Keeping the Skills for Vaginal Breech Birth Alive

In Springfield, Massachusetts, if your baby is in a breech position, you are routinely scheduled for a C-Section.  Even in this supposed age of medical advancement and skill, obstetricians and hospital-based midwives are not familiar with the maneuvers to deliver a breech baby vaginally.  Breech is defined as dangerous, as something wrong.

This is not true everywhere.  In Germany, in New Zealand, in parts of France, in areas throughout the African and Asian continents, in rural areas around the world, breech is seen as a possibility (4% of the time) and midwives are prepared for variations of birth. In the more medicalized areas, techniques have been researched, tweaked, practiced, and taught. In traditional villages or in the remote corners of our globe, practices have been passed from one practitioner to another over generations.

Why is this important?

You can look at it from different perspectives.

·       Breech presentation is often a surprise.  Breech can remain undiagnosed until the baby presents themselves at the vaginal opening, ready to be born. If the practitioner hasn’t been trained in breech, they find themselves in an “emergency”, as opposed to something they have the skills to respond to calmly.

·       C-Section is major surgery and carries with it risks that could equal or outweigh any risks that a vaginal breech birth might present. It is important to have options so that we can decide which risks are more appropriate in a particular situation.   

·       Not all women have easy access to a C-Section. Therefore, keeping vaginal breech maneuvers and research as an important part of birth worker training is a matter of life and death.

·       Not all women will agree to a C-Section, especially when they and their babies are healthy. The autonomy of the pregnant woman should be a central concept of maternal care, so we should have a vaginal birth option, especially when vaginal breech births are practiced safely in many parts of the world.

·       A careful review of the research does not actually prove that vaginal breech is any more risky than vaginal vertex (head-down).  We all accept that vaginal birth overall poses less risk to mother and baby than a C-Section.

Interestingly, the modern research around vaginal breech birth encourages upright positions, contrary to the conventional obstetrical model of supine positions.  It begs the question whether the fear of breech birth has been created because of a departure from traditional birthing positions.  Of course, there are situations in which a C-Section is necessary, and we, as midwives, are thankful for that option when it is indicated.  But, instead of immediately jumping to C-Section, why don’t we first explore something as simple as position changes to facilitate a straightforward breech birth?

Vaginal breech birth is a skill to learn, practice and take very seriously. This July 2023, Breech without Borders, an organization dedicated to researching and teaching the art and skill of breech birth, is coming to Springfield, MA to train midwives.  We will learn the traditional and modern methods – through hands-on simulations, actual videos of vaginal breech, and one-on-one mentorship opportunities from experienced breech providers.  We want to be ready to give our clients safe and skillful care, whatever positions their babies choose to be in.