I agree with Maka that breech is a variation of normal birth and sometimes
a baby presents breech for good reasons. I provided a detailed outline of
methods to turn a breech, both non-invasive and medical, to answer an
inquiry about how breeches were turned. It was meant to inform and did not
include personal opinions about preferred methods or the option to simply
have a vaginal breech delivery.
It is true that midwives are guardians of normal birth and sometimes that
includes breech delivery. My own third child was delivered frank breech
after I refused a c-section (a big deal 19 years ago). She chose that
position because of a marginal placenta and a double nuchal cord wrap. An
external version, had it been attempted, probably would have failed.
I have since attended breech births. However, I have also done external
versions when less aggressive methods have failed. It is wise, when making
a judgment call, to take into account the level of experience the midwife
has with breech delivery, the legal and medical climate in your area and
any limitations a midwifery license may impose. In my area, a licensed
midwife is not allowed to deliver a woman out of hospital if the baby is
diagnosed as a breech before labor. When I compare the number of medical
interventions that a woman would face in the hospital with the intervention
of an attempted external version, it seems reasonable to try the version.
If it fails, at least there are compassionate and experienced physicians in
my area who will do a vaginal breech delivery. Some areas are not so
fortunate to have this option and the midwife will then be faced with her
natural instincts to protect the mother and baby by attending a breech
birth. That is why it is important to have midwives who are well
experienced in breech delivery. Routine cesarean for breech presentation is
medical abuse, especially a frank breech in a multiparous mother.
Although I experienced my first surprise breech only three years ago, I
haven't had to perform an external version in nearly ten years. Babies tend
to turn on their own given a little room and mommy encouragement.
I hope this correspondence clears up any fears that midwives are promoting
aggressive medical attitudes toward breech babies. Joyfully, I find that
the opposite seems to be true.
-Maryl Smith
Reprinted from Midwifery Today E-News (Vol 2 Issue 9 March 3, 2000)
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