The Undervalued Art of Vaginal Breech Birth: Ina May Gaskin

A Wonderful article from Ina May on Breech birthing. A must read. Here is just a snippet. Go to the website to finish the article, you won’t be sorry.

A Skill Every Birth Attendant Should Learn

Little did I know, when I witnessed my first vaginal breech delivery at a small county hospital in middle Tennessee in 1972, that I was seeing a physiological process that was being rapidly phased out in the US. The birth was to a mother having her first baby. She had planned a homebirth, with me as her midwife. I discovered in early labor that the baby was a frank breech (buttocks first, legs straight up), and my training had not included how to deal with such a presentation. Off we went to the hospital. When we arrived, no one there even considered a cesarean section as an option. At the time, I didn’t know anyone who had had a cesarean. This isn’t surprising—30 years ago, the cesarean rate in the US was a little more than 5 percent, and then as now, women with breech presentations accounted for only 3 to 4 percent of all births. Exalt Birth Services Phoenix AZ

Over the next two years, six more breech babies in our practice were vaginally born at that same hospital, and a surprise breech fell into the hands of my midwifery partner, Pamela Hunt, at the mother’s home. There was never a hint from any of the several physicians involved that a cesarean might be better or safer for the baby. At our local hospital, it appeared that all physicians attending births, whether they were family doctors or obstetricians, were expected to be competent in the art of vaginal breech birth. It was the policies of other US hospitals that later made us aware of the trend taking place in the rest of the country vis-a-vis breech birth—the increasing use of cesarean section, without a trial of labor.

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The majority of injuries in cases of vaginal breech delivery are those caused by pulling or jerking on the baby’s body in an effort to hasten delivery. A panicked, inexperienced physician might resort to such measures, unaware of how much force he or she is using. It was precisely for this reason that some obstetricians, writing a generation ago, called for taking more time, using mannequin demonstrations of proper breech technique and other ways of training younger obstetricians in breech delivery. Videos of well-conducted breech births might also be a good resource in medical schools, but these are now in short supply because insurance companies have threatened to refuse malpractice insurance to hospitals that permit planned vaginal breech births.

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A British epidemiologist cites an eightfold increase in maternal death following elective cesarean section above the death rate associated with vaginal birth. The risk of a mother dying after an elective cesarean with no emergency taking place was 2.84 times greater than if she had a vaginal birth, according to one study. Other studies show an increase of 3 to 13 times the. maternal death rate for cesarean above the rate for vaginal birth when both elective and emergency cesareans are included.