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Hello everyone
Will make this quick if I can, with the aim to elaborate
more later if there is anything others want to know, I'm waiting for the phone
to ring, a woman in early labour...so don't want to get halfway through and then
have to go!
I've been at 2 breech births in the 3 years I've practicing
independently, both home births. The first one was an undiagnosed footling
breech, my first "catch" as a RM in fact. The woman was labouring silently
in water, turned over onto all 4's quite suddenly and then I reached down and
felt 2 feet. She stood up when I gently asked her to, as I felt I really
needed to see what was happening. She birthed her baby (no 2 for her)
slowly to the umbilicus, then a big loop of cord came down, then to the
shoulders, then the arms wriggled down one at a time, then baby had a big
wriggle, as if to let us all know she was fine! After about a minute -
which felt like an hour - I gently asked her to give a little push with her next
contraction. She just "let go" as has been mentioned before, and babies
head was born quickly, no sweeping gently over the peri, but no trauma to mum or
babe.
The second breech birth I attended was a diagnosed frank
breech which didn't turn despite all the tricks in the book including ECV.
The woman decided after much deliberation to take cues from her baby about place
of birth, and went on to have a quick trouble free labour, and birthed in water,
on all 4's. I don't recall her tilting her pelvis at all, she stayed on
all 4's for the birth and then sat back and picked her baby up. Baby came
out slowly, bottom first, restituted visibly, and then one leg extended a few
minutes before the next. We have fabulous photos of this, one leg out, the
other in. The woman breathed her out, and when baby got to the shoulders,
they were born in one motion with the head. All very quick, and again no
trauma to either. To say they were elated to have "cheated the system" is
an understatement.
Not sure if this ramble addresses any of the original post on
this topic, but it's something I feel incredibly privileged to have experienced,
and love to share my thoughts whenever I can!
Cheers,
Tania
x
----- Original Message -----
Sent: Saturday, November 27, 2004 11:34
AM
Subject: Re: [ozmidwifery] Breech birth
question
Hi Abby,
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??)
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