I was contacted recently by some midwives who had attended one of the breech workshops I have facilitated this year. They wanted to share their story of an unexpected breech birth and how thrilled they had been to be able to support the woman; no transfer, no drama, just a beautiful birth. They described the baby needing a little nudge to help its head be born drawing from the toolkit of skills and practices that we shared and practiced in the workshop, and how the baby cried immediately, safe and in great condition.
It was an utter delight to hear their joy and confidence in themselves and in the breech birth process. This is raw birth, it just happens to be breech.
This story was very different from a birth I was involved with many years ago, one of the first few breech births I attended and the start of my breech journey. I was working in a midwifery led unit, it was 4 am and a colleague and I had an unexpected breech baby needing a bit of help to be born. I had no toolkit to draw from and I had no real understanding of why baby had stopped coming and how to resolve it. My only training for breech has been as treating it always as an obstetric emergency with a single manoeuvre for assisting the baby’s head should it be needed. It didn’t work. And I had nothing else. So, I drew from what I knew from all the births I had attended over the years and figured it out and the baby was born and was fortunately fine. I was, at first, just very relieved, but this turned to confusion and then frustration.
Why did I not know more about breech births? Why did this baby need a hand and how could I have prevented it? This was the first breech where the baby had required my help – the other few breech births I supported had been very straightforward – so why wasn’t I taught breech as a normal process so I could understand the difference between the ‘normal’ breech and the ‘dystocia’ breech. There was a mighty gap.
So. I listened A LOT to many wise women, midwives and birthing mothers, older obstetricians and midwives who delivered breech routinely rather than defaulted to caesarean section back in the day, birth workers who had practiced abroad in countries where breech is just another birth. And I read A LOT. And I did a PhD research study into breech. And I gathered a whole toolkit for normal breech birth and for when the baby needs a hand. Nothing in the toolkit is complex; its just pulling together our extensive birthing knowledge, a smidge of research (there is limited quality research out there on breech), shared experiences and a good dose of common sense. The toolkit allows us to replace FEAR of breech with RESPECT for breech.
I believe ALL midwives can and should have good breech birth skills; inevitably the unexpected breech arrives at 3am in birth centres or at home with little chance of transfer or rescue from breech ‘experts’ – so all midwives need to be able to be confident with breech birth not just a few. It doesn’t require complex and expensive courses, but a groundswell of shared learning and ripples of knowledge sharing; a shift back to belief in breech as a predominately normal birth but, like ANY birth, the identification and resolution of deviations from this norm.
There should be a clear distinction between breech as a normal birth and breech requiring help. It requires a change to the current midwifery curriculum and skills update days; breech should be taught and understood within a normal birth context, then breech dystocia should be taught within the obstetric emergency model. There should be a clarity on how to support normal breech labours and births and identifying deviations and then providing a TOOLKIT of skills and practices from which to drawn on should help be required.
So, rather than the drama that can ensue when breech position is discovered lets skill up, share our stories and experiences and get breech confident!