Friday, November 06, 2009

Thinking about vaginal breech births

I have put a comment about the screening of this video at the MIPP blog.

A point that was only touched on in the discussion after the showing was the disenfranchising and deskilling of midwives in breech births. It has become an obstetric consultant ‘act’, even though every midwife should be ready and competent in spontaneous breech births. Midwife Fiona Hallinan mentioned that Box Hill hospital is setting up consultant cover for breeches – it’s all about defensive medicine. RWH refuses to support a woman’s choice, and staff will bully her into compliance with their wishes to do an elective Caesar. I was told that this is because they can’t be sure someone is competent at all times. And as Lionel Steinberg pointed out, an obstetrician goes against the current ‘gold standard’ at his own risk. The insurance will pay out for a baby’s brain damage in an undiagnosed breech birth where the midwives haven’t got a clue what to do, but won’t support the obstetrician who goes against the rules.

The video ‘A breech in the system’ made the point that the woman was lucky that the obstetrician on call at the time was competent – had learnt about breeches in India and PNG. There was great rejoicing around that fact. It’s tragic that an obstetrician needs to be given ownership of a spontaneous birth that a midwife could just as well have attended.

There was a lot of padding in ‘A breech in the system’. Beautiful underwater footage, lots of Byron Bay alternative hocus pocus – none of which seemed to make any difference. ECV (external cephalic version) got some bad publicity, and it ‘didn’t work’ either!

In the current climate of serious threat to all midwives’ right to practise on our own authority, breech births are a bit of a distraction. This video is good in that it demonstrates spontaneous birth – something we need to value and hold on to.


Sif Dal said...

I found the documentary and the discussion afterwards very interesting. I was particularly interested in what was said about the intention of the woman giving birth, that as long as her intention was to birth vaginally, her success was likely to be much higher than that of a woman who was "open to all options" - i.e. open to having a pre-emptive c/section.

I was a little concerned about the idea that a doula or a birth assistant need to build a woman's confidence to enable her to birth a breech baby vaginally, but the "definition" of a doula in the documentary was quite confusing anyway - part midwife, part birth educator... Hmmm, besides putting undue pressure on a birth assist to be quasi-medico quasi-sensei, I would say this MISleads women into a false sense of security that they don't need to work with their own bodies or know what they want because their birth assistant will make all their decisions for them, protect them and advocate for them.

I find that a little disempowering to the birthing woman, as if she is a child who needs to be taught what to think and how to act, and needs someone to defer to - or even blame, if her birth doesn't run to her hearts desire (if she even knows what that is)...

Joy Johnston said...

I also noted that confusing statement in the film, that the doula is some sort of mix between midwife and childbirth educator. NO and NO!.
The research that supports the use of a doula was quite clear that this person has no professional responsiblity - no investment in clinical decision making. A birth 'helper' who coaches and cajoles and encourages a woman to do 'it' in a particular way is not being a doula.
[And, BTW, this is a very different issue from the midwife's duty of care, by definition, to 'promote normal birth'.]
Michel Odent says it well, in discussing the woman's need to be free in labour: "And when I see a labouring woman on the floor - about to go off to another planet - and nobody around except a midwife reading a newspaper, I am optimistic." [I might add, "or knitting"]

Joy Johnston said...

ps: the reference is 'Birth and Breastfeeding: rediscovering the needs of women in pregnancy and childbirth', Michel Odent 2007. Pub: Clairview. Page 27