Vaginal Breech Birth - Breech home birth

 Breech birth can happen at home. But don't be ideological.

Breech birth is becoming more accepted in American homebirth culture. We are seeing more home breech birth videos on the internet. A good example is Annaka Faith's birth story and video on Leslie's Daily Surrender Blog.

We hear how her midwife brought in a second midwife with breech experience to increase support and skills if Leslie's baby were to need help during the birth. What happens is classic and is addressed four paragraphs down. Go read the blog first, though, its a lovely story.

Midwives learning from other midwives have the advantage of learning physiological breech birth but the disadvantage of a gap in 2-3 generations of midwives who've missed experience with more than an occasional breech. Home birth doesn't have the extra support for full resuscitation, though it is advantageous for the baby that many midwives know not to cut the cord during resuscitation. As I've pointed out before, there are strengths and weaknesses to both home or hospital breech birthing. Homebirth can be argued to have "inadequate resources" from the point of view of a hospital. The skills of the midwives, and the complexities of a breech birth will vary and occasionally the worst of both will collide. Even a midwife with many successful breech experiences behind her could suddenly be faced with a situation she can't solve. While this crisis can and does also occur in the hospital, having it happen in a homebirth puts parents and midwives into a whirlwind of exposure, review and too often, retribution by the system seemingly slighted by their choice to give birth another way. 

I believe it may be more likely that a very experienced midwife is more likely to notice when a labor leaves the range of normal, and be able to transport to get an intervention than, sometimes, an obstetrician, who hasn't seen many natural births, recognize the need for an intervention when they have set their heart on helping a woman have a natural birth. Few obstetricians have sat with women through natural labors observing the variations of normal. When a doctor who works where interventions are routine suddenly wants to help a woman achieve a natural birth, the doctor may not have the experience to notice when a labor actually needs an intervention. I know that sounds crazy, and I don't mean to be biased, but I've seen this dynamic in breech, VBAC, and head down births. Its one more reason that a midwife, doctor and doula team can offer the best care. That is, if everyone is working harmoniously and within their strengths (roles) and not pushing an agenda and not afraid to offer their strengths. Ok, and if this isn't enough preaching, here's another observation:

Occasionally, I hear/read women say they are planning to stay home with a breech because their midwife has been at breech births. The question arrises, how many is enough to satisfy her ability to handle the complications. (My experience is limited, too.) My hopes are that women who do stay home with a breech are following their inner voice and listening to their babies. We don't give birth from the left side of the brain. Facts and protocols are good, but they are not what we must rely on once a complication arises. Just because Breech Is Normal doesn't mean all breech births are spontaneous. Sometimes, when a breech birth is difficult, it can be very difficult very fast with no time to transport. Few American midwives have complete breech training and fewer have the skills of experience for breech emergencies, not to go into the unassisted breech home birth. 

Normal breech labor is really lovely, often more comfortable for the woman, dynamic and exciting for all. Most crisis are easily handled by the super well trained provider. Often the observer might miss the fact that there was even a stuck arm or head when everyone is calm.  But I have to go on a while about "the tougher variations of stuck" because they do happen and they do lead to scary close calls and even death. Face that fact, don't divert from it. And then you can better assess whether your resources are adequate to your needs in providing or receiving breech care. 

Listen to what God, Nature, your baby and your inner sense is communicating to you. When breech home birth is right for you, you will have a contentment and an inner conviction, not a heady drive to show the world that vaginal breech birth is possible. Rather, you will have an inner knowing that your are following what is right for your baby. Make sure your midwife has the same guidance, rather than being guided by philosophy or ideology. It is all of our response-ability to know the difference.

Thinking good thoughts about a home birth midwife being present at a home breech birth

It is good to sit beside the birthing woman with the understanding that she is following a wisdom which expresses her own natural physiology.

It is also good to know breech cardinal movements and recognize when the baby is unable to make the next cardinal movement. See Jane Evans, Independent Midwife in the UK, article on the Physiological Breech Birth, including the cardinal movements in MIDIRS journal. Then study Anne Frye's Holistic Midwifery, Vol. II, on teh breech cardinal movements. Use a doll and pelvis to illustrate each step. Do this 100 times.

Skills are processed with logic, but practiced with heart and hands. 

Here's a picture of a baby who is coming well in a hands-off, knee-elbow maternal position. The arms are about to come out on their own as indicated by the deep crease in the chest showing the compression of the elbows on the chest. https://www.facebook.com/photo.php?fbid=203201129701444&set=pu.113495458672012&type=1&theater

It is also good to know several ways of helping if the arms and/or head becomes stuck. If you can't see it coming before it happens, you have more to learn. The first view of the breech will show you if there may be trouble ahead. At the first peek, there may still be time to change plans.

Before a midwife attends a home breech birth,

...she will be more helpful if she knows well how to resolve the stuck shoulders of head down babies. Rotation and handling the shoulders in a head down baby aren't exactly like stuck shoulders with a breech, but are very similar. And the principles are the same, just applied upside down! Having been through several shoulder dystocias gives the midwife practical skills in a crisis. 

Other necessary skills would include

• Physiological resuscitation of the newborn
• Creative cord unwrapping
• Recognition of cord compression 
• Handling a rapid hemmorhhage
• Patience to keep Hands-off
• Knowledge when to be Hands-on

Early placenta detachment can occur and gives the midwife some extra juggling tasks as the baby is emerging or has just emerged.

And a very nice skill, though not a common one, would be pediatric craniosacral and myofascial release. One may refer to a person who can do "cranials" for the baby which will improve breastfeeding and other vital functions immediately, as well as in the following hours, days, and weeks after birth.

Even before the birth, communication skills with parents about birthing outside of the typically accepted practices of American birth and perhaps, without family support, is important to nurture the mother's body-mind connection.

Communication flows more smoothly when we let go of our desires, agendas and even assumptions. 

That being said, birth has a sense of purpose all her own.