To me breech is a variation of normal. Well not only to me, 4% of babies are breech so it must be pretty normal to them too. There is fear and unknown surrounding this which all circles around the “term breech trial” which was extremely flawed and commented on at the time by people like Maggie Banks. Practitioners with no concept of birth as part of the normal life cycle were involved.
In a nut shell the trial recommended that the practitioners were experienced, however 26% of them hadn’t been at a breech and it was even used as a learning tool on occasions. It was also recommended that the birth was totally hands off to at least the umbilicus and then only acted on in complications; but this was totally ignored. Of course it had to be cancelled the medicalisation of childbirth never works. Please read the critique by Maggie who followed it closely.
My experience with breech goes back to my training. The hospital had a 9% c/s rate so most babies birthed well. I was involved with both twin and breech births as part of my experience with normal. I have only seen one very traumatic breech which was an extraction done by a frightened Registrar. This is not something I would allow my clients to be subjected to EVER.
Over the past 12 months alone I have attended 4 breech born babies in a variety of positions. This included 2 frank 2 flexed and part of the end of the year before I attended a beautiful footling breech.
Women’s journey to a breech birth are often convoluted and very interesting. This really shouldn’t be needed but we are fed fear around breech even before pregnancy and unwinding the tangle to realising that it is just a birth, often takes lots of time and soul searching.
What’s different? Well for the labouring woman, nothing in particular, It is like any birth, most are fantastic and some need help. This is something that is not understood by the “system”. I have had an occasion to transfer a woman to Flinders medical centre with a woman carrying a breech and we were refused care unless she consented to a cesarean. Even when we asked for a second opinion we were refused the option so We left and went to The Women’s and Children’s hospital where we were treated with care and consideration of the women’s wishes. Breech as variation of normal is just not in their line of vision.
Most women with a breech baby birth gently and quietly at home with me just watching and encouraging as I do at all the amazing births I attend.
Midwives carry lots of skills with them that they hope not to use. Breech skills are just a few more in our arsenal. The rule is always HANDS OFF THE BREECH. Position is important. In my opinion the best position is leaning forward almost on all fours. It is kind and gentle for the baby and helps with great control for the mother. Even in the water this is the best position for birth. Standing squat seems popular: however it is my experience that the placenta separates and appears on top of the baby which is not really ideal for oxygenation after the abdomen has appeared. All the usual natural processes work, only push if feeling like, breath baby down the canal and watch. With some the slow motion is poetic and for others it’s a bullet. A woman I birthed with last year birthed Frank breech baby out in 4 mins. From first visibility of it to baby born. (this woman was 162 km from nearest hospital but that’s a whole other story)
Once the abdomen is birthed there are a few internal processes I go through in my head: time, length of cord showing and baby activity. Babies aren’t passive in this process and you can see them cycling their way down. At this point, if the woman isn’t leaning or on all fours the hang of the baby is incredible and can put lots of stress on the tentorium. This is even more so with lithotomy position (classical hospital control position). I don’t ever say anything But I am looking for progress that shows there isn’t a nuchal arm. The most common way to get a nuchal arm is to pull or touch a foot on the way out releasing the morro reflex in the baby and instant nuchal arms. The manoeuvres involved like the Pinard’s, Loveset or Smellie-Veit ( don’t forget they were all Obstetricians) are great for emergencies but for the majority should remain in the back of your mind.
Touching the cord to check or pull down a bit. Another potentially pointless manoeuvre. Important if very tight, but mainly just to look at and nothing more. FH could be as low as 40 at this point and with so much of the baby showing Why would you spasm the cord just to find out what we already know.
The birth of the head in my experience is also mainly spontaneous. Only occasionally is it deflexed and needing a small helping hand out. The Obstetric view of a quick head birth being an issue is also a debate for me. With a lithotomy Ob led extraction with a long hang and stress on the baby I’m sure it is a problem, but with little or no input from a practitioner mostly the baby will flex it’s head and birth alone.
Breech babies often lose a bit extra tone and response to slip themselves out. This is not a major problem and dealt with like any other. In half of the births I attended last year the cord was around the neck. It was around the neck twice in one birth but didn’t cause an issue at all.
Belief in birth as a normal process and trust in women and their ability goes without saying. Birth is beautiful and breech is a fantastic variety.
These last pictures are the baby spontaneously moving back in the water so the head will flex. It is the most amazing thing to see the mother and baby move together to make all the changes necessary to help the baby out.
Here is the finished product. Home made by a beautiful birthing goddess. Thanks to my client for letting show these fantastic pics you can read her breech story too.
- Do you
Homebirth? Share this post with your friends - Recommend on Facebook
- Buzz it up
- Share with Stumblers
- Tweet about it
Related posts:
Once again, that you for this post! I just attended my first breech birth, and the placenta did follow out the baby (mom was in a supported-standing squat). We have another client with a breech baby. I also really feel that breech is a variation of normal, especially with a skilled but hands-off midwife at home.
thank you, thank you, thank you. you echoed many of my thoughts and feelings on this.
the pictures are gorgeous!
the grammar on some of my late night musings is a little off. Hope to correct and improve.
Thanks for reading.
Thank you for this post and the amazing pictures. As a new midwife in the end of my apprenticeship, I often struggle to connect with my preceptor and nudge her to the side of seeing breech birth as normal. I will pass this post along to her and hope that it will facilitate a discussion.
Simple beauty. I’ve been “afraid” of a possible breech since I am carrying twins and Baby B has been off and on breech. I’m sure he’s just trying to find a good spot that’s not all squished!
It’s outside of my norm, so it freaks me out a bit. Reading your commentary and seeing the photos are a great calming effect.
CNH, Twin births are magic. Baby B will slide out. I hope you are birthing with a known midwife, always the best way. Check out the lotus birth article where there are twins with a shared placenta.
Thanks so much for your post. Those pictures are phenomenal! Kudos for a wonderful hands-off breech birth (and to the mama and baby especially!).
Thank you Lisa for this article. Perfect timing!
I just finished a workshop where the lecturer(s) were telling us that breech isn’t normal and the head will get stuck because the body can’t wiggle the head out (like a head first). As a mid student, being with mumma’s with breech babies will be a priority on my ‘must acquire’ skills list.
GIMME MORE!
Amazing photos. Thanks a lot. Sarah
Awesome, awesome, awesome!
Jeez woman, I love your blogging. You just make so much sense. No bullshit birth. That’s you!
Shine on you crazy diamond.
x B
so awesome!
thank you.
from a mother who had a surprise footling breech, but only has one picture of a foot coming out, it’s amazing to me to be able to view this and see what my son’s birth more or less looked like.
thank you! what a beautiful learning experience! (wish I lived closer to learn from you directly!) I have had one surprise breech, footling and she did fine. Hope to meet you at a conference someday. Keep up the great work!
cathi
Beautiful story. Thank you, as I see a breech coming my way in the not so distant future.
I did in fact give birth to a breech, but it wasn’t baby B! Both babies flipped breech and baby A was born complete with a dangling foot. She was a teeny 6 pounds 6 ounces and literally fell out after I passed her head through my cervix. PAINFUL birth. Baby B then flipped vertex and posterior and I had a HECK of a time getting him born as I was so exhausted from fighting that need to push for 2 hours while his sister’s foot dangled into my vagina! LOL
But it was a wonderful birth and I am SO thankful to have done it at home.
I had 2 Births , a Boy at 52 hours, at home for 42 hours,then hospital for 10 hours…7.8 # …2nd Birth a gorgeous boy with 5 hour lovely homebirth, 9.7#… then the 3rd birth, planning for a homebirth but found out 2 weeks before due date we were going to have twins, husband was not happy to birth at home, so we found a dr, had them it the hospital (with my midwife along as a support person), the dr told me if I went through with the birth, they were both breech, one would be a paraplegic & the other would be a retard, every one (except my midwife)thought I had gone nuts. Twin fraternal girls were born after 8 hours of labour, both breech 37 minutes apart,6.5# & 6.8# no bleeding whatsoever (actually made Dr mad I did not bleed as he had predicted I would hemorage big time)
The twins are now 4 and a half years old & wonderful
Hello Lisa~
Thank you so much for this post. I have read it many times.
What are your contraindications for breech birth at home? For instance, what if a mama has had an u/s at 40 wks and found a nice size baby (~10lbs) and a nuchal cord.
What is the largest breech baby you have attended at home?
Here in the US breech birth is becoming extinct. And the whole world is watching with a certain look in the eye, while holding in the breath, if any mama decides to birth her breech baby at home. Thanks for the bold print.
Hi, the baby in the video had a nuchal cord as did the baby in these pictures. I have never had a woman have an ultrasound at term.
I haven’t birthed a 10lb baby that was breech because I hasn’t occured. We did have a transfer of a woman at christmas who was having her 5th baby it was breech and didn’t seem to be progressing normally. We transferred for a section, baby well and mother well but didn’t want any intervention apart from the operation. The baby was just under 11lb. It’s like any other birth, sometimes there will be indications that the baby just isn’t going to come down.
That was beautiful. And what a gorgeous baby!
Thank you, this was great to read! I had a surprise breech at home a week ago today.
I was really shocked to find she was breech and have been googling it ever since.
My birth story is here if anyone would like to read:
http://amby.invigorated.org/?page_id=206
Hi Lisa!
Thank you for your website and blog spot. I am a midwife. As a student and new midwife I assisted in two breech births. One was a second born triplet. The other was a 38 week. In both the midwife was aggressive in birthing the baby, assisting in birthing the arms and the head. Neither looked very calm and peaceful to me. I am really interested in learning more. I don't know if you know Anne Frye, but she devotes a whole chapter in her book Holistic Midwifery II. to breech birth, very similar to your approach, where midwife is very hands off. I have yet to find a midwife in my community that has this approach. Please keep you posts coming. I would like to know as much as I can.
I am a 36 week primip with a breech baby due to bicornute uterus. Does this have any adverse affect on labour of a breech.
No it shouldn't affect your ability to birth at all.
Hey, not sure if you'll answer questions on here, but i'm 35 weeks pregnant with my 7th & little one is still breech – i'm trying to figure out my options before his birthday. My midwife has warned me that they're not "allowed" to attend breech births… i feel certain that we (me & little one) can do this with no interventions, but am frustrated at the lack of support…
Anyway – my question was about labouring on hands & knees – i have loved that position in the past but i'm curious if my anterior placenta this time has any affect on that being the ideal birthing position?
after 7 babies you will birth easily no matter if its a head or a bum. Having an anterior placenta shouldn't matter. There are midwives in Canada that will attend breech. Look at Gloria Lemays blog.
AmybUK – thank you for posting the link to your beautiful story!
And seriously – God bless you Lisa Barrett and all midwives who practice this way! Your blog has helped me so much in my search for information on normal healthy breech birth. I am currently 30 weeks with twins and one is breech – he still has time to turn but I'm confident he'll be born perfectly no matter which end is up!
you are so wonderful ~ and sharing those amazing pictures… THANK YOU!
Beautiful! Thankyou for sharing!