 Re: Breech Birth - the way we are taught
Hi All
I get a bit uppity about breech birth. I did my disseration on The Midwife's Role in relation to Breech Presentation blah blah blah. I spent over 2000 words of my precious word allowance critiquing the Hannah Trial which had just been published.
The Hannah Trial did not show that CS was a safer mode of delivery. The data were analysed by "intention to treat" not "mode of delivery". Women were randomised into plan for CS and plan for trial of vaginal breech delivery. No women were "allowed" to birth thier breech presenting babies physiologically ( more of this later). In the planned vaginal breech about half the babies (sorry can't remember exact numbers now) were born by CS. No surprise there and reasonable as all were primips so breech amy or may not descend in a hospital setting with woman flat on back. What most don't realsie is that in the planned CS, I think about 9% had vaginal breech deliveries because they fell out too fast to be cut out! So this leaves us comapring outcomes between two groups of mixed CS/vaginal delivery with different proportions in each. It says nothing about how the outcomes relate to the mode of delivery.
Earlier and later studies have found no difference at 6 months between breech babies born by CS, vaginal breech and cepahlic babies, though APGARs are lower for vaginal breech born babies.
Perhaps another thread on APGAR scores as a predictor of neonatal wellbeing - Moderators???
Back to physiological breech birth. Cannot recommend too strongly each of you tries to attend a Sharing The Skills - A Day at the Breech Workshop. Check their website for details. You will learn the mechanisms of breech birth, what positions mothers adopt and why and how to support a woman who plans to birth her breech baby herself.
Most women kneel upright (Christian prayer position) during their labour and ealry second stage. After the baby has rumped and descended as far as the chin being visible, if women drop their heads down, bum in air (more like a Muslim praying position) this helps the baby to flex its chin down onto it's chest and pivot around the pubic bone all nice and tidy.
My only personal expereince of supporting a woman with a breech birth was at an NHS midwifery led unit when I was an NHS midwife. It was the most breathtaking and amazing expereince to watch this baby manipulate herself out of her mother and be born in such good order that rather than clamp and cut the cord ready for resus, I simply passed baby through legs to her mother just as i might have done for a cepahlic baby.
Others are right - we have lost the Art of supporting breech birth as midwives. But our rules tell us we must be ready to cope in an emergency. In an emergency ie the baby is coming to quickly to be born by CS, remember nature wants this child to be born. Learn how to do no harm. Learn what normal breech birth should look like. Be ready to facilitate it. Transfer for help if your feasibly can. Not all babies are uncomplicated.
In sisterhood
Liz IM |