August 19, 2015
Volume 17, Issue 17
Midwifery Today E-News
“Breech Birth”
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How can you normalize the breech delivery?

MT online storeIf you attend pregnant women, you need basic knowledge of the breech delivery. In Normalizing the Breech Delivery, midwives Valerie El Halta and Rahima Baldwin Dancy share their expertise in a clear, detailed manner. You’ll learn a Breech Scoring System to help evaluate risk, various positions for the mother in delivering a breech baby, the key points for diagnosing and delivering a frank breech and more. Perfect for midwifery training programs and self-study by both student and experienced midwives, this DVD is a must-have for every birth library. To order



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In This Week’s Issue



Germany conferenceSpend a Day with Robin Lim at our Germany conference!

Robin is a mother, grandmother, author, poet, midwife and educator who lives in Bali with her husband and children. She is a founder and executive director for Yayasan Bumi Sehat Birth Center in Bali and splits her time between the birth center and the Tsunami Relief Clinic in Aceh, Sumatra. You can spend a full day with Robin when you register for the class “A Day with Ibu Robin Lim: MotherBaby and BirthKeepers in a Changing World.” She will also be teaching or co-teaching several classes, including Human Rights Issue: Premature Cord Cutting, Solving Common Complications and Pillars of Midwifery: Insight, Information and Intuition.

Learn more about the Bad Wildbad, Germany, conference.



Harrisburg conferenceLearn from exciting teachers at our conference in Harrisburg, Pennsylvania, next April!

Planned speakers include Debra Pascali-Bonaro (pictured), Mary Cooper, Sister MorningStar, Michel Odent, Fernando Molina, Barbara Harper and Gail Hart. Plan now to attend.

Learn more about the Harrisburg, Pennsylvania, conference.



Quote of the Week

Sometimes you have to let life turn you upside down so you can learn how to live right side up.

Unknown


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The Art of Midwifery

During breech birth, expect steady progress and do not accept a stall in a breech labor for more than an hour or two before rumping. Head-down stalls of up to four hours (and often quite a bit longer) can be overcome without poor outcomes. Stalls in breech, however, are universally considered reason to change to a cesarean. Midwives have long declined to induce or augment breech births since doing so may be associated with poor outcomes.

The clock is a fickle lifeguard; don’t rely on time alone to tell you when to initiate action. Learn the signs that show baby is asking for help and be a ready rescuer. Don’t make baby ask twice—the second time may be secondary apnea.

Gail Tully
Excerpted from “Tricks of the Trade,” Midwifery Today, Issue 106
View table of contents / Order the back issue


ALL BIRTH PRACTITIONERS: The techniques you’ve perfected over months and years of practice are valuable lessons for others to learn. Share them with E-News readers by sending them to mtensubmit@midwiferytoday.com.


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Editor’s Corner

Breech Birth

Birth is a political issue, and breech birth is an even bigger political issue. How did we ever get to the point where the biggest miracle we get to participate in—having a baby—is political? It should be emotional, spiritual and psychological, but not political.

I think it is important for all midwives to know how to assist breech babies in case there is a surprise, so we teach a full-day class at each Midwifery Today conference. We will even have a full day of breech at our South Seas conference in Suva, Fiji. We have highlighted breech birth because it is important for all midwives to know and because we hope to change the political paradigm.

Nowadays, there are more midwives who know how to facilitate a breech birth than there are doctors who do them. Doctors are not taught about breech birth in medical school. Wouldn’t it be nice to go back to the times when breech was just another birth? I bet our midwife sisters of a hundred years ago did not sweat over it or make it one of many political issues surrounding birth. Midwifery Today has an excellent back issue on breech birth—Issue 106 from 2013. If you are a midwife, do all you can to keep your knowledge of breech current. Midwifery Today can help with that!

— Jan Tritten, mother of Midwifery Today

Jan Tritten is the founder, editor-in-chief and mother of Midwifery Today magazine. She became a midwife in 1977 after the amazing homebirth of her second daughter. Her mission is to make loving midwifery care the norm for birthing women and their babies throughout the world. Meet Jan at our conferences around the world, or join her online, as she works to transform birth practices around the world.

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Conference Chatter

Breech birth can be such a source of anxiety for so many mothers. Helping them through a birth that isn’t quite what they expected is the norm for midwives like Mary Cooper and Diane Goslin. Understanding breech birth and knowing how to deal with the difficulties and “how-to’s” of safely delivering a breech baby is the topic of the day on Thursday, April 7, 2016, at our pre-conference in Harrisburg, Pennsylvania. Come learn from the best and ask all of the questions you’ve always been afraid to ask!

As Jan Tritten wrote in the Summer 2013 issue of Midwifery Today magazine: “Midwifery Today is concerned with the need for midwives to reclaim breech, twin and VBAC births. It is important that midwives gain the skills, experience and knowledge necessary to safely assist these births. Most doctors have lost knowledge of vaginal breech birth by allowing their few skills to get rusty as they needlessly perform cesareans for breech babies. Some doctors are willing to go against the ‘standard of care’ (or shall we call it ‘the standard lack of care’), but they are few and far between. Even when vaginal breech births were the norm instead of the exception, docs mainly used a medicalized approach to breech while neglecting some of the basic techniques, such as using physiology, position of the mother, and remaining hands-off and knowing when to be hands-on.”

Learn more about breech birth at our Harrisburg Conference!

— Misha Hogan

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Featured Article

A Surprise Breech at Home

The first day of labor was exactly one week past my due date. It was a warm but breezy August day. The steady contractions were a welcomed change from the irregular false starts I had had. I sat under the elms in the backyard, enjoying the crisp soft sound of the wind brushing the leaves together, the smell of sawdust as my husband cut the wood to build our new beehive and the delicious taste of salmon lox, while writing a letter to our unborn child.

We were so excited to meet our baby! We had not had a single ultrasound during the pregnancy. We felt confident in our midwife and reassured by the sound of our child’s strong heartbeat. My placenta was attached to the front of my uterus, but our midwife assured us it would not negatively affect the labor—it simply made it hard to feel the baby, especially in the early months. The baby had been head down and in an opportune position for weeks now, as felt by two midwives. We had every reason to expect a safe and beautiful homebirth.

The second night of contractions was less fun. I was unable to sleep in the 10-minute increments my contractions allowed me, and each one grew in intensity. As the night wore on, so did my nerves. My lovely husband was asleep and I thought it best to let him; I would need him to have energy for the birth. But with every contraction he slept through, I felt more irritated and alone. (I know now this would have been the perfect time to have a doula, but being headstrong about my ability to birth my child without interference I stubbornly refused the aid of any doulas. Live and learn.)

By dawn, I was feeling hungry and tired. I had spent the night pacing, squatting, sitting on the toilet and resting for 7–10 minutes at a time. I tried to make oatmeal, but the contractions were too intense. I felt like an animal—pacing, growling and “om”-ing.

Our midwife arrived. Seeing her in the door was a relief. Her keen eyes were brimming with kindness. She checked my dilation–I was 5 cm dilated with some swelling.

Time blurred. I was vaguely aware of our midwife prepping things and the tub being filled. Suddenly I had two contractions right on top of each other. I was kneeling on the couch, holding Adam’s hand when my water broke. My midwife checked me again: 7 cm.

The intensity and timing of contractions doubled. I have only a vague memory of getting into the warm tub, holding my lover’s hand. He kept repeating: “You’re doing great; breathe; you’re so strong”—everything a laboring woman needs to hear. I enjoyed the water immensely. Between contractions, my midwife checked my cervix again.

“Your baby is coming out breech.”

I was shocked. She had been saying the baby was head down for months now. I knew breech births had increased complications, and in our state, were illegal to deliver at home. I could not fathom going to the hospital with the baby already in my birth canal.

“I’ve never delivered a breech birth before, but it is too late to go to hospital. Do you trust my professional opinion on this?” I don’t recall if I said “of course” or only nodded. I honestly felt only relief they weren’t going to try to get me in a vehicle.

I leaned back holding my partner’s hands tightly and pushed. “The butt is out.” I pushed again. I was roaring—no words or “om”ing now, just a pure primal roar. “The shoulders are out.” I started to pant. “ElizaBeth, you need to push the head out now.” I breathed deep and gave the loudest scream I’ve ever done before or since. I pushed as though both our lives depended on it. The baby slipped out and the umbilical cord broke in a spurt of fluids.

Our baby was long, limp and blue. Our midwife quickly gave him mouth-to-mouth. I heard my husband crying behind me.

A breath! Weak and gurgled, but still there. My midwife put him on my chest—his eyes opened and he locked eyes with me, then Adam. Such love! He was breathing and cooing a little, but not crying. Our midwife cleared his nose and throat with a tube. His torso was now pink, but his limbs were still blue. In minutes, he was pink and giving a gurgled cry, the sweetest sound I’d ever heard.

ElizaBeth Whittington-Chambers
Excerpted from “A Surprise Breech at Home,” Midwifery Today, Issue 106
View table of contents / Order the back issue


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Order the Midwife’s Assistant Orientation Manual PDF book
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Get practical information about how to have a natural birth in any setting

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Birth Q&A

Q: Do you think breech births should be done by cesarean? Do you think they should be done at home? Should midwives or doctors be the practitioner of choice?

— Midwifery Today

A: Every birth attendant must learn how to assist mothers with a breech delivery. Despite protocols and rules, babies will still surprise us on occasion. If every woman is forced to have a cesarean for breech, these thousands of unnecessary sections will be causing a lot of harm to a lot of women and babies. A cesarean is a major surgery with sometimes long-term health problems for mothers. We are just now learning the long-term or lifelong effects on the baby’s health. Cesarean should be done only when needed. Most breech babies do not need a cesarean to be safely born.

— Gail Hart

A: This choice in not up to anyone but the mother. She is the one who should choose how to give birth to her breech baby; she is the one who will know what to do. Mamas open and babies mold and come out. It has been happening this way long before there were c-sections, text books and midwifery workshops. Birth works!

— Celesta Rannisi

A: I think most breeches should be delivered vaginally in hospital with a trained attendant, so it is too bad the doctors aren’t as well-trained as the midwives in that area. It seems that, at least in Ohio, the only way to get a vaginal breech is at home with an unlicensed midwife. I do believe in most cases a breech birth is not just a variant of normal but a slightly higher risk than a vaginal head first baby; however, it’s a greater risk for most women to have a c-section than a vaginal breech. Each breech case must be judged on its own risk factors and not just categorically risked out and sectioned. The fact that most haven’t a clue how to safely deliver a breech is a travesty.

— Marlene Waechter

A: Here’s the deal: 3–4% of babies present breech at birth. Birth workers (doctors and midwives) need to know how to assess the risk. They need to know the basic physiology and anatomy. Most spontaneous breeches will deliver without complication. However (and this is a really big however), when it goes bad, it can really go bad fast! Families (not just moms) need to be completely informed. I think we as a species owe it to the future humans to know how to assist a breech birth. It is a skill to be taught and protected. No one has any business learning on the job, so get a skilled set of hands onboard. In 800+ births, I have caught 6 breeches, all in the 80s, and all were a big surprise (this was before sonograms were readily available). I prayed the whole time.

— Deb Puterbaugh

A: I think they should happen wherever the parents want to birth and with whom. That being said, midwives and doctors should be taught the best way to help.

— Mary Bernabe


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