A Breech of Freedom

Nearly a year ago, I received a phone call one afternoon from a women who was 39 weeks pregnant. Her baby was breech. She had been planning a birth at her home 4 hours north of Portland, but due to the legal situation in Washington, although qualified to attend her breech birth, her midwife was not able to do so without fear of legal ramification. Her baby had been turned head-down several times by version, but each time had turned back. The hospital offered her only the option of Cesarean, despite the fact that she had previously given birth. And now at 39 weeks, she was running out of time.

Before I go forward, let's stop here and think for a moment: We live in a country built on freedom. Freedom of the press, freedom of religion...and, regardless of your opinion of the rightness or wrongness of it, a legal freedom for "a women's right to choose." Although she had the "right to choose" between abortion and birth (which was not at all the issue here, I am merely showing a point), she had no option in her home area when it came to the manner in which she would give birth. How on earth did we get here?

Breech babies, who come out butt first, knee first, or feet first, were once considered by all to be a variation of normal. Midwives around the world still believe this. A group of UK Midwives have a great site on the subject.

With the medical takeover of birth in this past century, more and more breech babies began to be born surgically. As this became more and more normal, less and less attendants had the opportunity to learn how to safely deliver breech babies. This cycle perpetuated itself. Then a few years ago, the widely publicized Term Breech Trial determined that Cesareans were safer for all breech babies.

But midwives were suspicious of the study: Midwives didn't have the same results with vaginal breech birth that the study claimed to! So we fought, we fought and we fought and we fought some more to keep the right to provide women with the option with the choice with the right to balance the risks for themselves and decide the manner in which they would birth their breech baby.

Let's be clear: Vaginal breech birth is not without it's risks. But neither are Cesareans.

Last month, the American Journal of Obstetrics and Gynecology updated their findings. The results? "Most cases of neonatal death and morbidity in the term breech trial cannot be attributed to the mode of delivery. Moreover, analysis of outcome after 2 years has shown no difference between vaginal and abdominal deliveries of breech babies." They then withdrew the previous recommendation of the Term Breech Trial.

This finding came last month. The baby almost a year ago? She was born vaginally, all 10 and a half pounds of her, in the presense of 3 other midwives and myself, after her mother drove 4 hours and across a state border to find a place where she had the right to choose. Her mother remains a active and vocal advocate of a women's right to choose...birth place and birth method of breech babies.

Will the new finding make vaginal breech birth offered more frequently in hospitals now? I hope for the best, but I don't expect it. Regardless of the study findings, there is still a shortage of OBs with experience in vaginal breech delivery. Those who are comfortable with it still must deal with the scrutiny and constraints of their hospital policies and malpractice insurance.

For now, midwives remain the surest bet for a vaginal breech delivery.