Breech birth - naturally
Breech birth can be a lovely experience for mother and baby. Most breech births go well.
You've chosen a good birth team, you feel confident, your baby is healthy. The important factors in safe vaginal breech birth include:
Labor begins on its own
Labor gets stronger, progressing on its own in good time
Once a woman is in active labor, there are no notable stalls in labor (over an hour)
The urge to push establishes on its own without direction from provider/nurse
The mother moves freely
When the baby's presenting part appears, the mother is in an upright position of her choice, not a learned position.
That said, the knee-elbow position is being thoroughly studied and though not published yet, has extreme improvement in baby's outcomes over the woman being on the back or even standing up for birth.
The Three Pillars of Safe Breech Are:
- Hands-off the Breech
- Hands and Knees (knee elbow)
- Leave the cord intact and unclamped
1.) Hands-off the Breech means few or no vaginal exams. No wiping mother's bottom or pushing her bottom up away from the mattress or floor to prevent her sitting on the baby. She'll feel baby and won't sit on the baby too much. Mother's rocking down may help or maintain flexion (Evans).
2.) Hands and Knees or knee-elbow lets the woman on a flat surface rock back and forth, rise up, and lower down as her instincts move her. A raised hospital bed or birth ball, or even her loving partner, are not in front of her accidently preventing her sudden movements. Gravity brings baby to the anterior as the hips or chest come through the pelvic floor.
3.) Leaving the cord intact, even with its white, is an important way to support baby's vitality after birth. What do I mean? Better Apgars! When to cut the cord? After the birth of the placenta.
Can vaginal breech happen in a hospital? Yes! But you may have to travel to find a provider, especially an experienced and physiologically based provider. A lovely little blog post on a sweet, hospital birth. http://drlindseymathews.wordpress.com/2013/04/09/breech-birth-interview-with-michelle/
(no, I don't think the episiotomy was necessary, but the doctor was learning to be comfortable with vaginal breech birth.
Next, a physician training film uses a doll and manikin. --Womb-ikin? The techniques are widely accepted in some areas of the world. I have some questions. One, the spontaneous birth (of the doll) as the body of the baby is being born, this segment shows the baby's spine to mother's hip which is a sign of an anterior shoulder dystocia. Yet the baby is born from the manikin easily. This is not generally the case with the baby in this orientation!! Two, in the breech extraction, the baby is rotated by rotating and pulling the leg. This will set up a twist in the pelvis and shoulder musculature. If the provider could stop with the legs as soon as the hips were reachable and continue with only holding the baby's pelvis (and not kidneys, of course) there would be less torsion in the body of the baby. Torsion sets up, I believe, a chance of obstruction that may not have occurred with less twisting. The baby must be rotated in these emergency situations when nature hasn't brought the baby or the baby can't wait for nature's timing (as when the placenta separates early).
The first thing women hear is that the breech baby's head can get stuck. True. But getting the head unstuck when baby is full term is generally not troublesome when the provider has a clear idea of how to flex the head and bring it into the AP diameter.
Shawn Walker, British Midwife, explains it like this:
"Some babies who are breech need help, more often than head-down babies. So having experienced support is crucial to the safety of breech birth. The head getting stuck is a terrible image, designed to terrify women, and probably the result of practitioners themselves feeling fearful or inadequate. I prefer to talk about the need for help because it creates an image that help is available, as it should be, but is realistic about the fact that occasionally some manual assistance is required.
Generally, even the RCOG guidelines (you can look up Management of Breech Presentation) recognise that second twin breech is no indication for a CS. The path will be cleared by the first twin, and there are generally few complications due to breech per se with a second twin. There is no evidence that there are more complications for a first breech twin which is fully grown, especially as you say for a woman who has birthed good-sized babies before. But the more unusual a situation, the more fear it is likely to generate.
Above is a link to an abstract of an article that looked specifically at results for twin births where the first twin was breech. I think you and the authors are coming at it from the same perspective. In their article (I can send you a copy if you want, to share with your providers), they write: "Being a rare clinical situation (less than 0.5% of all deliveries), one might question the need to study safety of vaginal birth in breech first twins. The point is not reduction of the overall cesarean rate, but preventing unnecessary cesareans."
A co-venture video experience with Spinning Babies and Blooma Yoga! Coming Soon!
Spinning Babies; Daily Essentials For Pregnancy Video.
Together Sarah Longacre, international prenatal yoga instructor and birth doula, and Gail Tully, yours truly, created a unique instructional video for flexibility and comfort in pregnancy and to support better fetal positioning in time for birth.
Here are daily activities for stretching and balancing a pregnant body. Start early in pregnancy to prepare to make the most space for baby's best birth position and the most ease for mother's opening during the birth process.
We begin the program for women of average flexibility (or just plain stiff to start with) and beginner tips. But soon, you'll be ready to move freely! That's when Sarah brings the stretches all together into her easy to follow, playful, sensual, and flowing "Blooma Style" daily routine.
Sarah's "dance of opening," moves joints and ligaments to come alive under the delightful melody and percussions of Carin Vagle. This isn't about core strength; its about freedom of movement and creating space in the body.
Sarah plays along with Gail's little game of "Flashlight" to show pregnant women how to evaluate their own posture and positions. Smart Maternal Positioning helps baby snuggle their backs into the front of the womb for Optimal Fetal Positioning.
The Daily Essentials For Pregnancy includes tips for using Maternal Positioning around the house. Actual scenes in the bedroom, living room -and even the bathroom- gives practical instruction like no other video. You will be sleeping more comfortably immediately when using these tips. Within a week or two many pregnancy discomforts of the pelvis and lower back may be reduced when all these nurturing techniques are integrated into your daily lifestyle. Spinning Babies and Blooma Yoga-- a natural collaborative!
Spinning Babies Childbirth Preparation Class.
Soon pregnant parents around the world can take a Spinning Babies class from their own monitor! Join six couples as they learn the reason why Spinning Babies works and how it can enhance your labor and birth.
See techniques to do daily or weekly. Actual, real consultations with two couples right at our class location, one with a breech baby (head up) and one with a baby in a transverse lie (lying sideways).
Couples do the techniques together and show you how to do these at home.
Used alone or with the Daily Essentials, Spinning Babies Childbirth Preparation Class goes beyond the basics. Simple props show complex concepts sweetly. Little-known anatomy is linked to childbirth and the role of fetal positioning.
The section on labor discusses two labor patterns- the one "promised" in other books and the unexpected one associated with the posterior labor. Learn the common causes of long labor and techniques to help baby through the pelvis.
Be empowered; be prepared. After using this video throughout your pregnancy, while we can't promise, of course, you may not need the tips for labor progress. You can use that knowledge to help your neighbor. This video is all Spinning Babies.
Blooma Yoga Prenatal Yoga for AM and PM.
Warm up in the morning and cool down in the evening in two 30-minute sequences. Sarah Longacre shares her own blossoming pregnancy, Blooma style, to the exquisite music of Carin Vagle. Sarah's affirmations will carry you through labor with emotional strength and encouragement. Play this video when the others become too basic and you just want to dance and have fun. Wait, dance? Isn't this yoga? With Blooma and Carin Vagle, your spirit won't know the difference. Soar to greater freedom of movement. Bring your hormones into harmony with the day. Begin your day with serious play. Cool down at night with a sleep enhancing stretch before bed. This video is all Blooma!
Sarah's video is ready for you now! Get Blooma's AM/PM Yoga here
All three videos are professionally produced by Melissa Koch of Grey Duck Productions, with stills by Tanya Villano Photography, each of these three videos are dynamic on their own. Together they will enhance your pregnancy and labor experience with fun and empowerment in the most practical manner. Feel hope for your birth abilities, this is support for your journey. Gain the confidence and flexibility to fully bloom. I believe these videos carry the potential to bring your best birth dreams into the gentle reality.
Compassionately priced. Estimated Due Date for Daily Essentials March 2014; for Spinning Babies Parent Class, Fall 2014.