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A simple breech birth criteria  

post #1 of 9
Thread Starter 
Reposted from my blog--I thought you'd find this interesting. Anyone have experience with this?

Last spring, I had the pleasure of meeting Dr. Mayer Eisenstein, a physician who has attended home births in the Chicago area for several decades with HomeFirst. He worked with Dr. Gregory White, also with HomeFirst and author of the manual Emergency Childbirth used by police officers and EMTs.

While we were talking, Dr. Eisenstein told me of a simple criteria for predicting whether or not a vaginal breech birth will develop difficulties. He learned this when he was a young physician from Dr. Frank O’Connell, who was a senior obstetrician at St. Francis Hospital in Evanston, IL. Dr. O’Connell learned it from his father, also an obstetrician, who had worked as the Chair of Obstetrics starting in the late 1950s or early 1960s.

The rule is simple and very accurate in predicting smooth vaginal breech births.

Rule #1: If the presenting part is at a positive station at 5 centimeters dilation, there is an overwhelming probability of an easy birth, irrespective of what part is presenting (foot, knee, butt) and irrespective of parity. In other words, it is just as true for primips as for multips, just as true for footling breeches as for frank breeches.

Rule #2: If the presenting part is at negative station at 5 centimeters dilation, there is a significantly higher probability of a difficult birth, irrespective of the presenting part or of parity.

These criteria are more accurate in predicting easy births than in predicting difficult ones. In other words, a women may still have a straightforward birth when the presenting part is at negative station, but it is just much more likely that difficulties will arise.

Dr. Eisenstein and some of his medical students reviewed over a decade of their records to see if this help up with the breeches they had attended. In over 100 breech births they had attended, the rule held true in all the cases.

Dr. Eisenstein added that it should be blatantly obvious at 5 centimeters that the presenting part is at positive station (this does not include zero station, only true positive station). No guessing.

Dr. O’Connell’s father also had another rule: “The sign of a good obstetrician is how few cesarean sections they do.” I like that one!
post #2 of 9
thank you so much for posting this! i am 38 3/7 with a breech. last week he was frank breech, and i'm hoping he still is (unless he turns vertex, of course). i found a doc who will deliver him naturally, hands-off! i met him last night and am really excited. i will share this post with him. i am 2cm and -1 station, so hopefully i will meet the criteria when i do go into labor.
the quote at the end of your posting is great too. this doctor has the lowest C-section rate in the city (at one time it was 13%).
thank you again!
post #3 of 9
Very interesting!
post #4 of 9
Thanks for sharing! I was reading midwifery today and it was on my mind.
post #5 of 9
That is interesting! I wonder if there have been any studies.

As a side note a family member of mine had a birth with Homefirst, a footling breech that did not survive.
post #6 of 9
[/QUOTE]Dr. O’Connell’s father also had another rule: “The sign of a good obstetrician is how few cesarean sections they do.” [QUOTE]


That is really good! Too bad not many practice by that anymore.
post #7 of 9
You know, I've been thinking about this, and this bothers me: legs are long. W/ a footling breech, what if the foot comes through the 5cm dilated cervix... could it not get very low station-wise (like, I dunno, +4?) while the rest of the body is significantly high in the pelvis? I just don't see how this would be a good sign. I do see how this criteria could be valid for a frank, though. I've never attended a breech birth btw.
post #8 of 9
Yeah, I'm not sure I agree with that either. I have attended a few breeches one of which was footling but it was the second twin so a little different. IMO there is no good footling but I'm sure others are not as conservative as I am on that one.
post #9 of 9
Thanks for sharing!
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