May 09, 2004

normalising breech birth

Brisbane was the venue for yesterday’s Midwifery Intensive event. It was a very rainy day, which was a treat, coming from Sydney where the drought is tightening its grip, but it didn’t dampen the enthusiasm of the large group of midwives who gathered to explore the issues around “keeping birth normal.”

The topic of breech babies seemed to especially catch their attention. Some hospitals in Brisbane have caesarean rates of over 60% and there are obstetricians in this city who will only do caesarean births (labour is “so unnecessary”!), so there is a desperate need for some midwives to reclaim their skills and find their own strengths in this face of this kind of opposition.

Because of the size of the groups who are attending, this program is not able to offer midwives practice sessions with dolls and models. However, as Maggie Banks, the wonderful midwife from New Zealand points out, a baby coming by the breech is not all that different from a baby who is head down: what is needed is time, no handling and freedom for the woman to move and the baby to wriggle out. One of the most interesting aspects of her presentation are her summaries of the risks of bed-birth, particularly as it restricts the pelvic capacity and the woman’s ability to move as needed. All our speakers have emphasised the dangers of labouring on the bed and the ease with which complications and interventions can be avoided when women have space and freedom to move during labour.

Maggie showed, using a series of lovely slides, the role that the breech baby plays in getting itself born. The baby needs space to wriggle and cycle its legs, to release it own arms and align its body within the pelvis for the birth of its head. Touching the baby can disrupt these actions. Having the arms brought down by the midwife or doctor can present special problems - the positions of the baby’s arms and hands up beside its head and face, provide a splinting action, helping to keep the head well flexed. If a baby is startled by someone handling its body or pulling on its arms, there is a great risk that the baby will thrown its head backwards (seen in the “startle reflex”) as a natural reaction, and perhaps find its head trapped within the cervix. Maggie has great respect for women and babies and complete trust that given the right conditions, a calm midwife and trust in the natural process, breech birth need be no more hazardous than vertex birth.

I wish that obstetricians would take heed of these wise words and stop being frightened of breech birth. Women can manage this kind of birth as well as any other.

Posted by andrea at May 09, 2004 01:53 PM

Comments

I agree, Maggies information on breech birth is so empowering. If a breech presenting baby is left it alone it will come if it is going to. Don't urge the mother to push, rather let her push as she has the need. Keep the mum upright. If there is a problem there will be no descent of the rump.
The last mum I looked after with no descent of the rump after full dilation, and two hours+ pushing turned out to have a uterine septum. The baby was well after emergency section.

Posted by: Kathy Young on May 16, 2004 04:05 PM