Why VBAC but not breech delivery?

[ReikiMommy07]

Can some of you tell me why a midwife would allow VBACs, but not breech deliveries? A local midwife is like this, and I'm going to get her reasons when I can give her a call. But allowing VBAC, but not breech, seems weird to me... : Any ideas here? Or if you allow one and not the other, would you mind explaining why?
Very curious!
TIA!

[turtlewomyn]

Not a birth professional here, but one reason may be what the law allows (assuming that she is in a state where midwifery is recognized and regulated). I know that here in Florida midwives can attend VBACs at home (provided that they have physician consultation) but if they have a known breech birth they cannot attend it at home, even if they have the necessary experience to do so (emergencies are another matter).

[greenthumb3]

could be what she is comfortable with, too.

[Nan'sMom]

It's often a legal thing. Here it is. You might want to question her what she does with breech clients. I asked a CNM what she does with breech clients who don't want hospital ECV or c-section and she said she can refer to a DEM who does at-home ECV and delivers breeches (some of the others gave me ridiculously unhelpful answers). You should ask about "post-dates" too...some mws have a good way of handling these legal restrictions, some don't (e.g., some think the answer is "natural" induction, although that can be very risky too).

[MsBlack]

Even apart from any regs she may have to contend with if she is legal, VBAC and breech are most often very different from each other (unless you have a Breech VBAC going on, I guess). Helping w/VBAC is just like helping with any other mom with a vertex baby--same variations on a theme in terms of mechanics. Helping w/a Breech is a different birth altogether, and does require more knowledge/experience. I would love to be able to help w/breech births, and have watched videos, read instructions, etc--however, I will not knowingly take on a breech unless I am able to find another mw to help me who is already experienced w/breech birth.

But beyond that (no idea if the mw in question here has similar reasoning to mine, above), breech birth is not only 'different', but there is a higher chance w/vag breech birth for baby to need help getting started, and certain injuries. Some mws simply do not want to have to deal with that possibility, for whatever reason--and every mw has the right to state her limits and preferences at the outset of relationship w/clients.

[nashvillemidwife]

Exactly what MsBlack said. VBAC requires extra monitoring, really no extra skills required, just extra time and attention. Breech is a whole other skill set. Apples and oranges.

[mwherbs]

weighing in VBAC is just a vaginal birth , yes it is politically a "hot topic" there are some special considerations, like increased miscarriage (but that doesn't change care as far management at term) placement of placenta- because there is an increased rate of more deeply adhered placenta if it attaches over the scar- and a very slight increase in uterine rupture rate- about the same as a woman having her 5th baby-- so really not much problem for a normal healthy woman and because it is a politically hot topic there can be alot of fear and emotional charge that can change labor.

Breech birth is not just a single category, there are several presentations for breech and each have different risks, knowing how to manage each type is a skill set and over all there is an increased risk to the baby, this can be a very normal birth as well but does take some special consideration and there is a greater chance of cord prolapse, is the baby presenting in this position for a reason, takes extra monitoring would also be in order-- wiki has a pretty good article on the subject- http://en.wikipedia.org/wiki/Breech_birth . this is far more of a political hot topic than VBAC and I have known mws who have had births where noting was wrong with mom and baby get into legal trouble (costing some to loose their license or things like legal fees of $30,000 + not to mention emotional wear and tear) and again there is an emotional change and increased fear that can impact the course of labor- increasing the chance of transfer

[Mindyleigh]

I would want her to be able to do more than want to.

Just as I would only hire a midwife for my VBAC who has extensive experience performing life-saving skills in an emergency situation, I would only hire someone with extensive experiences with breech birth were I having a midwife-attended breech birth. It's not just about willingness. I remember when I was pregnant with my twins...there was no shortage of midwives willing to attend me even though they had no relevant experience. Seemed kind of silly. Obviously, if everything goes well, there's no reason for the midwife to be there, but if things go decidedly unwell, I would want the midwife to have those particular skills, not just in theory but in practice. And getting that experience is very hard here in America.

[Ruthla]

It could be that the individual midwife isn't confident in her Breech Delivery skills, and is respecting her own limits.