Breech Birth Index
Compiled by LLM
from Sebastian's
Breech Homebirth Story
Following is information, stories and support
for giving normal vaginal breech birth. For more
about breech birth, go to BirthLove's Links
page.
Click to go to the desired section on this
page:
Breech Birth Stories
Ruth's
Birth Gabrielle is a marvelous birther
and her first baby would have been born with ease-
had it not been for the bumbling, bizarre and
cruel OB who attended (and could have killed)
her. Hugs to Gabrielle, and shame on him for his
barbarity.
Home breech birth
"Another one for the book! A&A had
been in touch with me and my midwifery partner
Jane Evans. A was expecting her second baby
and it was a breech presentation. A lived in
another part of the UK where the only option
on offer was a ceasarean. There were willing
and able independent midwives available, but
they had not had experience of breech birth.
Jane and I tried to work out how we could attend
A and assist her at her home. It was just impossible
for a variety of reasons.
"On Friday having had another upsetting
obstetric consultation, A&A phoned me to
say they were about to proceed in my direction,
a journey of over 500miles! They left there
home on Friday night arriving at Chichester
station yesterday (Saturday) morning at 09:45.
I met them with a student Midwife who was spending
the week with me. A told us she was now contracting
1 in 7 and the look on her face suggested to
us that she was indeed in labour!
"We proceeded to my home informing my
colleague Andrya that her services were needed
ASAP. On arrival at my home the student midwife's
room was rapidly transformed into a birth room.
Andrya arrived. The labour progressed as breech
labours do that are going to result in breech
births, and at 12:04 a lovely little (well 8lbs)
boy was born.
"Student midwife appeared quite chuffed
to be among those present. Joe my beloved had
placed some suitable fluids in the fridge before
taking refuge in his workshop and at 13:00 we
were all welcoming the new arrival with a toast
for his health and happiness. Sad though that
this woman had to make a stressful journey heavily
pregnant." -Mary
Cronk, Independent Midwife
Our
Birth Story Sherry's first baby- a baby in
the footling breech position- was born at home
with a gentle midwife attending. This includes
many techniques that Sherry tried to encourage
him to turn.
Kamden's
Homebirth Story Brandy's first birth left
her feeling brutalized and angry. Her homebirth,
a surprise breech, showed her how beautiful and
powerful giving birth really can be. Includes
family photos.
Sebastian's
Breech Homebirth Story September, a student
midwife, gives birth in glory and efficiency at
home to her second son. This story includes her
challenges with the medical "profession"
at the end of her pregnancy: she went in to get
an ultrasound, and what she got was almost unbearable
bullying that even she- a woman who had gone to
forty-five homebirths, including two breeches-
found difficult to stand up against. Includes
amazing photos.
My
Story as Doula and Mother Katie is a doula,
and a mother of four (with one baby in heaven).
She shares her birth stories here (all powerful,
victorious hospital births- including a double
footling breech hospital birth!) and her journey
to becoming a doula at age fifty.
Maia’s
Birth- A Family Celebration This is the birth
story of the fourth child born to an Australian
doctor. Maia was born surprisingly breech in the
water at home, with only her loving, reverent
family welcoming her. Includes mention of Maia's
lotus birth, and her mother's peaceful postpartum
experience.
Makalo's Magical Birth
Telka gives breech birth at home to her first
child in a tub of water- in his face she saw "a
glimpse of divine perfection, manifested as human
life".
James'
Beautiful Breech Homebirth A woman's first
baby comes down bottom first at home. A beautifully
told, empowering birth story.
Breech
of Faith by Patricia Blomme. This unique
birth story is told from before, during and after
the birth. Patricia's breech baby was born vaginally
in the hospital, with an amazing, supportive team
around her- making sure her birth plan was followed
to the letter. This page includes a link to photos
of the birth.
Etanna's
Birth A mother having her 7th child is surprised
to find out she's having a breech birth. She ended
up transferring to the hospital, but had probably
the only vaginal breech birth the hospital staff
had ever seen. Includes mention of how well colloidal
silver works in preventing strep B infection.
Ginger's Stories
Ginger gave ecstatic birth at home to two breech
babies- the first being born unassisted.
Letter to Leilah about her daughter's footling
breech homebirth
"I've been reading through your website
and appreciate your labor of love for the birthing
community. My daughter had a footling breech
homebirth yesterday morning. She didn't wake
up this morning with a surgical wound, and my
granddaughter is doing beautifully. I've been
thinking about the legacy of homebirth...this
daughter was born at home (I got mad at the
CNMs at the birth center and walked out dilated
to 7cm).
"My older daughters had both been born
at the hospital- they are both pregnant and
won't even consider a home birth (too risky!).
It seems like the spirit of the hospital attaches
itself to our children... how sad." -from
Janet. Read her amazing birth stories here.
Breech Birth Research,
Links, Quotes and Letters
How safe is a breech VBAC?
"Exactly the same as any other VBAC, about
slightly less than a 1% chance of scar problems
if the labour is spontaneous and progresses
well without intervention. With a breech one
never advises intervention anyway. If progress
is not good CS is my preferred option. BUT many
if not most breech labour progress well, and
breech presenting babies are born.
"My second last birth, just over three
weeks ago, was with a woman who had chosen not
to have screening tests as she would not have
wished to terminate a baby's life. Interestingly
she has a brother with learning difficulties
(cerebral palsy due to a botched forceps delivery)
so she knew the realities of life with a handicapped
family member. Her little daughter was born
easily at home a footling breech, with Down's
syndrome. She has chosen her parents well and
is a loved and welcome special member of the
family. Her elder sisters drew a lovely card
of welcome to their 'special' sister and the
elder has a little boy with Down's in her primary
school class and she told me her new little
sister was special, just like Fred her classmate."
-Mary Cronk, Independent Midwife
Vaginal Breech Birth Safe in Selected Cases
By Roberta Friedman, PhD
SAN FRANCISCO (Reuters Health) Feb 10 -
With proper selection based on prelabor
criteria and careful management of labor, women
with breech presentation can safely deliver
vaginally, according to Irish researchers who
described a prospective outcome study here at
the meeting of the Society for Maternal Fetal
Medicine.
The researchers at the National Maternity Hospital
in Dublin followed all 641 women with breech
presentation after 37 weeks during the four
years from 1997 to 2000. Computerized records
provided perinatal and labor outcomes.
A trial of vaginal breech delivery was allowed
only if the presentation was extended type and
if the estimated fetal weight was less than
3.8 kg. When vaginal delivery was attempted,
labor induction was avoided as was the use of
oxytocin, for either the first or second stages.
Slow labor was not an immediate reason to go
to C-section. The threshold to send a woman
in slow labor for a Cesarean was 6 hours for
the first stage, and 60 minutes for the second
stage, for a first birth. A woman who had already
given birth before was allowed to labor in first
stage for 4.5 hours.
Of 298 women who tried vaginal delivery, 146
succeeded.
"There are well-known criteria to have
a safe, vaginal breech birth," said Dr.
Karin Blakemore, of Johns Hopkins in Baltimore,
Maryland, who commented on the poster presentation.
"You don't offer vaginal delivery for big
babies."
The Irish study presented here found "no
perinatal death and no poor outcomes,"
as defined by an Apgar score of less than 7
at 5 minutes, or cord venous pH of more than
7.2, or abnormal neonatal neurology, Dr. Blakemore
pointed out. "Zero is a powerful number,"
she said.
Reuters Health Information 2003. ©
2003 Reuters Ltd.
Vaginal Born Breech Babies Fare Just
as Well as Cesarean Born
"Breech presentation at term: evolution
of French practices and an analysis of neonatal
results in regards to obstetrical management
of breech presentation"
Vendittelli
F, Riviere O, Pons JC, Mamelle N;
Les obstetriciens du Reseau Sentinelle AUDIPOG,
Departement de Gynecologie-Obstetrique et Medecine
de la Reproduction, CHU de Grenoble, BP 217,
38043 Grenoble Cedex 09.
OBJECTIVES: To describe the evolution
of medical practices in breech presentation
at term and to compare early neonatal complications
according to initial obstetrical decision on
the type of delivery.
METHODS: 71919 pregnancies are included
in the AUDIPOG Database from 1994 to 2000. Among
this cohort, pregnant women with a singleton
in breech, at term were selected which represented
2136 women after the exclusion of in utero deaths
and medical abortions. The first outcome was
global criteria of severe early neonatal complications
("death during per or immediate post partum
or transfer of the newborns to an intensive
care or surgery unit"). The size of the
sample authorized a power of 90%.
RESULTS: The rate of cesarean section
before labor was 40%. We found 2.3% of early
neonatal complications in the group in which
labor was accepted vs. 1.9% in the group with
cesarean section performed before labor (p>0.05).
After having taken into account prognostic
factors, we do not see a significant difference
for the risk of neonatal complications between
the two groups (OR=1.33; 95% CI: 0.63-2.80).
CONCLUSION: The analysis of the AUDIPOG
Database describes the French obstetrical practice
in breech presentation at term. We do not
find a different risk in morbi-mortality as
regards to the initial obstetrical choice regarding
the type of delivery, but the absence of
randomization in our study does not authorize
a strong medical evidence to guide national
recommendations.
PMID: 12016405.
[from AUDIPOG Database, article in French]
Breech Birth Quotes
Midwives talk about breech birth
"I think panic is what causes MOST problems
in breech birth. I would prefer any assistant
with some common sense and a clear head in emergencies
to the most educated person who freezes with
fear- or who bursts into panicked action. I
think a good outcome might be a combination
of things- your healthy folks, lots of multips
[women not having first babies], plus your skills
and your steady hands (and head).
"There are a couple 'named' methods for
breech delivery. Bracht's is easy to learn and
describe and is said to be the best for those
caught with a surprise. Bracht', and the Burns-Marshal
method is almost entirely hands off. 'Hands
off the breech' (unless unduly delayed). The
one thing I have seen is that most docs tend
to do a full breech extraction rather than an
'assisted' breech delivery. They start pullng
and tugging on the kids as soon as they show
up in the mistaken belief that the baby needs
to be born in a few seconds. Every text- and
all the old practioners I've talked with- say
that traction done too soon may extend the arms
or extend the head. And we don't want either
of those things...
"I once talked to a midwife from Africa
who had assisted in several hundred breech births.
She was SHOCKED at the standard US doc's 'method'
of breech delivery."
Gail Hart,
Midwife, Oregon
www.midwiferyeducation.org
"You certainly want the person with the
most experience bring their hands, heart and
head to assisting at a breech birth. The midwife's
field of expertise is exactly that. The obstetrician's
field of expertise is surgery." -Vicki
Taylor, Mama's
Cradle Midwifery
"I have done 55 breeches. None died from
complications of the birth. None were brain
damaged from complications of the birth. Smallest
breech I attended was 3lb 15oz and the biggest
was 11lb 1oz." -Judi Mentzer, midwife
"Hands off the breech!"
"These words are legend in obstetrics
and yet many practitioners do not seem to be
able to resist the temptation to meddle with
the baby who exits the womb with its feet or
bum first.
"Hands off the breech applies to doing
pelvics to see if the cervix is dilated to 10
cms. The woman should be told in advance that
she will be asked to resist the urge to push
for a full 45 minutes once her bearing down
begins. That way, the cervix will be out of
the way of the aftercoming head. I have seen
nurses declare the mother fully dilated and
then discover there is still cervix in the way
as the mother pushes. Hands off the breech also
refers to cleaning away meconium or lubricating
the vaginal opening of the mother. The slightest
outside stimulation can cause the baby to extend
arms over the head or gasp.
"Once the baby is born to the waist, the
baby's spine should be pointing towards the
symphisis pubis of the mother. Hands off at
this point means wrap a receiving blanket that
is folded like a strap around the baby's belly
near the hips. Twist the ends of the strap into
a handle and use that handle to keep the hands
of the practitioner away from the baby during
the rest of the expulsion. Gripping the baby's
abdominal region during this time can cause
damage to kidneys and other organs that are
engorged with blood. The cloth strap disperses
the pressure evenly all around the baby's body.
If the arms have extended above the head, the
midwife must reach in and pull down an elbow,
one at a time. This is the ONLY part of the
breech birth where the hands are used directly
on the baby's body.
"Hands off the breech again while the
body dangles and brings the back hairline of
the baby in to view. Once the baby is born to
the hairline of the neck, the body is lifted
with the strap up towards the mother's symphisis
pubis. Just the cloth handle is touched.
"This lifting upward of the body brings
the mouth and nose into view and at this point
an airway is established. Everything should
slow down at this point and the top of the head
is gently panted out. The only hands on part
of the breech birth is to bring down arms that
are up by the head. Usually, the arms stay down
at the sides if the breech birth has been hands
off." -Gloria Lemay, Vancouver, BC
Double Footling Breech Homebirth
"Dr. White is wonderful; I've attended
a few births in his presence- including breeches
and twins- as have many Chicago area midwives.
He never turned a midwife down who called and
said, "HELP." Several years ago, I
called him for the first time with just such
a call, when I had a lovely young primip [first
time mom] who, because of car trouble, had not
seen me in 3 weeks then began labor at 36.5
weeks with, 'Oh, and I think the baby's sideways'.
I dashed out there to discover no transverse
but a double footling, perfect toes dangling
through a 3cm cervix. The family refused adamantly
to go to the hospital, knowing a esarean would
be the result.
"After much discussion, they calmly excused
me from services, and I ultimately decided I
wouldn't leave them. When I called Dr. White,
he replied, "Sure, call me when she's 7cm
or her water breaks." We called with ROM
[rupture of membranes], he came over, quietly
did his own FHT [fetal heaet tones] regularly
(with a fetoscope), and slept under the kitchen
table in between. When offered an extra bed,
he replied that no, family might need that,
and he wanted to remain out of the way.
"When it was time to push, he just sat
in the corner as this mama did what she was
perfectly capable of doing and had a beautiful
7lb12oz boy. Many a mama in Chicago had breeches
and twins gently and beautifully at home because
of that man, who believed just about everyone
was normal most of the time." -Vickii
Gervais. Dr.Gregory White wrote the book Emergency
Childbirth: A Manual; it has helped many families
feel confident to have homebirths.
Surprise breech and twin births are the easiest
"I'm convinced that the best kind of breech
and twins births are the ones that are a surprise.
"There was a birth here in BC a couple
of years ago where the Mom was having her 3rd
baby with registered midwives. She was a bit
plump and the fundal heights were a bit high
but explainable from the extra padding on her
tummy. She gave birth to her baby and the midwife
was waiting to receive the placenta. When the
mother pushed, another bag of waters ballooned
out of her vagina... it was then that the midwife
realized she had a second twin. The second wee
one was breech and just slid out easily.
"Thank goodness they didn't know- she
would not have been allowed to birth at home
under the midwife's protocols and everyone would
have missed this lovely miracle. Mostly it's
the fear that screws things up." -Gloria
Lemay
From a "A Midwife's Story" by Armstrong
and Feldman:
"I knew how to deliver breech babies vaginally...
I knew how to keep my hands off the breech-
how to let the baby's legs and body drop and
hang, suspending its weight; I knew to allow
the baby's head to notch out, nape hair by nape
hair, from under the mother's pubic bone.. I
knew how to concentrate on watching- to observe
while physics and mechanics, uninterrupted,
synchronized the birth."
Breech waterbirth
"Practitioners throughout the world recognize
increased safety for the breech baby if it is
born in water. The most experienced doctor we
know of is Herman Ponette, an obstetrician who
practices in Ostend, Belgium. He has attended
well over 2000 waterbirths, including breeches
and twins. To him, a frank breech position as
an indication for a waterbirth." -Midwifery
Today E-News, Volume 3 Issue 33 August 15,
2001
A midwife's breech birth experiences
"I am a certified nurse midwife who has
done 43 breech births over the 25 years that
I have practiced. I practice in NJ but can only
do multip breeches [moms not having first babies]
now as I have changed backup docs and he will
only allow multip breeches. My experiences with
breeches have all been good- sans one that made
my heart beat fast and question myself if I
really needed to put myself through this hard
delivery. How many of us have felt the same
way with a shoulder dystocia? I reassured myself
that some births are just difficult.
"My last breech delivery my previous backup
stood at the door and watched and laughed hysterically
when I almost dropped the baby- it just didn't
want to wait for me to do anything except catch."
-Lonnie Morris CNM, ND
Articles, Links and BirthLove
Columns about Breech Birth
Breech Birth Links
Breech birth-positive midwifery email lists
Breech
birth in the Midwife Archives from Gentlebirth.org
Excellent critiques
of the Hannah study (Lancet, 2000) that
has, in many centers, elimated vaginal breech
births:
Heads
Up! -a breech birth website.
The
Birth Story of Donnegal Amber -the story of
a baby born breech, premature- and unassisted
at home.
Breech Birth Articles and BirthLove Columns
About
Breech Birth An English midwife talks about
her experiences of breech birth attendance; how
to tell if a birth is progressing well, or if
a cesarean is indicated (which it sometimes is),
and how to encourage the smooth descent of the
baby. Included: advocating for oneself in the
face of hostile medical personnel.
Breech
Birth Guidelines Gloria Lemay talks to birth
attendants about breech babies- how to prevent
the breech position in babies, and how to best
attend births where the babies are in the breech
position.
Question:
"Can I have a VBAC if my baby is breech?"
BirthLove Contributing Expert Gretchen Humphries
had a cesarean with her twins due to their being
in the breech position; she shares what she has
learned about breech in repsonse to this question.
BirthLove Columns:
- The Hannah
Study: A Breach of Reason (6/25/01) This
large trial has given doctors license to do
eradicate vaginal breech births internationally.
And this is a shame, because the study is just
terrible.
- Breech
Tales (8/7/00) Two footling breech birth
stories are told- one unassisted, and one hyper-medically
assisted. Decide for yourself which birth was
better managed.
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