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.
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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!
Hi, I loved the photos and learned something too! I was a breech baby and so was my mom which is why I did so much research to avoid a c-section for our son’s birth. At age 39, I gave birth naturally to our 8lb. 4oz. baby with a wonderful midwife, Susan Akins. It inspired me to collect other positive stories with evidence-based medicine for a new book! Birthing a Better Way: 12 Secrets for Natural Childbirth. Since the press is nonprofit, we are doing a birth “blog tour” and if you would like one to read and hopefully add to your “recommended books” let me know! Thank you, Kalena
wonderfull read
i am a comunity midwife and maily birth women at home.i too had a wonderfull home (unplanned) breech not to long ago.it was a client whom i had cared for before with a previous homebirth so when she rang to say she was labouring i went to attend her.when i arrived she was very obviously well established in her labour so i saw no reason to do anything except have a quick listen in to the baby.whilst i was getting my bag from the car she had SROM which was clear.during this time she was standing and walking around.shortly aftershe asked to sit on her bed this was quickly followd by a few spontainious pushes she then said Sue it feels different to my last my reply a smile and its ok jus do what you need to she did and out popped a nice rounded bottom her responce WOW SUE THATS DEFFANANTLY NOT THE HEAD! i advised her not to push just to breath the baby out as it was her 4th baby this was not difficalt and with just 3 well controled contractions her son was born! the whole time i was sat on her bad with her and did not touch the baby at all.he cryed spontaniously at birth and waighed 4010kg.placenta followed bout 15 min later.although i have delivered many a baby at home this was my 1st breech but as with most of my births i support but the women self deliver this was no different. except i still remember that amazing experiance in great detal which is more than i do with some of the births i attened.i live and work in the UK whee breech vaginal birth does happen and is becoming a wee bit more aceptable as women find thier voices and request to deliver HOW THAY WANT
A baby in my community died during a breech homebirth a couple of months ago; I went to the birth story. It was very sad and the midwives ‘ first homebirth death. The parents also came to the conclusion that if they had chosen a c-section the risks were about the same as the risk that the baby would die in childbirth. There are never any guarantees.
I wonder if this will be published.
In any event, re:sara r’s tragic story – How did they know the outcome by c-section would be the same? For all its flaws, the Term Breech Trial did establish that overall, the risk of major baby problems with vaginal birth is 3 times more as compared to caesarean section. 5% of vaginal breech births will go wrong – if you end up assisting in 20 vaginal breech births, 1 of them will end tragically, as with sara r’s story; with C-sections, you would do 60 before getting the same result. Lisa has been fortunate so far – but do a few more (i don’t know how much experience in total you have had, but 4 in a year is not many), and unfortunately the odds are something may go wrong.
Women need to know this. If you try for a vaginal breech at home, yes, you have a great probability of success (95%). But the 5% that you risk is of great significance (death or severe neurological impairment) in anybody’s eyes. If you have a Caesarean section, the risk is still present, yes, but three times less.
i would like to know that the mother is in her first delivery or the two or more, can first delivery be this way? with hand off and no assistent delivery ? thanks for your wonderful contributions!
yes, it was her 1st baby!
Lisa, Thank you so much for these wonderful stories about breech birth! It’s so encouraging and helpful! I’ve done several breech births and they’ve always gone really well. I wondered if you’ve ever done an OP breech? I have a mom with a baby in this position.
Bonnie
in my experience after the butt is born they tend to do a full rotation. I know they do come out OP but this is what usually happens. Until she goes into labour it’s always hard to know where the baby will be sitting right at the end.
Wow, I’m truly amazed to see this view on breech births! My first baby was breech, and my fear was that the head might be too big (father’s head is quite big
.
I read a couple of birth stories with the baby dying of brain damage in hospital births… (apparently after a birth that was not progressing well, so maybe it’s due to a wrong decision or who knows what.)
My question to you is: how do you know if the head’s going to pass? Couldn’t it be that some babies are ‘heads up’ because their head doesn’t fit in the pelvis?
Louise
No that is not a known reason for a baby to sit breech.
Hi Lisa
Woah this was amazing to read. I am 20 and my first bub is very close, she is Breech and I’m honestly in despair over having a C-section. My midwives keep saying to have the C-section as it’s safer, is this true? Am I entitled to say no?
I might sounds silly with that question but I’m so confused!
Pictures are beautiful by the way, the whole process of birth is so beautiful to me.
Thankyou
My mother had 4 out of 4 breech babies. I have had 4 babies, the first baby was footling breech – all born at home, all went well with care of doctor and midwives. Most likely I would have had a caesarian for the first babe if in hospital, therefore all 4 would have automatically most likely have been caesarian.
The eldest is now 31years, the youngest 19.
Yey to homebirths (if that’s where you feel most comfortable).
Hey! I’m Julia and my 1st baby was breech (ended up with a c-section). Now I’m pregnant again (17 weeks) and I was told I have a medium size septum in my uterus and that it means I have more chances of having breech babies. Is that true?
I know a woman with the same issue and she had 3 head down babies. Why do doctors always scare you with that kind of comments? I mean, he does not even know how my 2nd baby will be positioned, then why the hell he “predicts the future” telling me he is probably gonna be breech again?
I have just found out I am having twins, I have a 6 and 4year old.
I had perfect births 3 hours 20 mins and the second birth 1 hour 15 mins, both natural and enjoyable.
I don’t have private health, so guess I will be going through public system in rockhampton.
Just very worried about what I have read with twin births and epidurals/ ceserians/ when I mostly sure my body will give birth again naturally again.