Vaginal Breech Birth

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:

  1. Hands-off the Breech
  2. Hands and Knees (knee elbow)
  3. Leave the cord intact and unclamped

 

Baby's face is born in a hands-off, hands and knees breech birth

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.

http://www.ncbi.nlm.nih.gov/pubmed/10636499 (abstract below)

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."