birth choices, breech birth, My teaching, study days attended
Breech Birth
Breech birth is a very complex subject which requires 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 many breech births, attended international breech conferences, 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 used to consider this a normal type of birth.
“Although breech is a normal presentation it can carry some additional risks compared with a head down birth. Breech babies are often born swiftly and spontaneously, but sometimes manoeuvres or surgery are needed to ensure baby is born safely. For this reason I recommend upright birth in hospital with experienced care providers, for breech presenting babies.”
Joy Horner
Encouraging babies to turn.
About a quarter of babies are breech at 28weeks of pregnancy and most turn themselves head down by full term. If your baby has not turned by 34 weeks there is evidence to show moxibustion can encourage babies to turn head down.
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 early in pregnancy will turn themselves head down by 36/37 weeks.
In the NHS pregnant women and people are offered External Cephalic (head) Version (turning) from 37 weeks. ECV is done in hospital, by an obstetrician or midwife manipulating your belly to try to manually turn your baby from the outside. This can feel uncomfortable or even painful for some people. Sometimes a drug is given to relax the uterus . 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 recommendations on breech birth is available here.
Recommendations for birth
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 which show no differences in outcomes for breech babies born vaginally or by caesarean section. It is very important that you have a midwife or doctor skilled in breech birth caring for you whichever type of birth you have. See if there is a centre near you who may be more supportive of breech birth by participating in the Optibreech project.
If you would like to read more research visit Birth Without Boarders
The information and criteria which doctors use to determine who is a good candidate for successful vaginal birth can be found here.
I attended the International Breech Birth Conference in Washington DC in November 2012 and learnt from many breech experts including Dr Frank Louven who’s research and subsequent data published supports breech birth in upright positions. See more information from the conference in Dr Rixa Freeze’s fantastic blog here.
Further information
Breech birth videos:
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. Order your copy here
Of course I’m not saying all babies can, or should be born vaginally, but many can be born safely and easily, and families should be given balanced information so they can make informed decisions about their care.
Please contact me for a free 15 minute discussion about breech birth or Book an hour long consultation to plan for your breech birth, or to write a breech birth plan.
Midwives learning from other midwives have the advantage of learning physiological breech birth but the disadvantage of a gap in 2-3 generations of midwives who’ve missed experience with more than an occasional breech. Home birth doesn’t have the extra support for full resuscitation, though it is advantageous for the baby that many midwives know not to cut the cord during resuscitation. As I’ve pointed out before, there are strengths and weaknesses to both home or hospital breech birthing. Homebirth can be argued to have “inadequate resources” from the point of view of a hospital. The skills of the midwives, and the complexities of a breech birth will vary and occasionally the worst of both will collide. Even a midwife with many successful breech experiences behind her could suddenly be faced with a situation she can’t solve. While this crisis can and does also occur in the hospital, having it happen in a homebirth puts parents and midwives into a whirlwind of exposure, review and too often, retribution by the system seemingly slighted by their choice to give birth another way.
Women are sometimes faced with little choice in the UK. because of the really flawed Hannah trial in 2000 we have been wrongly suggesting caesarean birth for breech presenting babies. We mistakenly thought that this way was safer for breech presenting babies without always weighing up the consequences of abdominal surgery for the woman and risk to her future pregnancies. What the Hannah trial did illustrate was the experience of the care-giver is very important in terms of sucessful outcomes..
I feel so very sad that many women are denied the choice of breech birth due to the loss of skills in this area. I am doing my small part in redressing the balance by running “Once More Unto The Breech” workshops with Mary Cronk, to equip midwives with the skills to support women in their choices.
Thank you so much for all of this breech infarmotion! It is so good to know that the art isn’t lost. I live in Los Angeles and its very hard for a woman to find anyone to support her having a vaginal breech birth. These photos and videos you share are priceless. Thank you so much for your work.