Question on breech births...

[lilmamabrown]

This is just out of curiosity as I'm not expecting my LO to be here until February but she likes to hang out breech so it got me wondering...

There is no chance of a vaginal breech birth in any hospital for quite a large area here, the only option offered is c-section. I'm planning a homebirth and my midwife (a cpm) has strict guidelines for attending a breech birth at home... she only allows squat or hanging squat position and she has said the mother must be willing to push hard once the body is born bc there is only a 4 minute window before damage to the baby begins due to compression of the cord against the head inside the birth canal.

Ok, no big deal. I'd way rather go for it at home than in a hospital where I'm guaranteed a c-section!

Then I saw this video on youtube...

http://www.youtube.com/watch?v=jD593...eature=related

the birth is very laid back and definitly takes longer than 4 minutes from body to head.... it made me wonder about what my midwife said. I really trust her and she's very experienced but where did this 4 minute thing come from? Does it sound correct? Where can I find further information on the safety of vaginal breech births?

I know I need to ask her about it too but I don't have an appointment for another couple weeks and I'm curious

[Kidzaplenty]

[MsBlack]

Your mw is going on what I consider 'old school' breech birth info--and as you saw on the youtube video, there is new info, understanding and new tactics available for vag breech birth. No time to get into it at the moment, but Brenna Waite has a book on breech, also Maggie Banks if I recall correctly. Midwifery Today magazine probably has current info/links available. There are also a ton of breech videos out there--some going on that 'old school' methodology, some on the newer understanding....if you take a cruise through a sampling, I think you will not have any trouble deciding which looks (and actually IS) gentler and safer!

To be perfectly blunt here....if I were in your shoes, and my mw was not willing to start looking into current info on breech birth, I would not let her help me have a home breech birth. Have you ever asked her about her participation in continuing education? In a lot of important ways, a mw of high experience is a wonderful thing....but the downside is that some do not keep up with changes/improvements in the field through attending conferences/reading newer books, things like that. When I hear of a mw like yours, who mentions the particular methods/restrictions she does about breech vag delivery, I hear that she has not kept herself current with breech birth.

good luck! Maybe there is another mw around who could help you with breech birth at home, that you are not aware of yet.

[lilmamabrown]

Thanks! I don't know that she's unwilling and I see some other things she says/does that seem right in line with the times so I'm not sure what the deal is with this issue. I'll definitly look into the resources you provided and question her ideas further... and hope I don't have to find someone else!! It took me 3 mos to find her! lol That birth video just looked so much more serene than ok the countdown is on type experience....

[caned & able]

I do not know where the four minute thing comes from, but I know as long as the cord is connected and not cut the baby is getting oxygen.

The problems are with a breech:

1) The baby may extend its arms in the womb before it exits creating a need for a wider exit which may not be available. This can be controlled by slowing the descent of the baby, reaching in and pulling down the arms, and putting a finger in the baby's mouth to flex the head for good descent.
2) The baby may try to breathe inside and take in amniotic fluid because of the shock of the cold air on its body. The attendant should carefully wrap the emerging body in a clean blanket.
3) The baby's body may slip out and be born before the cervix is fully dilitated. The head of a full term baby may get stuck in the womb with the rest of the body out.
4) With the body out and the head still in, there may be cord compression and this may compromise the baby's oxygen supply.
5) There are birth defects connected with sacrum presenting babies as hydrocephalus, dislocated hips, short cord or placental implantations, and defects in the uterus as a muscular band or a poorly co-ordinated contractions or muscle tone.

Do not sweat it; many babies move before delivery.

[kltroy]

Chances are excellent that this won't be an issue for you. BUT if it were me I'd want to know exactly how many vag. breech births your MW had attended. Multiple studies have shown that provider experience is an important factor in neonatal outcomes, so I would personally want to know that my provider had attended somewhere over 10. If she is sufficiently experienced, I say you go with what she is comfortable with and not try and convince her to change the way she practices based on something you read. She's done it that way and it works for her.

ETA: Yes I know it may not be the most current info she's practicing with, but I think her comfort level and experience with a particular technique are important.

[Astraia]

If my options were a c-section OR a mw with old school restrictions on breech birth... eh, I'd probably take the midwife.

The BEST thing your midwife can do is nothing. Don't touch, pull, rotate, or grab- nothing. If she's willing to wait and watch until your baby is born at LEAST to the umbilicus (preferably even later than that, and then it's just supporting the trunk while you push out the rest of the baby) then I'd go for it.

Yes it's probably best to deliver in hands and knees (ala mary cronk), but there has been evidence that a squat works really well also.

Heck, there's a dr in Colorado who delivers a lot of breech and he will ONLY do it if you're on your back because that's what he's comfortable with- and he has a really really high success rate.

If your baby is full term, the chances of something going wrong with a hands-off care provider are pretty slim- slightly higher than a vertex baby, sure, but nothing to get into a panic about (IMO). And if she'll attend you, and can sit on her hands until her help is actually needed, then go for it.

I have read that instead of the 4 minute window it should be closer to 8 minutes, but the dr in Colarado (who spoke at the Breech Birth Convention this year) said that most babies come out really fast once they're born to the umbilicus and there's no need to get worked up.