Over on The True Face of Birth, Rixa has reviewed two books on breech birth. Quite interesting! Rather than repeat what she says, I’ll just link to it and highly recommend that you read them — you never know when the information may come in handy!
But one thing I noticed is that there are three schools of thought when it comes to breech: 1) all breech births should be Cesareans; 2) if a vaginal breech birth is attempted, it should be highly medicalized; 3) if a vaginal breech birth is attempted, the mother should avoid medication and be as mobile as possible.
When a woman finds out that her baby is breech, the most common thing that happens is that she is scheduled for a C-section (assuming the baby doesn’t flip to vertex, or cannot be turned by ECV). Occasionally, a woman may find a care provider who will allow her to have a vaginal birth; but much of the time, there are restrictions placed on the conditions of the birth: she must have an epidural in place, must give birth in the operating room, must have her legs up in stirrups, must have an episiotomy and forceps, etc. The idea behind the first two is that should a C-section be required (especially in an emergency situation), they will already be in the OR with anesthesia in place. (Probably she will need to have the epidural strengthened, but the tubing will be already in her spine to make it quick to add a stronger dose; although it may be that the epidural would already be C-section strength “just in case.”) The idea behind the latter two restrictions is that with her legs in stirrups, the doctor can see things better, and make whatever adjustments or interventions need to be made; and the episiotomy with forceps is to facilitate the birth of the head.
The biggest concern with a breech vaginal birth is what if the body comes out, but the head does not. While the circumference of the buttocks (which is the typical presenting body part, rather than one or both feet) is generally about the same dimension of the head, once the baby’s body is born to the navel, it is prudent that the head be born without delay — not only could the cord be compressed and the oxygen supply cut off, but once the cord is exposed to air, it begins to gel and seal, which cuts off the oxygen supply. But in so many births, the baby’s head (which presents first in all but about 3-4% of term births) has ample time to mold, and can frequently take a few hours to move down the birth canal. My sister pushed for 4 hours with her first baby (who was posterior and had the worst cone-head of any baby I’ve seen) and my sister-in-law pushed for 5 hours with her first. It is an understandable fear that the head would not have enough time to mold and be born before the baby dies — the birth should be accomplished in minutes, not hours!
But what if these restrictions are wrong? What if the “hands-off the breech” midwives are right? I remember reading on some site (pretty sure it was British), that the midwife’s suggestions for a breech birth was, once the baby’s body was born, that she pour herself a beer, take it to the corner, and drink it very slowly. The idea being, of course, that she should allow the woman and baby to accomplish the birth without her interference, which might cause problems.
When a woman has an epidural, it will be very difficult for her to labor and birth upright (and the stronger it is, the more difficult it will be). If she is further required to give birth on a narrow operating room table with her feet up in the air, her pelvic outlet will be much less than it would be if she were upright and squatting. This means that head entrapment becomes more likely! So, while the restrictions ought to make vaginal breech birth safer, it makes me wonder if that is truly the case. I look at it this way — having a woman in the OR, on a narrow table, cold, and with her pelvis unable to open to its full dimensions makes it more likely for her to have a C-section, or for other interventions to become necessary. The way it is set up in the above scenario, all of these things are done routinely, not on an “as necessary” basis. If they were truly necessary all of the time (as some people believe), then no baby could survive a breech birth. But how often are they truly necessary?
It seems to me that so many hospital protocols (not just with breech birth, but with other things as well) cause problems that would not otherwise exist, and then they swoop in with drugs and interventions to correct those problems. Case in point — not letting women walk in labor to help strengthen the contractions, but making them have Pitocin instead. Or not letting women eat or drink in labor, but requiring them to have a glucose IV. The natural is to be feared, while the medical (because it can be measured in milligrams or lines) is to be revered. Regardless of how safe the natural is and how unsafe the medical is — the idea is that the medical is standardized so it is safe, while natural cannot be standardized, so it cannot be safe. Despite the fact that different people react to the same medication or protocol in varying ways. Because people are different, not standardized. Humans, not machines.
Why is it that home birth is as safe as it is, without all the protocols and restrictions and requirements and denials that are so frequently the norm of hospital birth? Why do so many women who give birth in the hospital “have to have” Pitocin or a C-section or AROM or an oxygen mask or to be told how to push and when to push and where to push and… and… and…? This isn’t the case at home. These things happen occasionally at planned home births; but the frequency with which they happen to low-risk women at hospital births is disconcerting, to say the least.
Vaginal breech birth is something to consider very carefully and very seriously. There have been babies who have died — in home and in hospital — during or because of a vaginal breech birth. Most babies will do just fine — there are many examples of women giving birth to breeches in all the “wrong” or “high-risk” categories (first baby, footling breech, etc.) and everything went just fine. One of my brothers-in-law was a first-born breech, “folded up like a taco,” his mom said — a hospital birth, back when vaginal breech birth was the norm, instead of having to be fought for, tooth and nail. That being said, it’s not for everyone, but I believe I would feel comfortable with it under most circumstances.