|April 10, 2013|
Volume 15, Issue 8
|Midwifery Today E-News|
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You will spend the morning with Cornelia as she shows you how to work with breeches in water and explains the advantages of waterbirth for breech presentation. In the afternoon, Carol and Gail (pictured) will show you how to turn breech babies and discuss what to do if the baby won’t turn. The class covers palpation skills, estimating fetal weight, amniotic fluid, how to communicate with the baby with touch and words and much more. This full-day class is part of our conference in Belgium October 30 – November 3.
In This Week’s Issue
Quote of the Week
The greater the risk, the more likely it is that the woman will benefit from midwifery care.
— Katherine Jensen
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The Art of Midwifery
All the normal comfort measures for head-down babies help mothers of breech babies, too. As birth nears, all mothers need to hear comforting words to reassure them that they are not alone and that they are in a safe environment. They also need encouragement to stay in close contact with their instincts; to stay loose, open, willing, trusting and either upright, in water or moving. Remember that normal labor follows varied patterns. Assess mother/baby well-being throughout labor and birth, just like during head-down labors. Ask yourself two simple questions: Is the mother okay? Is the baby okay? If the answer is yes, then the labor pattern is normal for this mother and baby. If the answer is no, change mother’s position, offer her a drink or piece of fruit, ask her to breathe deeply and ask the questions again. If the answer is still no, seek help.
ALL BIRTH PRACTITIONERS: The techniques you’ve perfected over months and years of practice are valuable lessons for others to learn! Share them with E-News readers by sending them to firstname.lastname@example.org.
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[Editor’s note: This edition of Jan’s Corner is provided by Marta, a Midwifery Today reader.]
On March 18 shortly after midnight, the coming of our baby was announced by the first contractions.
Quickly the contractions got longer and more intense, and soon the labor felt like I was surfing on huge waves, holding on to the heating in our bathroom like a surfboard, with lavender aromatherapy and Reiki music in the background. My husband and my 17-year-old daughter supported me with drinks and food. They called the midwife and doctor as the sea of birth grew stronger and stronger with every minute. While my husband hurried downstairs to open the door for the midwife, our baby decided not to wait any longer, and she was caught by her sister’s hands and put softly into my arms—all of this happened in the familiar surroundings of our home.
My midwife and doctor stayed in the background, reassuring us that all was going well and to wait for the placenta to come out naturally. Only after our Victoria started to drink from the breast and approximately one hour after she was born, the placenta (her spaceship during pregnancy) was born. Upon the arrival of the placenta, nobody rushed in to cut the umbilical cord. With the baby being breastfed while she was still connected to the placenta, baby, mother’s breast and placenta were united in the holy trinity of life, giving us time to perform a small lotus birth ritual with flowers, honoring and showing gratitude for nature’s gifts. After one and a half hours, the umbilical cord was cut by my teenage daughter while my husband was holding the baby in his hands for the first time. We feel very blessed and are enjoying our babymoon. This weekend we are going to bury the placenta under a silver birch tree in our garden. The placenta kept our baby alive during pregnancy providing it with oxygen and nutrients—with this burial we would like to close and honor the symbolic and continuing circle of life.
Jan Tritten, mother of Midwifery Today
Jan Tritten is the founder, editor-in-chief and mother of Midwifery Today magazine. She became a midwife in 1977 after the amazing homebirth of her second daughter. Her mission is to make loving midwifery care the norm for birthing women and their babies throughout the world. Meet Jan at our conferences around the world, or join her online, as she works to transform birth practices around the world.
Jan on Twitter: https://twitter.com/jantritten
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Human Rights for Breech Mamas
Mamas with babies presenting breech are a very special minority group whose right to birth naturally has been systematically removed in recent years. A woman often finds out that her baby is breech during prenatal care, but she may not find out until labor. She relies on midwives, doctors, nurses and other caregivers to review the risks and benefits of birthing choices and to support and guide her through labor and birth. Too often, she is met with condescension and coercion instead of information, guidance and respect for her right to choose.
The decrease in vaginal breech delivery has been dramatic. In the United States, in 1970, the cesarean rate for breech presentation was 29.4%; in 2002, it was 86.9% (Nichols 2010). The opportunity for vaginal delivery disappeared completely in many hospitals in the United States and around the world after the publication of the Term Breech Trial of Labor Study in 2000 (Hannah et al. 2000).
This was a study of 2083 women birthing in 121 centers and 26 countries around the world, with frank or complete breech babies at the start of labor. The women were randomized into two groups: planned vaginal delivery and planned cesarean delivery. The trial ran from January 1997 until April 2000. It was stopped at an interim analysis because of excess morbidity and mortality among the babies in the vaginal delivery group.
On publication of the study, the availability of vaginal breech delivery immediately decreased around the world. However, criticism emerged from many quarters. Inexplicably, two women whose babies were found to be dead when they entered the hospital were included in the study, both in the vaginal breech group. Two other neonatal deaths in the vaginal breech group were unrelated to delivery; one from diarrhea, another from SIDS.
Many large centers with expertise in vaginal breech delivery, particularly in Europe, had decided against participation in the study. A concern was that for accurate results, candidates for breech birth should be carefully chosen over time rather than by randomization in labor. Ultrasounds were recommended to evaluate the weights of babies who were candidates for vaginal breech delivery, but were unavailable in many centers that participated in the study. Providing ultrasounds might have prevented the deaths of seven vaginally delivered breech babies who weighed less than 2500 grams. (A premature baby has a larger head size relative to the size of its body and is at greater risk of complications in breech delivery.) Further, in three deaths in the vaginal breech group, heart tones were lost during labor and emergency cesarean was not available. The mortality rate in the study was refigured, and no significant differences between the two groups were found.
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Q: Please tell us about your thoughts and experiences with breech birth.
— Midwifery Today
A: I caught a breech once as a labor and delivery nurse and have seen several other breech births. There are so many times I wanted to tell the provider to just let the baby come—they are so impatient!
— Tora Spigner
A: OBs and midwives need to bring back the safe practice of breech delivery. My breech baby changed my life. She was born via c-section and forever I will be a VBAC. I have had five successful VBACs, but I should have never had that first c-section.
— Tammy Gifford
A: From a dad’s perspective: My daughter, now 15, was a footling breech born at home with a great midwife. From my standpoint, it wasn’t an easy birth although it took just five and a half hours, but the first words out of my wife’s mouth after it was over were, “I want to do it again!”
— Brad Miller
A: I think the old docs were right. Most breeches are a breeze, but now and then one will scare you, and now and then one won’t make it no matter what you try.
One very experienced midwife told me, “Nine out of ten will fall out and you will feel really proud of yourself. But the one that won’t…that’s going to give you grey hairs.”
And then there is that consistent 3 to 5% mortality stat which shows up decade after decade in the textbooks. I think it is mostly a matter of luck, except for those nice 9 lb 40 wk frank breeches with intact membranes!
A: My first breech was a scrotum presentation. He just needed a few puffs of oxygen and he was right as rain. His scrotum was a tad swollen and bruised, along with his left butt cheek, but all healed well in a short amount of time.
— Laura M. Perez
A: If I were having a breech birth, I would enlist the companionship of one of the midwives I know. I trust my body would do beautifully, but I think that the presence of a midwife would help me remain calm and let my body open.
— Denee Metzger
Craving more birth info?
We want to invite you to come to the Midwifery Today International Conference being held in Blankenberge, Belgium, 30 October – 3 November 2013. You can learn many great skills while enjoying the lovely retreat site at which the conference is being held. It is on the sea and only about 12 kilometers from the amazingly beautiful historical town of Bruges. The entire area is well connected by rail and tram, so you can use this as a learning/vacation time.
Many of our best teachers are joining us for this important event with the theme of “Autonomous Midwifery: The Key to the Future.” Please join Lieve Huybrechts and Eneyda Spradlin-Ramos (pictured), Suzanne Colson, Elizabeth Davis, Robbie Davis-Floyd, Michel Odent, Verena Schmid, Debra Pascali-Bonaro, Gail Tully, Gail Hart, Soo Downe and many other excellent presenters.
We have over 50 classes in what promises to be a great event, including In-depth Midwifery, Hemorrhage: Prevention and Management, Shoulder Dystocia, Special Massage for Restarting Labor and Spinning Babies.
You’ll find more information here.
— Midwifery Today
Even with never having taken Lamaze classes, I still knew how to breathe when one contraction came that was very sharp. When it was over, I let out a sigh of relief and the labor and delivery nurse exclaimed, “Wow! You handled that like a tramp! Er, champ! Champ is what I meant!”
— Dawn Hart Freeman
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