More On Breech Birth . . . Could There Be Change Afoot?

For those of us keeping an eye on what is happening with breech birth these days, there are hopeful signs that vaginal breech birth may become a more accessible option once again.  We blogged about the new guidelines put forth by the SOGC (the Society of Obstetricians and Gynaecologists of Canada) last week, but wanted to follow up.  We hope that ACOG is paying attention to what their colleagues to the north are saying and doing.

 Please read the SOGC guidelines, as well as the commentary from Dr. Andrew Kotaska.  The guidelines state that “planned vaginal delivery is reasonable in selected women with a term singleton breech fetus”.  Dr. Kotaska, one of the authors of the guidelines, points out in his commentary that over 100,000 women have babies that are breech at term, and that with reasonable and conservative practice guidelines, over 25,000 of these women (and babies!) could avoid cesarean and have their babies vaginally instead.  WOW!  And imagine up to 25,000 women that wouldn’t have to navigate the politics of a VBAC.

In case you think this estimate is being pulled out of a hat . . . check the PREMODA study, which trumps the (in)famous Term Breech Trial study.  You can read the abstract and summary of the PREMODA study here.   The Term Breech Trial has been widely criticized for major study design flaws and conclusions, though it was at one time considered the definitive study on cesarean vs. vaginal breech birth. Lots to look up on this one.

Below is a letter from  Robin Guy, co-founder of the Coalition for Breech Birth in response to the new guidelines issued in Canada last week:

Dear friends of CBB –

Well, here we are. Women’s voices are finally getting heard – the Society of Obstetricians and Gynaecologists of Canada has issued new breech guidelines that above all, advise that women need to be offered the choice of vaginal breech birth. What is the most important about these guidelines is not the nitty-gritty of candidate selection and techniques of delivery, but rather that they have tackled the ethical issue of forced surgery and come down firmly on the side of not obliging women to have surgery they neither want nor need.

Link to the new guidelines and commentaries (please especially read Andrew Kotaska’s commentary) – http://www.sogc.org/media/advisories-20090617a_e.asp

For those of you not in Canada, this is a great opportunity to approach your own organizations and present this example of progressive movement towards recognizing women’s autonomy over their own bodies and ownership of their birthing.

So one battle is won, but the next is beginning. The guideline change will offer those doctors and midwives who were willing to catch, but afraid of professional censure or litigation, the excuse they need to start catching openly and helping to train their colleagues. The SOGC is also launching training initiatives that will help the care providers currently in school to gain these skills and graduate competent to include vaginal breech in their practice.

However, as always, the real change must come from us. The real change must come from women and their families expecting better care. Expecting to be offered unbaised informed choice discussions and for our choices to be respected and supported. Expect referrals to competent attendants when our own midwife or doctor legitimately doesn’t have enough experience to safely catch our breech babies.

Please. Tell your friends what has happened. Shout it to the rafters. Watch for the Conference registration announcement (it will be October 15-16, in Ottawa), and do whatever you can do to be here.

Let’s make some noise.

blessings,
Robin


Learn. Educate. Speak out. http://www.breechbirth.ca

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“Denying vaginal breech birth is a human rights violation in that it forces a woman to consent to surgery in order to obtain medical care. The right to informed consent is meaningless where there is no right to informed refusal.”

 – Henci Goer, author of “The Thinking Woman’s Guide to a Better Birth”

Please contact Christie Craigie-Carter, at International Cesarean Awareness Network (ICAN) for more information about what ICAN and other organizations are doing at the national level to draw attention to this issue and effect change. You as a consumer can make change happen too!  Christie, incidentally, had two breech babies by cesarean before having her third breech baby vaginally at home. 

And lastly for some inspiration and a reminder that breech is a variation of normal . . .here is an amazing photo sequence of a footling breech homebirth in England.  Check it out!

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2 comments so far

  1. Jodi Rockwell on

    I left Seattle and birthed in Portland to avoid a c-section when my baby was breech. It was a beautiful, 6 hour birth at home with an experienced midwife, and I had to fend off many skeptics to get there. I hope that soon hospitals can offer vaginal breech birth deliveries for women like me who know we can do it!

  2. Jodi Rockwell on

    I left Seattle and birthed in Portland to avoid a c-section when my baby was breech. It was a beautiful, 6 hour birth at “home” with an experienced midwife. I had to fend off many skeptics to get there. I hope that soon hospitals can offer vaginal breech birth deliveries for women like me who know we can do it!


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