When did a Breech Baby stop being just a variation on Normal?

Breech BirthI remember, as a student midwife, sitting in a lecture being taught the mechanics of a breech birth by a lovely Obstetrician.

Vaginal Breech Birth was definitely being presented as just a variation on normal birth back then.

Yes, there were some considerations and ‘special hand manoeuvres’ to learn, but nothing a competent practitioner couldn’t handle.

Unfortunately, I never got to become a competent practitioner because in 2000 the Term Breech Trial Collaborative published their paper 

“Planned caesarean section versus planned vaginal birth for breech presentation at term: a randomised multicentre trial” 

It  concluded that:

“Planned caesarean section is better than planned vaginal birth for the term fetus in the breech presentation”

Although, even as it was published, others started to question the validity of the ‘Trial’, it was quickly adopted and heralded the beginning of the end for vaginal breech birth.

Luckily a small cohort of competent  midwives and obstetricians did keep offering vaginal breech births.

This was because there were women who still wanted them.

Dr. Andrew Bisits (aka “The Baby Whisperer”) is one of these wonderful Obstetricians and I was fortunate to hear him speak at the International Normal Labour and Birth Conference, Sydney 2016.

His talk was titled: “Can Breech Birth Be Normal Birth?”

 

Breech Birth

 

Of course, the resounding answer from the audience was “YES!”

But what about the obstetric world, what do they think?

And what about the general population?

Dr. Bisits has pointed out before that we have created a “spiral of fear and loss of confidence” in relation to birth in general but particularly around the possibility of vaginal breech birth.

As I said, this  all started 16 years ago with the Canadian Term Breech Trial.

For so many in the obstetric world, the ‘Trial’ answered all their questions and allowed them to stop even thinking about vaginal breech birth, let alone continuing to research it.

The teaching of vaginal breech birth skills stopped at this point and we now have a generation of senior obstetricians and midwives who have never even seen a vaginal breech birth let alone assist in one.

But luckily women have continued to have vaginal breech births (some unexpectedly), and some researchers have continued to look at the evidence, and some continued to analyse the “Trial’.

Some of the problems  were that there was a big difference in the skill level of those attending a vaginal breech birth, and differences in the methods and interventions used.

Even the original researchers did a subsequent analysis.

They did still conclude that  pre labour c-section was best.

However, they conceded that the adverse outcomes in the original trial were associated with labour augmentation, birth weight less than 2.8 kg, longer second stage, and no experienced clinician at delivery.

A longer second stage was associated with epidurals, which some of the women in the ‘Trial’ had.

So basically they are now saying Vaginal Breech Birth is safe with a healthy baby low-risk pregnancy, no intervention and a practitioner who knows what they are doing.

Which comes as no surprise to those who attend vaginal breech births.

 

 

Here are Dr. Bisits’ recommendations for a successful vaginal breech birth

 

  • Treat a vaginal breech birth as normal, this is a normal birth
  • Describe to the mother beforehand how her body and baby work together
  • No epidurals because of the need for mobility and a good second stage
  • No episiotomy
  • Hands off the baby
  • Mum should be in an optimal position that encourages mobility and works with gravity eg. standing, birth stool, hands and knees.

What really strikes me about these recommendations is that they apply to ALL normal births!

So yes Breech Birth is just a variation on normal birth.

A couple of other talks at the NLBC 2016 really impacted me too.

One was Shawn Walker’s talk on the need for breech clinics and teams in our hospitals.

Shawn has  developed the Heads Up care pathway and the role of Breech Specialist Midwife in an NHS breech clinic in the UK.

She believes that we need honest but non-biased counselling, non-judgemental support, and continuity of midwifery care, for women choosing  both external cephalic version (ECV) and vaginal breech birth (VBB). Here, Here!

Shawn has also just published this great research :

Principles of physiological breech birth practice

Which is available for free download until 13th December 2016.

Another speaker was Karol Petrovska who has researched Women’s expectations and experiences around planned vaginal breech birth.

You can listen to Karol talking about her work here.

The take-home message for me was that women feel really unsupported when they plan a vaginal breech birth. Not just by the medical profession but also by their family and friends.

So I decided to start a support group for women in Perth who are planning a VBB in the hope that they get information and honest, non-judgemental support, as they decide on the best option for them.

If you are in Perth Western Australia and want to support women with breech babies please feel to join :Perth Vaginal Breech Birth Support

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