Coalition for Breech Birth Conference

Life made sure I went to the Coalition for Breech Birth Conference in Ottawa, Canada.



Robin Guy and her Coalition co-madres joined efforts with UnderstandingBirthBetter.com Midwife Betty-Anne Daviss. They brought several top breech experts to Canada to share their hope to continue vaginal breech birth on Earth. Starting with Dr.s Andre' Lelonde and Robert Gagnon of the SOCG and ending with Ina May Gaskin, I also got to meet Jane Evans of the UK.

Jane reminds me so much of my late partner and friend, Jan Hofer. They both so get birth and what's important without getting lost in the mental maze, and at the same time, Jane Evans explained breech cardinal movements so well that several of the OBs were saying that now the lights were on. Now they got it and would be trying hands and knees breech birth when they got back to their cities.
Dr.s Frank Louwen and Anke Reitter came with cheerful stats on knees and elbows position (hands and knees, but without straining the wrists). Of 300 breech births with mothers using "knees and elbow" position, only 2 needed help with extended arms and head, even the footlings. Even the primes. This correlates perfectly with midwife observations of hands and knees breech births. Hands-off-the-breech really means hands off. They also didn't touch the baby, basically until trying to catch the baby in mid air before the baby hit the mattress. Hands-off doesn't mean don't touch until the umbilical cord is out, but rather until the head has just come out past the parietal bones and you prevent a fall.

So check these resources for current breech conversations
Society for Obstetrics and Gynaecology of Canada Guidelines for Vaginal Breech Birth
Stand and Deliver
http://www.breechbirth.ca/Welcome.html
http://www.birthinternational.com/product/book/bk846.html
Hands off the Breech by Jane Evans
http://supportdrfischbein.blogspot.com/
http://video.who.int/streaming/rhl/breech_web.wmv
http://www.abreechinthesystem.com/home.html
http://enjoybirth.wordpress.com/2009/09/25/unexpected-cesarean-due-to-surprise-breech-baby/
http://blog.givingbirthnaturally.com/2009/06/vaginal-breech-birth-socg.html

and of course, www.SpinningBabies.com The Breech info has been reorganized, made simpler, but more detailed.

Have fun surfing, there's lots more, but I have to go make dinner...

Fun w Belly Mapping

This post from an expectant mother's blog lifted my spirits today.

"We also got to find out our baby's position in the womb (called belly mapping). S/He was enthusiastically responding to our hands. So our baby's back is on my left side and the knees & feet are up against my belly's right side (which would explain all the kung-pow action going on over there). And the head is down!"

They feel the baby responding to their hands, and to their hearts. Wonderful!! What and extra blessing with Belly Mapping !

http://theswensonfamily.blogspot.com/2009/10/two-more.html

"Women always have a choice. The question is not whether they have a choice, but are they willing to make a choice." - Kim Wildner,
in Midwifery Today Issue 68, Winter 2003, "The Ties that Bind, How Belief Creates Birth Realities"

This is exactly why I say Homebirth isn't a choice, its a way of life.

More on the value of apprenticeship

Considering the ACNM letter of late, I hope that each of you would take the time to promote the apprenticeship model of care. If midwives are only trained in institutional settings, how would we learn normal birth (home birth?) Institutional settings utilize obstetrical solutions for pregnancy and birth problems, but not traditional midwifery care. If we want to preserve traditional wisdom we need to preserve the traditional model of education.

http://mana.org/ICMSurvey.html

Apprenticeship is an avenue for gifted, hands-on learners to succeed.
Apprenticeship allows the learner to "absorb" the modeling behavior of the preceptor (in this case experienced midwife).
I learn what I do; I become what I feel.
Apprenticeship in midwifery allows the student to come into the culture of birth.
Apprenticeship in homebirth midwifery allows the student to serve the culture of homebirth and so help to preserve the culture of homebirth, including mother child skin-to-skin bonding in a family flora environment, delayed cord clamping (if at all), less need for resuscitation, less vagus nerve reflex (gagging and breath obstruction)
Apprenticeship relies on relationship building, not the business model of the institutional educational setting. So, personal growth is enhanced rather than the profit margin-ization of people who want so much to learn that they'd pay and do anything to enter into the world of birth only to find that they've entered the policy world of institutions.
Oh, ok, university learning has value, yes, but its destination is not the only valuable destination, especially when we are seeking to preserve hormonal function for spontaneous birth and breastfeeding.

More proof that homebirth with Midwives is safe

I'm so glad that I learned my midwifery from midwives in the home during homebirths. I learned there what I do there. (I know that's a silly sentence, but think about it. Women go to an institution hoping to learn how to honor birthing women and then practice in another institution that depends on interventions and complications to make a profit...)

I help in the home and I've learned the culture of homebirth. Through the apprenticeship model, though the midwives I worked with didn't have a formal apprenticeship during the years I was learning, I learned the skills I share today:

• reductions in hypertensive disorders through diet
  
• avoiding premature birth
• achieving a healthy birth weight for babies
  
• safe breech birth at home
  
• vaginal birth of posterior babies
• safe vaginal birth after cesarean
  
• resolving shoulder dystocia

I didn't learn that out of the approved textbook or classroom training that tells many an enrolled past homebirth midwife not to share their knowledge about breech and other midwifery skills with the other students, but to stick with the curriculum. I'm grateful that homebirth (and hospital trained midwives!) came together to form a model of testing to show that the apprenticeship model works well. And I'm proud to put that to use as I hold the CPM credential from the North American Registry of Midwives.
Canada is promoting CPMs and has come out with statistics that also include CPM births. http://www.usatoday.com/news/health/2009-09-03-midwife-home-birth_N.htm

New Navigation at Spinning Babies

I fixed the messy menu problem. I don't know why I didn't get the fix earlier. I thought I'd double clicked on some extension or module. But, no, it was just me being wordy. Now cleaner.
Please visit www.SpinningBabies. com

Can this cause a breech position?

"Hi Gail,

"I wanted to run something by you... We had a client a couple weeks ago with a somewhat irregular but progressive labor pattern, and we used the rebozo to do a little sifting, plus some abdominal lifting (which seemed to regulate and intensify ctx). After several hours things picked up rapidly, her water broke, and we went to the hospital. Upon arrival she was 7cm, baby's shoulder was presenting and by birth (by c/s) he was full breech. The CNMs were stunned, as they'd thought baby was vertex for months. [My doula partner's] question to me was, "did we cause this with the rebozo??" I couldn't imagine how, but she spoke with another homebirth midwife who said indeed it was possible. Thoughts??"


Dear [Doula],
Is it possible the sifting caused the baby to go breech or the abdominal lifting? I would think not. But let's analyze this in detail. Lets examine the possibilities.

Sifting with the Rebozo will relax the broad ligament of the uterus. A relaxed broad ligament will not cause a breech presentation. Sifting is done with the mother either on her back or, more comfortably, on her hands and knees. Neither posture is likely to cause a baby to flip to a breech position. I doubt that sifting was the cause of the breech presentation.

If one of these techniques caused the breech, I would suspect that doing the abdominal lifting too much might be a possible cause, but not the sifting. The reason to do an abdominal lift is to relieve distracting back pain or reposition a stuck posterior head. A fetal head in the posterior position is also often deflexed, the chin is up.
Abdominal lifting will lift the baby's head and reangle it, ideally to fit the pelvis better. Abdominal lifting helps tuck the posterior baby's chin towards the baby's chest, making rotation and/or descent easier to accomplish.

It is incorrect to lift the baby aggressively, or too high out of the pelvis in some cases. Its incorrect to use an abdominal lift without the need for one. A fast, progressing labor would not indicate an abdominal lift, even with incoordinate contractions.

Done incorrectly, the abdominal lift can bring up the head and, if the pelvic alignment were to be off or the pelvic floor asymmetrical there could be a possibility that the baby might flip in response.

Now I would like to examine signs that the baby may flip on its own in response to labor.

Was this baby posterior before flipping breech? If so, labor may have been the cause of the flip, or labor with abdominal lifting.
Incoordinate contractions indicate an asymmetry in how the baby is presenting in the pelvis. Likely the fetal position is dependent on a preexisting asymmetry in the Asymmetry in the pelvis is associated with a higher rate of malpositions, in my experience. Carol Phillips, DC, explains how the misalignment of the bony pelvis pulls the soft tissues out of alignment, including the pelvic floor. The baby is forced to accommodate as best he or she can. Sometimes, rarely, this includes flipping to a breech presentation. It usually means, a posterior or asynclitic presentation.

While rare that a baby would flip in labor, this has been a summer of breech babies, and some babies do flip in labor.

In other words, doing nothing may also have seen a flip because the downward movement of the baby's head may have brought the head into contact with a type of restriction that can cause a breech presentation.

...This is a very important consideration. Unless we start sharing these experiences we won't know if the techniques themselves can cause a malposition. I don't think so at this point, but without dialogue, we'll never know.


In the mystery,
Gail