I was lucky enough to be invited to speak at the RCM and Maidstone and Tunbridge wells Maternity services annual conference this week. This was a fabulous day with a variety of speakers and attendees who shared their experiences, thoughts and vision of being the change in maternity services. Inspiring talks, driven and positive students and midwives and service users made for a wonderful day and the homemade food at lunch was just an extra bit of delicious (thanks to Sarah and her family).
The language we use and hear is a quick barometer of current position and culture. Cathy Warwick wants to ban the phrase ‘allow’ anywhere within the spectrum of maternity services and birth; our remit is not to prevent, police or judge but to enable, inform and support. Lots of vigorous nodding agreement on this one. But sadly the multitude of stories from women (and midwives) that includes ‘I wasn’t allowed’ persists daily so this is our current narrative and one that we need to face.
How can we change it? It seems simple but it can be deceptively hard when medicalisation of birth has embedded a medical language and strong powerful hierarchy enables it to persist. But it can be done one person at a time.
‘I alone cannot change the world but can cast a stone across the waters to create many ripple’ Mother Teresa
For many years I have refused to use the term ‘undiagnosed breech’. Breech is not a disease, it is not an abnormality, it is not something requiring a medical diagnosis. It is just different, a bit unusual and relatively uncommon. Occasionally there is an underlying problem that has caused the breech position so this, of course, has to be explored but mostly there is no issue, breech just happens. So I use the descriptors ‘unplanned breech’ or ‘unknown breech’ for when breech is discovered.
Once known, its then a question of a good thorough review. In medical terms this is called a ‘risk assessment’ but this to me is remarkably negative; I want to find all the risks relating to you then we can tell you what you may be allowed to do. Instead lets call it a safety review; I want to take you as an individual and make sure you and your baby are as safe as possible. Much more positive and much less like a test to pass or fail.
And another one to consider if we really are going to provide real birth options for women is the term ‘breech expert’. Medicine, the legal profession, and the media, are really keen on ‘experts’. They hold extraordinary powers to persuade and command respect and awe. But they are difficult to define. Who or what determines the expert and who is able to challenge them and their opinions? For birth if we create breech experts who are the only ones to support women with breech births this severely limits our service provision in this area. It risks disempowering midwives and women who will be the ones at 3am at a birth centre with an unplanned breech in advanced labour. It risks breech becoming more detached from the sphere of normal birth, more medicalised and a significant disruption to women on their birth journeys. If only breech ‘experts’ can teach breech we will end up with the medical type approach with expensive elite courses and competencies to achieve before we are ‘allowed’ to support a breech birth?
Instead can we take a step back and consider breech birth as just a birth that requires respect, knowledge of A&P, recognising the reassuring normal signs and signs of when the baby or mum are asking for help (as with all births). All midwives [and obstetricians] need to be breech confident. They need to be able to recognise when a problem occurs and what to do, just like for cephalic birth. So lets see and teach breech in 2 ways; as a normal physiological event, which the majority (70% for upright breech birth according to study by Bogner et al, 2015 ) are. And teach breech dystocia as part of the maternity emergency training alongside shoulder dystocia, when and how to help the baby.
Language is vital for shaping a culture, and each of us plays a part in this. Use a different language and start the ripples. Together we will make waves, and soon the tide will turn for more positive, collaborative and confident breech narrative and practice.
I am currently travelling around the country providing affordable and accessible workshops to share breech skills, stories and knowledge. #bebreechconfident #notanexpert #breechgeek