Two Breech Water-Births

Many thanks to Nicole at Bellies and Babies for first posting these — they are awesome! They also give testimony to the voice of wisdom from those skilled in attending breech birth, namely, “hands off the breech.” One website (I believe a UK midwife’s site) said something about attending a breech birth along the lines of, “after the baby’s feet/legs/bum is born, go stand facing the corner of the room, and sip a beer s-l-o-w-l-y,” to allow the baby’s head to be born naturally. After watching these two videos, I understand a bit more why. In one of the videos, the contractions are five minutes apart, which seems agonizingly slow, to see the baby’s body dangling in the water… with his head and neck still inside the woman… and the umbilical cord is obviously next to his head… which makes me think of cord compression… and I want to reach through the screen and grab the baby and pull him out to safety. The other video is not that different, either in timing or in the length of time I was holding my breath! Whew! And if I have that reaction from watching a video clip, I can only imagine what it must feel like to actually be in the room, and be able to act (even if the action is misinformed, misguided, or downright dangerous).

And if you either have no skills or experience in breech birth, or if you want to brush up on them, be sure to read Rixa’s posts about the Breech Birth Conference in Ottawa recently: Day One, Day Two Part 1, and Day Two Part 2 — quite informative!

Putting the videos and the posts together makes me think that I’d rather go unassisted with a breech birth than to have a nervous care provider attending a vaginal birth. Some time ago, someone made a comment on a post at The Unnecesarean about being mad at herself for having accepted a C-section for breech presentation rather than trying to find a skilled breech-birth attendant, and says,

I guess I am also posting because I want to feel that I did the right thing, that it would be unwise to deliver breech while fighting the hospital and without a trained attendant. I still am mourning the birth I almost had.

Particularly hearing the “success stories” of the skilled attendants who spoke at the Breech Birth Conference, contrasted with some of the births they were aware of in which the baby was injured or actually died, speaks much of the difference it makes to have a skilled attendant. I’ve read enough unassisted breech birth stories to know that most women will automatically assume a hands-and-knees or (more commonly) a standing position to birth their breech baby, which is what the skilled attendants at the Breech Birth Conference said is the best position; whereas most doctors (who may or may not have any skill or experience in attending a vaginal breech birth) will want the woman in a stranded-beetle position, for a better view, more easy access to the vagina, etc. But this is physiologically abnormal for a vertex birth, much less a breech birth; and if it can impede normal birth, how much more might it impede a “variation of normal” breech birth?

So, yeah, I think she did the right thing. One of the examples of a fatal breech birth mentioned at the conference, was one of those in the Hannah “Term Breech Trial” that was responsible for the recommendation that 100% of breech births be by Cesarean — due to fatal flaws in the study, as many people, including the SOGC, the Canadian version of ACOG, now attest. One of the deaths was in a birth not attended by a skilled attendant, and when the head did not descend in a timely manner, the baby was pushed back up into the uterus and a C-section was performed. The skilled attendants mentioned a maneuver in which they slightly press on the baby’s shoulders, to get him to reflexively tuck his chin in, so his head could be born. Unskilled attendants would not know this maneuver. They might either do as the aforementioned doctor did, or perhaps start yanking and pulling on the baby’s body to try to free the head (potentially causing spinal problems, or even death), or cut a huge episiotomy to insert forceps and pull the baby out, or something that might otherwise  harm you or the baby more than a C-section would.

It is important that women know that vaginal breech birth can happen, without damaging or killing the baby. I’m thrilled that there was a conference on breech birth recently, and hope that it is the start of returning vaginal breech birth to a “variation of normal” instead of its current position of “you’ve gotta freakin’ be kidding me!” One problem, of course, is that few people are taught how to properly attend breech births, with a whole generation (probably) of med students learning “breech = C-section,” and few midwives attending enough births to learn for themselves or to pass on skills they may have in attending breech birth. The SOGC has taken the huge step, the 180 degree turn, to now promoting vaginal breech birth, but it will undoubtedly be some time before it becomes the norm, simply because of the years of 100% C-section rates for breech birth (and the nearly as high C-section rates prior to that). It will take some time before the current crop of med students gain the skills to attend breech birth; and it’s anybody’s guess if current OB-GYNs will take the necessary steps to “go back to school” as it were, and learn this old new skill. But it’s a step in the right direction.

What would I do if I had a breech baby? Hmm… good question. It’s not been an issue so far, since my babies were both head-down from the first time their position could be determined by palpation, and once babies are vertex, they usually stay that way. I would first do everything I could to try to get the baby to turn, including chiropractic manipulations. If the baby remained breech, I would consider my options at that time, and try to reach the best conclusion I could — it may be that something would change my mind when faced with it in real life, some nagging doubt or unsettled feeling, that would impel me to go a different way. But, sitting here at this time, not even pregnant, much less in my third trimester with a breech baby, I would try to find a birth provider skilled in attending vaginal breech birth (fortunately, I don’t think I’m too far from The Farm — perhaps about a four-hour drive). Some may not feel comfortable with that, but not only do I have a fair amount of book-knowledge about breech, but I have given birth to a 9lb baby so obviously have an “adequate” and “proven” pelvis, so I’m not anxious about it. Were I to find out that my baby was both breech and estimated to be ten pounds or more in weight (which is highly unlikely) I might change my mind; but I feel like giving birth to a breech baby of less than nine pounds would be certainly within my range of capabilities.

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12 Responses

  1. Why was the midwife pulling on the baby in the second one? I too felt so nervous. Crazy.

    • Probably trying to get the shoulders and arms down — if the baby had his arms up by his head, that would probably make the birth of the head that much slower. Then, once the arms were out, they were possibly doing external manipulation to get the baby to flex his head and come out.

  2. Everytime I try to leave a comment about breech birth, words fail me. That being said, I’ll try. My daughter was a planned breech home birth with skilled midwives in attendance. The midwives were patient, my body worked hard, my daughter descended quickly and without complications, my hubby was supportive, and I am still in awe of God’s hand on the entire pregnancy and delivery. We tried so many options to get her to turn, to no avail. I wish every woman had access to skilled providers, discernment to make wise choices, and the confidence to follow her baby’s cues, whether they lead to c-section or not. There was such power in trusting my midwives would work with me for as long as they could and help me to the hospital if things were not progressing normally. If only they let them work more freely in our particular hospital, a lot of complications that influence others to accept a planned c-section could be avoided.

    • My brother-in-law was breech. His mom said he was “folded up like a taco” (I’m assuming that means frank breech), and that for several days after he was born, he would draw his feet up by his ears a lot of the time. He was also her first baby, which would doubly mean an automatic C-section today (a few doctors will allow breech with a “proven pelvis” but almost none will allow a first-timer to attempt a breech birth), but the birth was handled matter-of-factly 35 years ago.

  3. I can’t even finish watching those. I had a patient of a lay midwife come in one time after trying a breech birth at home, with the head still in, horrible outcome.

  4. I didn’t like that second birth, and still wonder how the baby is since it was soooo floppy. I understand the nipple stim to get a contraction, but thought it might stress the baby with the head in. Scared me….a lot.

    • Babies born in water are often more floppy, slower to start breathing, etc., than “land babies.” I remember my midwife telling me that during a prenatal visit, and after Keith was born, it seemed like *forever* for him to start breathing. He was looking around, at me, and everything else, but he just wasn’t breathing. Even remembering what the midwife said, I still was anxious because it seemed so long. But I didn’t time it, so it might not have been as long as it seemed. You’re right about the baby being very floppy, though — longer than I think it seemed like with Keith. But I remember reading a vaginal breech birth story recently, in which the mother or midwife telling the story said that breech babies are often floppier than vertex babies — and there has to be some sort of cord compression, as the head is being born — the umbilical cord *has* to be next to the head in the vagina — so there is likely some oxygen deprivation. How much and how long, before the baby is compromised might depend on the particular situation; but in this birth story, she said that the baby was very floppy, with a low 1-minute Apgar, but pinked up pretty quickly, and had a high 5-minute Apgar, so that might be the situation here.

  5. Kathy, I am an opened minded individual. But I could never, never deliver a breech baby at home. The idea of a body hanging out of the womans vagina and the head inside as I slowly drink a beer makes me want to run screaming into the night. So at least I know my own limitations. lol. That being said, if I am in the middle of Guatamala without any Operating room in sight, I guess I will have to pack myself some beer?

    • That being said, if I am in the middle of Guatamala without any Operating room in sight, I guess I will have to pack myself some beer?

      That is one very good reason why breech birth should be learned by and taught to all doctors and midwives. What if? I remember NGM posting a birth story, in which one of her clients had an unexpectedly breech baby. She realized it when she did a VE and found her at full dilation with most certainly not a skull presenting! Barb was unwilling to attempt a VBB at home, so they t/f to a hospital where the woman was given an emergency C-section. But if she (or the doctor at the hospital) had breech birth skills, this might not have been an emergency, nor a C-section.

      And there are places in the world where C-sections are not available, or are more dangerous than VBB if the birth attendant is skilled in breech birth. And what if something happens here in America (a suitcase nuke?) and suddenly we’re plunged back a few generations or centuries, with no breech birth skills? It’s best not to let the knowledge die out.

  6. With the second birth. I think if I was forced to do it, I would ask her to stand up. I think the upright position facilitates the birth of a breech. Also the attendant did take the fhr by palpating the cord which I thought was responsible practice. However, will that make the cord spasm? Hmmm. Tough question. Also why didn’t she clear the baby’s airway after birth? A little bulb suctioning will go along way in doing 2 things 1) clears airway 2) stimulates to breath. Breathing after birth? I am a huge fan. I noticed the Dad giving some instructions on the birth but then said “oh his hands are blue” Knowledgeable birth folks know that blue hands are NORMAL….thanks for the video…

  7. […] to Woman Childbirth Education – Two Breech Water Births: Amazing videos and some great reflections on breech birth from […]

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