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.
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.