I'm in an interesting place today and feel the need to process and write and share. I've been planning to post some thoughts on the incredibly varying road to pregnancy, pregnancies, labors and births that I've witnessed and will do so soon. This post is part of it, but is happening in real time, as I write. I received word late yesterday afternoon from a client that her baby is frank breech and her medical team thought it best to schedule her for a cesarean this afternoon. She has handled the "change of plans" so beautifully and with an open hand. I'm so proud of her and am thrilled that she will hold her baby in a few short hours.
As a doula, this is a big first for me... the first time that I've walked through pregnancy with a couple and am not getting to support them in person for their birth. Am I ok with that? Of course. Is there a sense of disappointment? Of course. NOT with the couple, NOT with their sweet baby, but with the situation... wishing that it were different. Wishing that breech babies were more commonly delivered vaginally, or at least attempted. The reality is that 90% of them are not and it's not the parents fault or the baby's fault, or I would even go so far as to say not the actual doctor's fault. It's because cesarean for breech babies has become the norm in the last 50 years, and therefore the training has nearly vanished from US medical schools. "... [vaginal breech birth] risks are reduced when an experienced, skilled caregiver attends the birth. There are few doctors with the necessary skills, however, since obstetric training programs have stopped teaching how to assist at breech births. Doctors who have the necessary skills are unwilling to use them, because the standard of care today requires that all breeches be delivered by cesarean." (from pg. 190 of The Birth Partner by Penny Simkin).
I HOPE that our maternity care system strives to give women in this situation the option when it's safe for her to try to birth vaginally. I know that it's a rare thing for an OB to be skilled in vaginal breech deliveries and that depending on the type of breech, that vaginal delivery most likely isn't an option. But there are OB's out there who have opened themselves up to this skill and I HOPE that they are allowed the freedom to offer this service to women who want to pursue it. I HOPE that breech deliveries aren't portrayed in the media as being the end of the world. I HOPE that when a woman finds out that her baby is breech, that her care provider is quick to offer her suggestions of possible ways to turn her baby into a head down position before automatically scheduling her for a cesarean.
I'm 100% in agreement that "a healthy baby & healthy mama is the most important outcome." I am not arguing against having a cesarean birth for a breech baby when that truly is the safest option. I'm just processing and writing from where I'm coming from today... hoping that things will change and women with breech babies will have more options.
Helpful sites on this topic:
Overview of Breech Presentation
External Cephalic Version
Version Prior to Labor
Study Finds Possible Link Between Genetics & Breech Presentation