Log onto Squarespace
Archives
« What Influence? | Main | Cesarean Scar: Sarah »
Wednesday
Jun202012

Dead Breech Babies

Recently, I read an article about Ina May Gaskin entitled “Mommy Wars: The Prequel - Ina May Gaskin’s and the Battle for Home Births.” In the very long piece, Ina May speaks about breech babies, saying in part:

 “’Footling breeches, which are thought to be the most difficult, in our experience, they often just slid right out.’

Now, I have a huge issue with her saying this in print at all because footling breech babies are the highest of high risk breech babies and out of the hands of someone as skilled as Ina May, the birth can also be a death. Granted, she wasn’t saying it to the reporter, but to a breech class at The Farm, but it’s out there, nevertheless. And she’s teaching this to women in a weekend seminar? C’mon.

Ina May continues:

“‘The main danger with breech babies is that the head, the largest part of baby, is last to come out, so it may get stuck,’ she told the students. ‘If the baby has been delivered to the umbilicus, you have five or six minutes before hypoxia sets in, but you don’t want to pull on the head if you can’t see the neck for fear of injuring the baby,’ Gaskin said.

 Sounds a little more than the baby “sliding right out,” doesn’t it? sigh

There is the belief (true, from what I’ve seen) that midwifery care creates a level of connection so intimate that if things go wrong in birth, the midwife is rarely blamed by the parents. In fact, even when the District Attorney or Medical Examiner takes up prosecuting the midwife, it’s extremely rare to have the parents speak out against her. Instead, parents often become the most vocal of supporters. To this end, the article says:

“Farm midwives give intimate intensive prenatal care and have a high degree of trust with their patients. That’s why, Gaskin said, in 2006 when a breech baby she delivered became temporarily stuck and suffered permanent neurological problems, the parents did not sue. ‘We thoroughly discussed the issues, and they didn’t see a reason to be punishing,’ Gaskin told me.

That’s one damaged breech baby born.

The newspaper piece continues:

“When I visited the Farm, Gaskin was planning to travel to testify at the trial of a C.P.M., Karen Carr, who delivered a breech baby in a home in Virginia who died.”

That’s one dead breech baby.

Karen Carr, a midwife “pleaded guilty to two felony charges in an infant death that she attended during a home delivery in Virginia last September. The state of Virginia argued that Carr was negligent during the home birth after the baby's head became entrapped for more than 20 minutes during the delivery. The baby died two days later.”

Lisa Barrett is another midwife who has lost a breech baby. (I’m struggling to use the word “lost” because I feel she was more actively responsible, not a passive bystander.) Jahli Jean Hobbs died in April 2009.

Two dead breech babies

In April 2004, the first twin of Elizabeth Hammill (in the UK) delivered breech and got stuck, the parents refusing to allow the three midwives required to attend to do anything, believing only an unassisted birth was a true natural birth. (“Home birth baby died after mother told midwives not to interfere”) Even when the mother was counseled two weeks before the birth about the risks of delivering a vaginal breech birth, the family said they wanted the unassisted (but observed) birth anyway. Then, after the death, the mother had the gall to say no one told her of the “gravity” of the situation. Makes me cringe, her backpedaling on her initial beliefs. (I do believe some women aren’t told the risks clearly enough, but it sounds like this mom was so freakin’ married to natural birth that nothing less than unassisted was going to do for them. Who knows if the baby might have lived if the midwives were able to assist at the birth. Possibly, that’s for sure.) The woman’s twin was delivered via (emergency) cesarean at the hospital. Alive.

Three dead breech babies.

Two babies died at home after the mother tried to be birth them breech. (“The tragic dangers of home birth – ‘A senior coroner has urged a change in the guidelines for midwives on home births after two breech babies died.’”)

Phoebe was born at home in January 2002, her midwife “suspecting” the baby was breech; the mother saying she accepted the risk of delivering at home. While the birth had a challenge with the head, the baby delivered and was resuscitated. She seemed fine, but two days later, died from an adrenal hemorrhage caused by lack of oxygen at birth.

Four and five dead breech babies.

Christopher was born in July 2002 and seems to have been a surprise breech whose head got stuck and the baby died an hour after the birth.

Six dead breech babies.

In March 2012, Sara Snyder’s baby Magnus died 13 days after birth, attempted breech birth at Greenhouse Birth Center in Okemos, Michigan.

Seven dead breech babies.

And this is just searching “dead breech babies” on Google. How many more stories are out there we don’t even know about.

I’m writing about this because it isn’t a subject spoken about very often. Instead, breeches are considered “a variation on the norm” of pregnancies and labors. On the contrary, 3 to 5 percent of babies present breech at birth. That is hardly a variation of normal. That would almost be considered “not very common.” I think that until the very real risks of breech births are talked about, women who choose to birth one out of the hospital isn’t receiving true informed consent. Romanticizing and simplifying these types of births… as Ina May seems to do in her breech workshops (just reading what was in that original article at the beginning)… does an enormous disservice to women needing the most information before making their decisions.

I initially began this post after reading the article about Ina May because in that piece, she mentioned one damaged breech baby and one dead breech baby all while touting their ease of delivery. I can’t recall an article that talked about birth while including a mention of a stillbirth because they are so incredibly rare. It seems, from reading the press alone, that breech deaths are not that uncommon at all.

Think, oh women with a breech baby, before coming to the conclusion that it’s fine to deliver your baby at home or in the birth center. I’m aware the options aren’t fabulous for a vaginal birth in the hospital, but is the life of your baby worth the risk just not to have a cesarean? Please be sure of your decisions. I once thought I would want to deliver my breech baby at home. Now that I know better, I would have a cesarean without hesitation. You have to make your own choice, but you also have to live with it. And I don’t think anyone can say “I didn’t know any better!” anymore. Now you know.

References (61)

References allow you to track sources for this article, as well as articles that were written in response to this article.
  • Response
    Response: Dead Breech Babies
  • Response
    Response: news article
    magnificent post, very informative. I wonder why the other experts of this sector don't notice this. You should continue your writing. I am sure, you have a great readers' base already!
  • Response
    Response: news feed
    Hi, i read your blog from time to time and i own a similar one and i was just wondering if you get a lot of spam responses? If so how do you prevent it, any plugin or anything you can suggest? I get so much lately it's driving me mad ...
  • Response
    Response: breaking news
    I have not checked in here for a while because I thought it was getting boring, but the last several posts are great quality so I guess I will add you back to my daily bloglist. You deserve it my friend :)
  • Response
    Response: breaking news
    I and also my buddies were actually studying the great thoughts located on your web blog and then all of a sudden came up with an awful feeling I had not expressed respect to the site owner for those strategies. The young men are actually consequently happy to see them and ...
  • Response
    Response: news article
    Very interesting points you have observed , thankyou for posting . "Nothing ever goes away." by Barry Commoner.
  • Response
    Response: breaking news
    Hello I am so grateful I found your website, I really found you by mistake, while I was researching on Bing for something else, Anyways I am here now and would just like to say thanks a lot for a tremendous post and a all round thrilling blog (I also love ...
  • Response
    Response: Source
    - Navelgazing Midwife Blog - Dead Breech Babies
  • Response
    - Navelgazing Midwife Blog - Dead Breech Babies
  • Response
    Response: longchamp logo
    - Navelgazing Midwife Blog - Dead Breech Babies
  • Response
    Response: moncler homme
    - Navelgazing Midwife Blog - Dead Breech Babies
  • Response
    - Navelgazing Midwife Blog - Dead Breech Babies
  • Response
    - Navelgazing Midwife Blog - Dead Breech Babies
  • Response
    Response: UGG outlet steder
    - Navelgazing Midwife Blog - Dead Breech Babies
  • Response
    - Navelgazing Midwife Blog - Dead Breech Babies
  • Response
    Response: Billige Ugg
    - Navelgazing Midwife Blog - Dead Breech Babies
  • Response
    - Navelgazing Midwife Blog - Dead Breech Babies
  • Response
    Response: 123-reg voucher
    - Navelgazing Midwife Blog - Dead Breech Babies
  • Response
    Response: crisis loans
    - Navelgazing Midwife Blog - Dead Breech Babies
  • Response
    - Navelgazing Midwife Blog - Dead Breech Babies
  • Response
    Response: new aquaman
    - Navelgazing Midwife Blog - Dead Breech Babies
  • Response
    Response: new relic
    - Navelgazing Midwife Blog - Dead Breech Babies
  • Response
    Response: new to you
    - Navelgazing Midwife Blog - Dead Breech Babies
  • Response
    - Navelgazing Midwife Blog - Dead Breech Babies
  • Response
    Response: xmas cash loans
    - Navelgazing Midwife Blog - Dead Breech Babies
  • Response
    Response: new ssri 2013
    - Navelgazing Midwife Blog - Dead Breech Babies
  • Response
    Response: new knicks
    - Navelgazing Midwife Blog - Dead Breech Babies
  • Response
    Response: new nds games 2013
    - Navelgazing Midwife Blog - Dead Breech Babies
  • Response
    - Navelgazing Midwife Blog - Dead Breech Babies
  • Response
    Response: new zodiac dates
    - Navelgazing Midwife Blog - Dead Breech Babies
  • Response
    Response: new richmond news
    - Navelgazing Midwife Blog - Dead Breech Babies
  • Response
    Response: new netflix series
    - Navelgazing Midwife Blog - Dead Breech Babies
  • Response
    - Navelgazing Midwife Blog - Dead Breech Babies
  • Response
    Response: Handmade Purses
    - Navelgazing Midwife Blog - Dead Breech Babies
  • Response
    - Navelgazing Midwife Blog - Dead Breech Babies
  • Response
    - Navelgazing Midwife Blog - Dead Breech Babies
  • Response
    Response: envoyer un fax
    - Navelgazing Midwife Blog - Dead Breech Babies
  • Response
    Response: new oxford pa
    - Navelgazing Midwife Blog - Dead Breech Babies
  • Response
    - Navelgazing Midwife Blog - Dead Breech Babies
  • Response
    - Navelgazing Midwife Blog - Dead Breech Babies
  • Response
    - Navelgazing Midwife Blog - Dead Breech Babies
  • Response
    - Navelgazing Midwife Blog - Dead Breech Babies
  • Response
    - Navelgazing Midwife Blog - Dead Breech Babies
  • Response
    Response: lita
    - Navelgazing Midwife Blog - Dead Breech Babies
  • Response
    Response: crisis loans
    - Navelgazing Midwife Blog - Dead Breech Babies
  • Response
    Response: new jordans
    - Navelgazing Midwife Blog - Dead Breech Babies
  • Response
    - Navelgazing Midwife Blog - Dead Breech Babies
  • Response
    - Navelgazing Midwife Blog - Dead Breech Babies
  • Response
    - Navelgazing Midwife Blog - Dead Breech Babies
  • Response
    Response: free youtube views
    - Navelgazing Midwife Blog - Dead Breech Babies
  • Response
    - Navelgazing Midwife Blog - Dead Breech Babies
  • Response
    - Navelgazing Midwife Blog - Dead Breech Babies
  • Response
    Response: find out here
    - Navelgazing Midwife Blog - Dead Breech Babies
  • Response
    - Navelgazing Midwife Blog - Dead Breech Babies
  • Response
    - Navelgazing Midwife Blog - Dead Breech Babies
  • Response
    Response: www.lirec.org
    - Navelgazing Midwife Blog - Dead Breech Babies
  • Response
    Response: www.youtube.com
    - Navelgazing Midwife Blog - Dead Breech Babies
  • Response
    Response: milf dating
    - Navelgazing Midwife Blog - Dead Breech Babies
  • Response
    Response: milf dating
    - Navelgazing Midwife Blog - Dead Breech Babies
  • Response
    Response: Video SEO Tampa
    - Navelgazing Midwife Blog - Dead Breech Babies
  • Response
    - Navelgazing Midwife Blog - Dead Breech Babies

Reader Comments (37)

The first homebirth transport I ever received was a dead breech baby (that's one more) and then there's the famous case of Lucian Kolberstein (that's two more) who was born to a teen primip (news flash: that's two poor prognostic factors for breech birth) out of hospital by a midwife who'd attended a breech workshop and decided to try it out for herself. My partner got THAT transport --- entrapped head in a teenage girl brought in by ambulance. Lovely. I have done about 25 breeches (because I'm old and we did them when I trained), and when it goes well, it goes well. When it doesn't.....

June 20, 2012 | Unregistered CommenterMarti

In 1974 my daughter was a vaginally delivered breech baby at Kaiser Hospital, San Francisco. She was delivered by an older doctor and was observed by 2 younger doctors who hadn't learned his techniques and would have done cesarean. Nicole needed some resuscitation effort, had a low apgar at birth & a bit higher later. She grew up to be intelligent, getting a masters degree with honors. A bit of essential tremor and recently diagnosed MS were never attributed to her birth.

I went on to teach and nurture moms preparing for birth. In spite of my own footling breech delivery, I do believe that having a healthy baby outweighs an idyllic birth experience for mom.

June 20, 2012 | Unregistered Commenterbecky ward

Here in Israel, where sanity in obstetrics usually reigns [at least], we have been very shocked about a case where a registered nurse who did not have ANY kind of midwifery license [and, by law, all Israeli midwives are the equivalent of CNMs] undertook a breech delivery at home. Home births are very rare in Israel; the demand is very low.

In the event, the mother very nearly had a hysterectomy following hemorrhage and DIC, and the baby has just gotten out of NICU, severely brain damaged. When a TV reporter attempted to interview the "midwife", she called him "garbage" and hung up on him.

The so-called "midwife" is an immigrant from the US, a recent one, judging by her poor Hebrew. It is currently unclear whether she ever participated in any kind of midwifery program, or just decided to call herself one.

June 20, 2012 | Unregistered CommenterAntigonos CNM

In the 2005 Johnson and Daviss CPM study, they recorded 80 breech births, and two of those died. Those of course were excluded from their results when tabulating the perinatal mortality rate for CPM births. I don't find these numbers reassuring, they are far from a variation from normal.

June 20, 2012 | Unregistered CommenterBecky

I used to think I would want a vaginal breech birth over a cesarean. Then I had a friend who's baby was an undetected footling breech, who started coming out at home (planned hospital birth), and ended up entrapped. He was resuscitated upon birth, but was brain-dead and they took him off life support four days later. It was an incredibly traumatic birth and an absolute tragedy. That personal connection has really affected me and now I don't know what my choice would be. I likely would opt for a cesarean, but I know that my feelings are colored by the fact that my next baby is likely to be my last, meaning I wouldn't have as many worries about VBAC. If it was my first or second baby, it would be a lot harder to make that choice.

June 20, 2012 | Unregistered CommenterAimee

I am curious--why your stance on this while still supporting HBAC? Because if HBAC became more common, even with the restrictions you list, there would be more stories on the internet about those deaths, too. Also, why did you establish strict safety criteria, only to theoretically waive one of these in the hypothetical case of your daughter?

June 20, 2012 | Unregistered CommenterAnonymous

As an L&D nurse and student midwife, and also as a mother --- if I had a breech, and if all possible remedies to turn the baby to vertex did not work, I would want the most trusted and experienced physician to attempt a vaginal breech delivery IN THE HOSPITAL. Only if the baby was in a frank or complete breech position. Footling? Give me a c-section.

June 20, 2012 | Unregistered Commenteratyourcervix

I had my first baby at home, and am planning my second home birth. However, I will absolutely opt for caesarean if my baby is breech. I don't think ANY American birth providers have enough experience with vaginal breech birth to do it safely. In order to gain that experience, they would have had to endanger countless mothers and babies.

I personally know two women who have lost breech babies during vaginal delivery, one in the hospital and one at home. The home delivery was a surprise breech and the baby girl was actually born during transport to the hospital and unfortunately died a few days after resuscitation. It is just not worth the risk to me. I haven't seen any evidence that there is a safer way to deliver breech babies than by surgery.

June 20, 2012 | Unregistered Commenterhwar

I couldn't resist this quote from the guidelines I linked to:

"Even with the quality of care limitations of the Term Breech Trial, the long-term outcome was equivalent
in the planned vaginal birth and planned CS groups, and
parturient autonomy takes precedence over practitioner
concerns about small levels of fetal risk. Women should be
informed of the safety of a TOL in a setting with
experienced care providers."

June 20, 2012 | Unregistered CommenterMelissa Vose

It looks like I've been e-mailed some comments that aren't yet showing up? I just wanted to comment on the Term Breech Trial and the SOGC. While the TBT had some flaws, it is not the only basis for preferring cesarean to vaginal delivery for breech babies. The evidence is overwhelming that cesarean is safer, the only issue is just how risky a vaginal breech delivery is. Even with the revised SOGC guidelines, they are NOT promoting or recommending vaginal delivery over cesarean. Rather, they state that it is a reasonable option under narrow circumstances with intensive monitoring and conservative intervention guidelines.The mortality and morbidity stats that they cite are still greater than those for vertex babies and for cesarean birthed babies.

Personally, I'm not reassured by "the serious morbidity doesn't seem to have long term consequences for the child," because I'd rather avoid serious injury to my child altogether. I'd wait to withhold judgment until I see neuropsych testing on these kids at schoolage or later. At two, there could still be many subtle learning problems indicative of brain injury that would just seem like developmental differences but would become apparent later.

June 21, 2012 | Unregistered CommenterBecky

A post too on breech deliveries that went well? I'm sure there are many!

June 21, 2012 | Unregistered CommenterJamie

I'm still losing sleep over the second of these surprise breech twins:http://www.mothering.com/community/t/1352351/4th-uc-unexpected-twins-warning-transfer/20

June 21, 2012 | Unregistered CommenterLibby Cone

My first birth as a qualified midwife was a dead breech baby. It was an intra-uterine death before I ever met the women or labour started. Not a nice thing to start your career with, but very rewarding in the end. I stop and think about that mum and baby sometimes...From research babies in the breech position do appear to be at higher risk.

Ina May Gaskin has a different from mainstream view of life. A lot of the women she works with from reading their accounts in her books have similar beliefs. I get the feeling that she expects and sees as life experience some death within her midwifery practice. The older I get the more I wonder if she isn't right, as iatrogenic (caused by medical intervention) harm and death is so present. For every cesarean that saves a baby, there are many more that were unnecessary, place more financial stress on an overburdened health system and add to the resistant infections due to the prophylactic antibiotics given. The medical community and humans in general are not good at assessing the state of things on a global scale; i suspect Ina May thinks about this more than most.

I’d hate to be the one to explain those reasons to the mother of a baby that died from head entrapment though.
Hard topics.

The risk of death to mothers with an elective Cesarean is higher, but better for babies. It's not a huge risk to mothers but it's there none the less. I think if I had a breech (not sure about footling) I would try ECV, and then go and camp out in Mary Cronk's neighbourhood/someone else very skilled and try and persuade her to be my midwife, and if that wasn't an option I might well have a Cesarean.

June 21, 2012 | Unregistered CommenterEllie

Since you mention Lisa Barrett, Barbara, may I ask if you have read the coroner's inquest report recently issued concerning her involvement in at least one HB death and suggest you write a post based on that.

June 21, 2012 | Unregistered CommenterAMysAuntie

I am deeply disappointed to see you've jumped on the bandwagon of peddling fear regarding breech birth. While safe breech birth is highly contingent upon the knowledge and skills of the attending doctor or midwife, there is little evidence that that attendant needs to be in a hospital. Breech babies - and vertex babies too - are injured or die in the hospital, too, and caesarean is by no means a certain method of avoiding this. I strongly encourage you to come to the Heads Up! Conference in Washington DC this November and learn so that you're speaking from an educated standpoint rather than repeating the results of a deliberately negative web search.

I've not jumped on any "bandwagon" and I didn't start the conversation, Ina May did.

You state that safe breech birth is contingent on the knowledge and highly acquired skills of the attendant and this is exactly why I speak out against home breech births; there simply are not skilled and experienced midwives doing the breech births out there. If there was a way to acquire the skills AND practice them often, this might have been a different piece. However, until there is a massive wave of breech births that happen to be birthing where there are extensively skilled midwives teaching apprentices, I will be adamently against home breech births. Unless you have Ina May or some other midwife equally experienced attending. And for most women, that isn't likely.

Practicing with dolls doesn't count.

June 22, 2012 | Registered CommenterNavelgazing Midwife

AmysAuntie: I don't know where to find the whole coroner's report. Where can I find it?

June 22, 2012 | Registered CommenterNavelgazing Midwife

Ellie, I don't see how a mother could ever see things on a "global scale." When faced with the choice of an increased risk to my baby due to a long labor versus the increased risk to the population due to an increasing c-section rate, I'd choose (and actually did chose) a c-section. You're not risking my baby's life to drive down the national c-section rate.

We all decry the increasing c-section rate. Everyone seems to "know" (and let's acknowledge that we don't always "know" what we think we "know") that it should be lower. But none of us want to risk our babies so the rate won't decline. The unspoken part of the decrying of the high c-section rate in the popular media and mommy forums and blogs is that if the rate went down some babies that are born healthily now would die. It probably wouldn't be a huge number and from a "global perspective" it might even be better for the population. But every mom says "not my baby" and we're right back to where we started.

June 23, 2012 | Unregistered CommenterJenna

All births involve decision-making in regards to risk-management, and each mother assesses these risks to make the best decision she can for her baby and herself. As a mother of a breech baby, I decided that the best decision for us was a vaginal-breech birth in a hospital. My OB's lack of breech experience, and anecdotes of poor outcomes (this time in a hospital setting) were among the factors that led to my baby being born by cesarean.

I agree that hospitals are considered the best place to birth a vaginal breech baby, in cases where things go wrong (this is a personal view, and others may come to their own conclusions). When things progress well, hospital / obstetric interventions can cause more problems than they solve; just because a birth happens in a hospital, doesn't mean a woman / baby receives the best, or the most skilled care. Women and babies deserve true informed choice - this means full disclosure on the risks and benefits of all options: c-section and vaginal breech birth, not just worst-outcome scenarios of vaginally born breech babies.

Skilled and experienced care providers are also essential. The midwives and OB's with the skills and experience to attend vaginal breech births are a valuable resource who can share their best practice /experience with others in the obstetric community, but only if others are willing to listen. I suspect that if a care provider delivers enough babies, they are, sadly, going to have a death at some time, despite everyone's best efforts. For the families, the loss of their baby is a terrible tragedy. Sadly, we have no crystal balls to tell us which babies are going to run into problems, and which will be fine if left alone. Hopefully lessons are learned from each of these births and deaths that will improve best-practice for vaginal breech births, rather than focusing on who's to blame. Ignoring the lessons that can be learned will lead to future mortality and morbidity: babies will continued to be injured or die when evidence-based best-practices for vaginal breech birth are not implemented, and women and babies will be injured or die as a result of unnecessary cesareans.

June 23, 2012 | Unregistered CommenterCeline

It is precisely because of the lack of crystal balls that obstetricians intervene based on risk factors -- like breech position. They are well aware that some babies would survive a breech vaginal delivery, but they are also well aware that it will be deadly for some babies. They don't say, "Well, some babies die. What a tragedy for those parents!" but "This is too risky." How many cesareans is one baby's life worth?

June 24, 2012 | Unregistered CommenterBecky

Ellie, do you really imagine any grieving mothers at home, with their sweet babies in the ground, are telling themselves, "Well, at least I didn't contribute to any antibiotic-resistant strains of bacteria!"

Yes, the high C-section rate, the overuse of antibiotics and the costs of health care are all valid concerns. However, for most women, they are a faaaaaaaaaar distant second to the well-being of their own children. Most women, no matter how much they support natural birth, do not want to sacrifice their babies on its altar.

June 24, 2012 | Unregistered CommenterAlexis C.

I don't know if this link will work for you since it's fighting my old computer tonight. But this is the link as reported.
http://www.courts.sa.gov.au/courts/coroner/findings/findings_2012/Spencer-Koch_Hobbs_Kavanagh.pdf
I don't know if you are averse to visiting Amy Tuteur's site, but she has a couple of posts written after the inquest rulings came down.

June 25, 2012 | Unregistered CommenterAmysAuntie

Jenna: I agree. I would be one of those mothers and would feel the same for any baby in my family, and indeed any family I look after. Does this make it the right reaction though if we're upping the mortality/morbidity rate overall? It's the Trolley Problemwith more complicated and less certain outcomes...

I hope you don’t think i’m being unemotional about these issues with the above link. On the contrary I am so passionate (I think being passionate comes with being 23) about getting the best outcomes that I was trying to look for a logical way of deciding..

Celine: Yeah, Midwives and Doctors could do with more breech experience if only because even if no-one chooses vaginal breech, sometimes labour progresses too quickly to do anything about it and you have to deal with what’s sent!

Becky: Again I agree. In terms of your question, what do you think? How many? In the same way how many mothers dying from caesareans for would justify babies being born safely from cesarean for breech presentation? It’s so complicated.

Alexis: First, hit your blog, your daughter is as pretty as they come and looks like a happy little imp. I’m considering subscribing to your blog except i’ll start getting broody..whoops, too late. Haha. Lipstick fiend. No Ellie, you’re too young and have too much cycling to do first...
I agree mothers would not be consoled by that fact at all and we would be getting into dangerous medical-dictatorship ground if we demanded parents made the ‘right decision for the good of medicine and the human race’.
But, and it’s a big but, what if we are pushing ourselves further into problems by doing all these caesareans? Shouldn’t we be doing something about that? As a journalist I’m sure you must have assessed similarly complex and inflammatory issues. Did you learn anything from those or from being a Mum that you could apply to this situation?

June 25, 2012 | Unregistered CommenterEllie

Ex-apprentice: I'm going to take your comment and make it a post all on its own. I've been working on something similar, so might join them together, but believe your words need to be heard louder than in a comments section.

Thanks so, so much for writing. It's nice to be in harmony with someone else instead of just singing solo.

June 25, 2012 | Registered CommenterNavelgazing Midwife

Ellie, there are very, very few mothers dying from cesarean. The difference in mortality between cesarean and vaginal delivery has been steadily dropping, and some studies are suggesting that with thromboprophylaxis, there is no significant difference in mortality rates between the two. Maternal mortality is vanishingly rare compared to perinatal mortality.

Is cesarean being overused and possibly contributing to the US's maternal mortality rate? Possibly, although large epidemological studies have shown no correlation between cesarean rate and maternal mortality in wealthy countries, and some countries with higher cesarean rates, like Italy, have better maternal mortality rates than we do. If we need to cut back on cesareans, though, we can do so by increasing access to safe VBACs in hospital, and by setting firmer diagnostic criteria for failure to progress. Breech births are dangerous enough that it is MORE than worth it, in terms of objective health numbers on a population level, to deliver them by cesarean.

There are some studies showing that using very strict criteria, like utilizing ultrasound weight estimates as well as pelvimetry, and strict procedures, including immediate access to an OB and anesthesia, may allow some breech vaginal deliveries with only a small increase in risk. That's not happening in a living room.

June 26, 2012 | Unregistered CommenterBecky

I do think that there's a tangible difference between frank breech deliveries and footling breech deliveries - my hospital in England was actually very supportive of rump breech deliveries, but once they saw that my baby was footling, both the head consultant and the head of midwives (experienced in breech deliveries) said that they would not support a vaginal delivery as the risks were too great. On natural birth blogs, footling breech deliveries seem to get collapsed into the general 'breech' category as a kind of birth to be reclaimed from the surgeons - despite the Canadian breech consensus suggesting that footling should be risked out of vaginal deliveries because the chance of cord prolapse is about 20% higher. I don't think it matters how experienced the practitioner is if feet and cord start coming down when the mother's only five centimetres dilated, does it?!

Since I had my son via caesarean (I started dilating at home and on checking myself, found his foot descending, still in the amniotic sac, and promptly dialled for the ambulance) I've met mothers of two other footling breech children. One mother was a multip with a history of precipitous deliveries - by the time she got to the hospital with her undiagnosed breech, she was fully dilated and his feet were coming down. She said that she delivered him in two pushes, and the midwives told her she was very lucky. The other mother was having a homebirth, and lost her child due to slow hospital transfer (which was the most excruciating playdate conversation I've ever stumbled through). I know that the plural of anecdotes isn't anecdata - but I still can't regret choosing the caesarean in this case.

June 28, 2012 | Unregistered CommenterTam

OK - I don't know if I'm waking up from a dream - or still dreaming - but does anyone think this is reasonable "risk assessment"?

"Ina May Gaskin on Risk Assessment for Breech Birth - Midwifery Today Birth Essentials"
http://www.youtube.com/watch?v=Q5kTuEkPapE

Maybe this video has already made the rounds - but I'm a little stunned that this is considered legitimate instruction on how to evaluate risk status of a woman carrying a breech baby and desiring a vaginal birth. I know it's sacrilegious to criticize Ina May - but... ooh... really?

To be fair - this video has been edited, and we haven't heard the entirety of her talk - so perhaps the H & P aspect of risk assessment preceded the commentary shown in the clip. We can hope.

June 29, 2012 | Unregistered CommenterEx-apprentice

Speaking as a woman who chose to birth my now *almost* fully healthy 8 year old frank breech daughter in the hospital, I'm not sure what I would do if in this situation again. The birth itself was fine, no problems at all. I believe it helps that she was my second and a bit smaller than my first. I think I must also have a roomy pelvis as my first had no head molding. One nurse even thought he was born via cesarean because his head was perfect...even after 17 hours of labor and 2 hours of pushing...but I digress.

There is a point to the next part, and it 100% relates to breech birth...it just takes a bit to get there. :-)

The reason I'm now conflicted about what I would do now and my saying that my daughter is now "almost" fully healthy are connected. My daughter (L), has major pelvic floor dysfunction and overactive bladder (OAB, which is made much worse by the pelvic floor dysfunction). After years of back and forth with her pediatrician (who initially said her potty training reversal was just a normal regression issue...for 2.5 years), then dealing with the pediatric urologist who put her on medication that then caused constipation and impacted bowels, which causes the same symptoms as OAB. The pediatric urologist wanted us to give her miralax every day, indefinitely, saying there were no risks. We opted to stop the medication and try to deal with the OAB ourselves...but when you're 7 year old has the bladder function of a 9 month old, dealing with it totally on your own is HARD.

I swear I'm getting to the point.

Here's the timeline: she potty learned at 2 (100% on her own), regressed at 2.5, misdiagnosis/unhelpful doctors/medications for 4 years, stopped everything at 6.5 years old, then I had an epiphany when she was 3 months shy of 8. What do adult women with OAB do aside from medication? They go to physical therapy! Finding a Women's Health PT who had experience with OAB AND was willing to see and work with my 7 year old was quite difficult. After more hours than I want to count on the phone, calling every PT in town, I finally found someone...who is 1.5 hours away from us in a very small town (we live in a rather large metropolitan city). This PT is a women's health PT and the only obstetric certified PT in the state. She also started out as a pediatric PT! I called and left a message for her and she called me back the next day. I told her about L's history and the first question she asked was if she was a frank breech at birth. She was a frank breech. Her response: yup, I thought so. She asked how I birthed (I love that she didn't assume anything) and when I said vaginally she asked how soon she could meet L. We were in her office the next day.

That was when we discovered that L not only had OAB but, and this was likely the precipitating factor in the OAB, she also had major pelvic floor dysfunction. The precipitating factor in the pelvic floor dysfunction? Same thing that it is for many women who suffer from this after childbirth: hyperflexion of her legs both during the pregnancy and at birth. Our PT said that most, NOT ALL, cases of OAB and pelvic floor disorders found in kids (and even in adults, especially if discovered before giving birth) are likely the result of frank breech presentation. She says it can happen regardless of if the baby was born vaginally or via cesarean but it is more likely (and oftentimes worse) in babies who were frank breech much of the pregnancy and/or were birthed vaginally.

After months of weekly PT appointments (1.5 hours each way), and continued daily exercise, L is doing much better. At 8 she usually only has 1-2 accidents per week (usually if we have to find a bathroom) and stays dry 5 of 7 nights a week (the other 5 she is up 2-3 times at night to go to the bathroom). She still has urgency to pee and the PT says she is much more likely to develop interstitial cystitis (IC) later in life. Interestingly, my best friend has IC and was frank breech (born via cesarean birth).

So my point is, even though we know the answer and know how to fix it...I don't know that I would risk these same issues again if I had another breech baby. I would really have to do a lot of thinking and talking to decide what we would do. I do wish we had been told and/or were able to know that this was a risk. I did do a lot of my own research, it's my responsibility to be informed IMO, but no where did I find that frank breech babies, especially those delivered vaginially, were are more risk for these issues. Honestly, I don't know that this information is widely known. Our PT was the first of over 10 medical professionals to make the connection for us. I wish more people knew this...especially if a woman has a breech baby (regardless of mode of birth). They need to know to look out for these issues and how to fix them.

Two side notes...My daughter now has an awesome pelvic floor! And if she continues to do her exercises as an adult, hopefully being so aware of her pelvic floor will benefit her during birth. Second, after doing more research I discovered that PT is the most effective treatment for pediatric OAB...but most doctors (pediatricians and urologists) prefer medication and will rarely refer out for PT. But I think this is largely due to the lack of PTs who 1. know how to treat OAB and 2. are willing to treat a child.

Sorry this was so long. And I didn't go back and proofread...I'm running late picking up my partner because I lost track of time writing this! :-D

June 29, 2012 | Unregistered CommenterCatie

Wondering if you happened to see this "Left hospital to deliver footling breech at home" birth story? I'm the 'L&D nurse turned midwife' commenter there and, after just starting to read your blog, I'm curious as to your reaction to the story.

It's at: http://knowmommy.blogspot.co.uk/2012/02/left-hospital-to-deliver-breech-at-home.html?showComment=1333560146114#c8927555660970900952

The mum's follow-up to all the comments is at:http://knowmommy.blogspot.com/2012/04/in-response.html

Her baby is apparently well at 2 y.o. after having quite a difficult birth. Just thought I'd bring it to your attention. Seems no matter how nice and calm one writes in response to such a story, it just doesn't get through the haze.

July 14, 2012 | Unregistered CommenterLatterlife Midwife

What a disgusting story. This is my comment:

It took me about 20 years before I was able to admit my stupidity at having a UC. I almost killed my daughter by not having a cesarean. She had a shoulder dystocia and needed mouth-to-mouth to get going (no chest compressions, thank god). For *years*, I bragged about how wonderful the birth was, about how quickly she came around, how great UCs were. I am horrified at how many women I might have led towards a UC or an unsafe homebirth. My daughter is now 27 years old, brilliant beyond words, but she began breathing on her own within one minute of being born. Her first Apgar was about 6, her 10 min. Apgar was 10. Your baby's Apgar was not anything nearing that.

I can't help but warn you about your future guilt when your baby shows the signs of your arrogance... school will be very telling for you.

A horrible, sad, devastating story that deserves nothing but pity.

July 15, 2012 | Registered CommenterNavelgazing Midwife

I'm going to watch for responses to your comment, Barb. Sometimes I think I can be too polite to people and not direct enough. My two, long and very well thought-out comments on her birth story just sailed over the defences of her and her friends, so entrenched they are in their positions. You wrote so much more directly, and I could feel your emotions in what you said.

I noticed one of her supporters said she cried at reading the beauty of Janelle's birth story..."I think I scanned some negative comments, I couldn't bring myself to read them after being so uplifted by your story. I would imagine those comments come from a place of fear, our society has done a good job of embedding that in us when it comes to birth! Thank you for sharing your story, I'm going to pass it on."

Exactly why I commented in the first place - she's going to pass it on, before bothering to read any dissenting comments. Brilliant.

Janelle responds to her, "Yes, there are negative comments but that is to be expected when you do something that goes against the norm, especially when it comes to birth and babies; people tend to get very upset. I, too, believe that a lot that comes from fear of the unknown of from insecurities of not being able to listen to their inner self. Thank you for sharing my story and helping spread the word that natural is normal."

Janelle knows it's not fear of the unknown. It happened, it was known, right in her own home. It wasn't normal. Does she really believe what she's saying? Is she trying to save face? What's to be done?

July 15, 2012 | Unregistered CommenterLatterlife Midwife

I believe she's like me and is totally high in the experience (even 2 years later) and might be until her child shows signs of problems. When Meghann was left-handed was my first inkling there was a problem... some believing that left-handedness is a sign of oxygen deprivation, which Meghann did have since she was in secondary apnea. Who knows for how long.

The blogger's baby was in oxygen deprivation for a bloody long time, dangling out of her vagina for so long before even being born. Those midwives should be shot for not calling 911 with that happening! 10 minutes of PPV?!?! C'mon! My heart aches for that poor, extremely depressed baby who needed expert help. She said herself the cord had prolapsed so any oxygen that *might* have helped, wasn't there, no matter if they cut the cord or not.

Just a sick situation, I just don't think I can even share it in FB.

July 15, 2012 | Registered CommenterNavelgazing Midwife

I was born in 1982, and I was a vaginal breech baby. I was born at a birth center, not in a hospital. I would NEVER make that choice for my own child. I'm very grateful that I was born safely.

August 17, 2012 | Unregistered CommenterKate

Finding an abstract that stated breech babies born vaginally were more likely to have developmental delays in two or more domains at age 2 than those delivered by c-section was more than enough to convince me..Why risk your child's future to fulfil your expectations of what birth "should" be like?

September 1, 2012 | Unregistered Commenteraraikwao

As a NICU nurse I am so glad to read that most are advocating C/S for breech babies. As stated above, your child's life/ future should not be risked. Is your goal a healthy baby or your ideal delivery?

October 13, 2012 | Unregistered CommenterTrace

There are a good list of breech deaths in this list of "Sisters in Chains". More like a list of HCPs to avoid in my opinion.

https://m.facebook.com/note.php?note_id=10151255934770792

And so much for the Coalition on Breech Birth, midwifes in this group are delivering breech babies and then admitting they themselves were unaware of the risks.

http://www.skepticalob.com/2012/11/she-found-us-wallowing-in-our-stupidity-quick-lets-hide-and-wallow-some-more.html

November 25, 2012 | Unregistered CommenterCaptain obvious

UC might have been stupid, but in the absence of diabetes AND suspected macrosomia, a prophylactic c-section is NOT recommended. Shoulder dystocia is notoriously unpredictable. You should have labored with an excellent attending professional, not gotten a C/S.

December 7, 2012 | Unregistered Commentermimi

PostPost a New Comment

Enter your information below to add a new comment.

My response is on my own website »
Author Email (optional):
Author URL (optional):
Post:
 
Some HTML allowed: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <code> <em> <i> <strike> <strong>