Tuesday, March 08, 2011

Normal birth for a breech baby

From time to time a presentation becomes available via this wonderful www that is really worth sharing.

Today I would like to direct my readers to the blogs of two colleagues, midwives who are committed, as I am, to sharing the knowledge and skill of authentic midwifery. I would encourage you to follow these two links, then come back and read my comments. Please feel free to make any comment here, or on the other blogs too. (You know that comments are very much appreciated by bloggers.)

Lisa Barrett has written about the Mechanisms of unassisted normal breech birth, with a superb set of photos.

Carolyn Hastie has presented this You-Tube video, which is in Spanish, with her own comments.

The de-skilling of midwives and obstetricians in breech vaginal births has been one of the top items on the maternity shame file of our generation. When I sat the Victorian state midwifery exam in 1973, one of the questions was breech: diagnosis, external cephalic version, indications for caesarean, and foetal risks. Breech births were part of normal midwifery practice then. Not now.

Some years ago I was asked to review a case in which midwives in a private hospital had been confronted (literally) with an undiagnosed breech birth. The woman arrived at the hospital in strong labour, her waters broke, and a baby's legs were visable. Here's what happened:
  • The doctor was called urgently.
  • The woman, very distressed, was put on the bed and prepared for 'delivery' by putting her legs in stirrups (so that she was ready when the doctor arrived)
  • The baby's abdomen was, by this time, on view, back uppermost.
  • There was a small bright bleed, and the baby became pale.
  • About five minutes passed before the doctor arrived and 'delivered' the baby, who was unresponsive and did not take a breath.  The placenta came out with the baby - it had separated prior to the birth.
  • Efforts to revive the baby were successful in the sense that the baby lived, but the baby suffered severe hypoxic brain damage, and developed cerebral palsy.
When this case was reviewed, the two midwives who had been in attendance were asked why they did not assist the mother to give birth to her baby before they doctor arrived.  The midwives said they did not know what to do.  They did not recognise the abbruption of the placenta, and cessation of blood flow through the umbilical cord.  They only knew how to set up for the doctor.  The very act of putting the mother in the lithotomy position (legs in stirrups) probably interrupted what could well have been a spontaneous birth if she had been upright, allowing the weight of the baby to assist by gravity.  A woman in lithotomy for breech birth is very likely to need the assisted delivery of the fetal head.

A tragic birth like this one tells me one thing: that midwives must hold on to the knowledge and skill of normal, physiological breech birth, even if the only breech births they are ever likely to see are the unexpected, undiagnosed ones.  

Thanks to Lisa, and the woman in the presentation, for your excellent pictures and discussion.

Thanks also to the ? doctor and the mother on You-Tube, for the record (in Spanish) of a beautifully gentle and patient normal birth for a breech baby.  There was no interference with this baby as she took her first breaths; no rush to untangle or clamp the cord: just confident and patient support.


Thinkbirth said...

Joy you are so right that midwives must be educated to help a woman give birth to a breech baby. That those midwives didn't know what to do is a tragedy and one that was and is totally avoidable. For midwives working in hospitals, those hospitals have a duty of care to ensure midwives are up to date with their skills by providing opportunities to refresh, update and learn new developments. Midwives have a professional responsibility to ensure we are up to date with our skills & knowledge. There is no excuse on either part. Even though the Term Breech Trial has been discredited, its legacy lingers on. The trouble is, poor care like this is what gives breech birth a bad name.

That poor mother and her partner, plus that little one who will never reach full potential is so heartbreakingly sad. Each of us practitioners, need to review birth and its complexities to ensure we are able to move swiftly into the right action to take in diverse situations. Thanks for this post. Gives us rich food for thought.

false positive pregnancy test said...

Well as everyone believes that a breech baby is scary but a baby that is breech is not an automatic dangerous situation. Just think that breech babies are another variation of normal. Your baby is breech for a reason. So never panic! Just calm yourself.