We need more OBs to support vaginal breech deliveries

Dr. Howard Vogel, Third From Left, Is Assisted...

“Recent studies reaffirm earlier World Health Organization recommendations about optimal cesarean section rates. The best outcomes for mothers and babies appear to occur with cesarean section rates of 5% to 10%. Rates above 15% seem to do more harm than good (Althabe and Belizan 2006).

The national U.S. cesarean section rate was 4.5% and near this optimal range in 1965 when it was first measured (Taffel et al. 1987). In more recent years, large groups of healthy, low-risk American women who have received care that enhanced their bodies’ innate capacity for giving birth have achieved 4% cesarean section rates and good overall birth outcomes (Johnson and Daviss 2005, Rooks et al. 1989). However, the national cesarean section rate is much higher and has been increasing steadily for more than a decade. With the 2007 rate at 31.8%, about one mother in three now gives birth by cesarean section, a record level for the United States.”  ChildbirthConnection.org

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One in three births are cesarean?

Okay, so I have shared that my soul is at peace with my cesarean. Spiritually, I can use this experience to learn and grow. I trust that life brings me what I need when I need it.

But I think some clarification may be needed: I am still a great believer in natural birth and continue to think the political and economic pressures (well, I am talking insurance, mostly) as well as well-meaning concern from doctors (who live at the edge of where ‘everything could go wrong’) can sometimes lead to unnecessary interventions – meaning mother and child would have done just fine without them but it made everyone feel better that ‘everything possible’ was done. Yes, there is a place for intervention – but I still believe they should be a very last, break-in-case-of-emergency resort. And stats tell us it is not so. 5 to 10% of women medically need cesareans. 30% of women birthing in the US have cesareans. Shocking, right?

In fact I may be one of the cases where no intervention was *needed* as such and where arguably having the surgery did more harm than good. There was no medical emergency. Baby was breech but otherwise all was well. Labour was progressing. Baby was not distressed. I had even had a cat-scan (after much agonising – as nobody takes an X-ray of their pregnant belly, lightly) that proved my hips were wide enough to birth a breech baby, naturally. Indeed, millions of women have delivered breech babies vaginally, perfectly safely (including my mom – I was a breech footling). There is a slight increase in the risk of complications, yes, but most women birth breech babies just fine. The ONLY reason they stopped my natural birth process (after over 20 hours of labour) and said it was time to go to the OR is because it was 8 o’clock on New Year’s Eve and the only doctor with a specialty that includes vaginal breech deliveries (out of 5, I think, on the whole West Coast – all 5 in this one, fab hospital, UCSF) she was the only one who was even in the area during the hols and she was now off to her own New Year’s Eve party. As I say, I feel at peace with this. I believe God gives us the experience we need, in order to grow. But in purely practical, human terms it is pretty sad that there is only one hospital in the Bay Area (and allegedly in the whole of Western USA – covering, nearly 100,000,000 people) that will even consider doing vaginal breech deliveries, now – which really should be the mother’s choice, wherever possible, in my view. It is crazy that if your labour starts on the ‘wrong’ day, you are automatically scheduled for a cesarean whether it is in your child and your best interest or not. Parties and leave days come first. Not that I begrudge doctors their time off. I think they deserve and NEED it. I just wish there were more qualified doctors assisting this kind of birth so that the schedule could be fully covered!!

Why not use a home midwife, you say? Why, I had one of those. If you remember, I was planning a homebirth but my midwife, lovely as she is, had never taken the lead on supporting a breech delivery and did not feel qualified/experienced to do so on her own, without calling in back-up, and it turns out that was not easy to find. So, here too: please midwives do not neglect this important skill. Make sure you can confidently identify a breech baby in the womb and that you have the experience you need to deliver a breech baby vaginally, please!

Cesareans, as we know, decrease chances of successful breastfeeding – which in linked to all sorts of things from improved immunity, higher IQ and even decreased behavioural problems. Cesareans are major surgeries with risks for the mother – and even if it goes well it takes time and care to heal properly and completely. And cesareans deprive children from the final ‘inoculation’ of good bacteria that other children acquire passing through the birth canal, such that cesarean born children are two to eight times more likely to have allergies, later in life. Natural birth also gives babies a ‘massage’ that stimulates their whole skin and pumps out the lungs – cesarean babies miss out on this and can be born with water in the lungs. Cesareans should never be a given, don’t you agree?

So, yes, modern medicine can be a life-saver, literally. But in this case, it more saved a doctor’s chance of seeing the New Year in, in style. My plea: please train more midwives and OBs in normal, natural, vaginal deliveries of breech babies. Our babies deserve a chance at natural birth and all the health benefits that come with that!

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2 thoughts on “We need more OBs to support vaginal breech deliveries

  1. Amen! These are choices ACOG says women should have, yet too few doctors have the experience to do it. I am thrilled my friend has found an awesome OB who is unafraid to deliver a footling breech (a twin, no less!) vaginally.

  2. Pingback: Parto obstruido y parto por cesárea: el costo-beneficio de la intervención quirúrgica « Facultad de Ciencias de la Salud Universidad Anahuac

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