more information from the conference in Dr Rixa Freeze’s fantastic blog here.

See beautiful breech birth videos here:

A first baby born Frank Breech at home. Attended by a gentle doctor, this is a good illustration of spontaneous breech birth. The doctor does use a manouvre to help the baby’s head be born, and the baby doesn’t breathe immediately (this is fairly typical of breech born babies). You will notice how the doctor wisely does not cut the umbilical cord and how baby just requires stimulation to start breathing within a minute. Click here

A wonderful video of breech birth at home in water. It is the woman’s 4th baby and I can’t help wondering if baby would have got herself out sooner if the mother was in the supine position so buoyancy would have lifted baby’s body? The reverse of dry land breech birth, when the mother is on all fours and the baby descends aided by gravity. Anyway it’s a beautiful birth and a lesson to midwives that babies play an active part in the birth process.  You tube beautiful breech waterbirth

Another you tube film of planned breech birth at home clearly illustrating baby lifting her legs to flex her head (necessary for birth of the aftercoming head). It also shows how quickly breech babies can be born (this is the woman’s third baby), the midwife makes a very good catch of this little one! click on link Breech homebirth

There is also a lovely DVD you can buy which tells one woman’s story of deciding which birth was right for her and her baby. its called A Breech in The System. See the trailer here  and order your copy here

Of course I’m not saying all babies can, or should be born vaginally, but many can, and women should be given balanced information so they can make informed decisions about their care.

Delayed cord clamping is a much kinder transition for the newborn baby

Cutting the baby’s umbilical cord is a ritual repeated unthinkingly by many doctors and midwives every day. Please educate yourself about the potential harm that could be caused for the baby by doing this.

In the 1980’s I was taught to feel for the umbilical cord around the baby’s neck, once the head was born, and to cut it if it was tight to facilitate delivery. I realise there were so many things wrong with this practice now. What if we cut a cord and then have a shoulder dystocia? We have effectively cut the baby’s lifeline. I don’t think many practitioners do this now. I certainly do not feel for nuchal cords as babies can be born, even when the cord is tight. The somersault manouver  can be used to keep baby close to the mother whilst the cord is untangled.

The brilliant midwife thinking blog highlights the dangers of premature cord clamping if a baby needs help to start breathing. Basically when the baby is born a significant amount of his blood is still in the placenta. After birth that blood is needed to perfuse the baby’s respiritory system, enabling him to transition to breathing air for the first time. If a baby is slow to breathe but has a good heatbeat he is still receiving oxygenated blood through his cord if it remains intact.

Some women like to keep the cord intact in the form of a lotus birth. Aida’s birth and lotus birth was filmed, and illustrates how not cutting the baby’s cord helps when her baby needs help to start breathing.

Here is a 7 minute film with good, common sense advice about not cutting baby’s cord immediately after birth. This film has brief images of a woman’s breast and nipple as she is with her newborn baby as his cord is cut and as he crawls to the breast to self-attachment. This process, called Self-Attachment and/or Breast Crawl is becoming known now as a very critical part of human development that has been disrupted by modern, medicalized birth. Click to view: We can be much kinder

Penny Simkin gives a visual aid teaching session on the subject of how much of baby’s blood is still in the placenta if we cut the cord too soon after birth. here

Robim Lim explains the importance of not clamping or cutting a newborn’s umbilical cord here:
https://www.youtube.com/watch?v=SwvRUrn0p90&feature=player_embedded