I really love your interest in all the finer details of birth - your inquisitive nature will hold you well as you watch all your births unfold - all in their own manner, positions and time frame.
I attended a breech birth two weeks ago - making my fifth breech in all - 3 at home and 2 normal vaginal breech in hospitals.
I have also not long returned from Maggie Banks Midwifery Intensive in New Zealand where we really bashed out breech births from all perspectives and positions.
If you run a breech simulation through a plastic uterus, like we did many times in NZ, it appears that the most accommodating position ie the easiest 'sweep' of the baby's head through the bones and the perineum is with the pelvis tipped slightly forwards ie mum leaning slightly back, but upright not sitting on her pelvis ('bed dystocia' as Maggie calls it).
However, 2 of my 3 homebirth breeches were standing leaning forward which does allow baby to drop through well, but with each of these, when the head was ready to be born ie after the nape of the neck was visible, when asked to 'let go', both mothers spontaneously tipped their pelvises forward (into the better sweeping position). The third homebirth breech was a waterborn primip breech and I can't recall if the mother tipped her pelvis forward or not, but she was reclining into her partner's arms, so probably had her pelvis tipped forward anyway.
The 2 hospital breeches were both on the bed - one with the British-trained doctor lifting the baby's feet up to right angles to the mother's body which exposes the face through the vagina and thereby providing an airway so baby can breathe if necessary but doesn't birth the head(I can't remember the obstetric name for this manoevre). At this point I suggested the mum hold her own baby's feet. The doctor turned around to get his forceps and I then encouraged the mother to 'let go' the head which she did - again with that forward lift and slight thrust of the pelvis - and the doctor turned back to the bed to see the mother lifting her baby up to her breast. He did turn to me and asked me how we did that, as he obviously had never seen or thought that the head could be born spontaneously. I told him at the time the secret was 'woman's business' but did spend some time later explaining how it felt to release the head and what was required (I had a breech at home so that was from first-hand experience...)
The second hospital breech was with the woman already in stirrups, end of the bed off, doctor in place on a stool, and he very obstetrically managed the birth mechanism but without forceps. Again I encouraged her to let go the head which she had to do pretty quickly or the forceps would have been applied. Cord cut immediately, off to the resus trolley, suctioned, aspirated, shown to another midwife out the door - all before mum even had a look!! Disgusting behaviour !!
So Abby, I agree that there is a very wide difference of practice around breech birth, and we'll each be shaped by our experiences and /or teachings. There is also variety in our pelvic shapes but in reality the breech mechanism is quite simple and straightforward. When we played with the pelvises in NZ, it became quite clear that even an extended head or 'stuck' breech was only as tricky as stuck shoulders, and often the same mechanism was required to free stuck shoulders and stuck/extended heads. This makes senes to me anyway, as we all know the difficulties sometimes faced with severe dystocias which sometimes end in tragedy.
Birth is a dynamic process and we always have to be on out toes and expectant, rather than complacent. But as you say Abby, 'the best way to birth a breech baby is just like any other baby, her way in her time.'
Sue
Hi,
Just reading about breech births and differences of opinions between caregivers. Came across this comment, on a homebirth midwifes page and found it kinda odd. I would expect it from some Obs and hospital staff, but not sure what to make of this. There are other things on the page that I think are weird eg. semi reclined position, do this, do that, I'm in charge kind of attitude, but this comment struck me as `fear`.
7. At this point the baby must be born quickly. STAY CALM! It is possible for the baby to suffocate if not born within 5 minutes. Note: Time seems to stand still when we are under stress. Have an assistant keep track of time. What will seem like twenty minutes to you will have probably have been two!
http://www.moondragon.org/obgyn/pregnancy/breechhome.html
Any midwives out there that have differing views on breech births. I realise that these days most women are encouraged to have c-sections, but thought some of you would supported women at breech births.
I have learnt from a couple of wise women that the best way for women to birth a breech baby is just like any other baby, her way in her time.
Love Abby
(P.S. She also warns against the advocation of the squatting position, where as Michel Odent believes it should be insisted that women birth a breech baby squatting?? Any thoughts??)
