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The Dilemma of Breech Birth: Prevention, Management of Care and Options

Brian O'Neil

by Marie-Paul Baxiu. She is a clinical hypnotherapist, birth doula in the LA area and the founder and owner of Childbirth Hypnosis Training: EasyBirthing.com . This article was first published in The Epoch Times

 

Part 1: A different perspective

One thing we all have in common is we come into this life through birth. However, the quality of the experience and the different choices parents make regarding the event can vary widely.

These experiences and choices can be limited for those who are in breech position in the womb and for their mothers-to-be.

In breech birth, the baby enters the birth canal with the buttocks or feet first as opposed to the normal headfirst presentation in which the baby is positioned head down, facing back.

Today, about 3 to 4 percent of babies present themselves in a breech position and the vast majority will be born by cesarian section.

Early in June, I joined leading professionals from the Los Angeles-area birthing community to discuss prevention and management of care for breeches and other malpositioned babies.

Sharing information, experiences, and insights, we addressed real alternatives to C-sections for breech births, which are so common in the United States. Ana-Paula Markel, doula (birth coach) and childbirth educator, hosted the event at BINI Birth in North Hollywood for 100 people.

Many questions were discussed, such as: Why are some babies in a breech position? Can we prevent a breech or posterior presentation? What are the options for a mother with a breech baby in our community?

Markel moderated the panel, which included Naoli Vinaver Lopez, a midwife from Mexico; Davi Kaur Khalsa, an LA-area midwife; Dr. Suzanne Gilberg-Lenz, who specializes in vaginal birth of breech twins in hospitals; Jessica Jennings, a prenatal yoga instructor who works at BINI; Dr. Elliot Berlin, an LA-area chiropractor who specializes in helping with breech babies; and Dr. Stuart Fischbein, an obstetrician-gynecologist who assists women who choose to give birth at home. Under certain conditions, Fischbein will deliver breech births at home.

Breech presentation carries the risk of serious complications to the baby during the process of birth. For example, since the largest part of the body, the baby’s head, is the last part to emerge, it may have difficulty getting through the birth canal.

Additionally, there is the risk of cord prolapse, a condition in which the umbilical cord is compressed as the baby moves toward the birth canal, slowing the baby’s supply of oxygen and blood.

For these reasons, a vaginal mode of delivery for breech presentation, as opposed to the more accepted C-section, has been very controversial in the fields of obstetrics and midwifery.

Yet a cesarean birth is not without its own risks, mainly to the mother, such as infection, hemorrhage, and stroke.

According to Vinaver, traditional midwives have many techniques that are used with a breech baby, such as specific exercises for the mother or use of ice, heat, or even a bell placed at the mother’s hip, to stimulate the baby to turn. She estimated that these techniques were successful in 98 percent of cases.

Dr. Fischbein spoke of his practice of assisting women whose babies are breech to give birth at home. However, he said, “There is zero training for breech deliveries.” There are only a handful of doctors in the Los Angeles area willing to help a mother attempt a vaginal breech birth, and hospitals frown on the procedure.

We know now that babies are fully conscious in the womb, and that communication can take place. Babies can be guided to present themselves as they are most easily born.

I feel there were some important issues missing from the forum, including the use of hypnosis to help babies present themselves in an optimal position in utero or to be guided to turn around before the birth.

At the event, we only looked at the mechanics of turning babies, treating them as ‘objects’ instead of honoring the fact that they are fully conscious beings and can be spoken to.

This awareness would lead us to explore the phenomena of why babies choose to present themselves breech and enable us to step away from the limited causes that medicine presently recognizes.

Part 2: Communication with the unborn baby

An unborn baby will usually turn to present himself in whatever position it is going to be born around week 34 to 36 of a pregnancy. Before that, it is mainly in an “across” position.

Some recognized medical reasons contributing to breech presentation at the time of labor include the following:

•       Preterm labor and birth if labor starts when the baby is still too small to move easily in the uterus.

• A placenta in the fundus: The placenta takes up some of the space in the top of the uterus.

• An unusual shape of the mother’s uterus or fibroids in the lower part of the uterus.

• More than one fetus (such as twins).

• A very relaxed uterus from many previous children.

• Too much or too little amniotic fluid.

Yet more subtle or emotional factors can be at play.

Marie-Paul Baxiu explains breech positioning from a non-medical perspective: “They sometimes hide, as parents are very fixed on the sex of their unborn child, and they are afraid of not meeting their parents’ expectations and will chose to hide their gender in utero, or there could be a parental dispute. The baby is saying, ‘I am not ready to come out the way things are,’ and there are so many other possible reasons.”

Describing how she establishes communication with an unborn baby, while encouraging the parents to communicate as well, Baxiu says: “Well, when a mother is relaxed (connected to her own body), her brain waves are much slower (4 to 7 hertz, theta brain waves. Most of us operate at beta brain-wave level, our regular cognitive state of mind, at 13 to 30 hertz).

 “A mother gets into the same brain wave her baby is in continuously while relaxed, and so there is a way to establish true connection and communication. Babies are completely conscious and capable of responding to their mother’s deepest thoughts.”

With the father, she adds, “It works differently. They can only connect to their voice, since they don’t share the same physical space.”

Midwives are traditionally trained by one another and have preserved and passed down skills that have helped eons of people be born throughout the ages. “They are often the experts who facilitate the training of gynecology students in all that is natural,” Baxiu says.

There are some obstetricians/gynecologists who feel comfortable assisting women with breech babies in a hospital, people such as Ronald Wu, M.D., located in Glendale, Calif. Dr. Wu has the knowledge to facilitate such birth. He has helped breech single and twin babies to be born vaginally in the hospital setting. Unfortunately, he will soon retire.

Dr. Stuart Fischbein explained at the breech-birth event that he is comfortable assisting a woman giving birth to a breech baby as long as the baby is a frank presentation (where the baby is presented with its butt close by the cervix and his feet are close by his head).

Dr. Fischbein pointed out that any other breech presentation, such as feet first, can make things more difficult to handle in a natural vaginal birth in a home setting.

For parents facing breech birth, when choosing a natural home birth with a midwife, they won’t have the safety net a hospital birth could offer with backup doctors and equipment if a last minute C-section is needed.

What does this imply? It means that to encourage natural-minded parents to deliver in a hospital, doctors will have to learn to keep their hands off, allowing a woman to give birth without the constriction of time and all the interventions that are usually taking place unnecessarily, which too often lead to a C-section.

Part 3: Knowing one’s options

What would a solution to the breech-birth dilemma that benefits everyone look like, and what challenges would it present?

Dr. Fischbein explained at a breech-birth conference of professional birthers in Los Angeles in June that parents have to know there are options. They are not offered options because obstetricians/gynecologists do not have the training and the skills for a breech birthing other than a C-section in a hospital setting.

The clear conclusion was the need and necessity to bridge the immense gap of these two choices and the present gap in our system. Neither choice is ideal.

As it stands today, parents have only two choices: to deliver at home naturally with a midwife, without the backup of the doctor and a facility to make it safe for the high-risk delivery, or to deliver in a hospital, which demands intrusive surgery.

Empowering parents to request obstetrics to incorporate the knowledge of midwifery skills will truly offer parents and children the best of both worlds—a natural childbirth guided by the need and wisdom of the individual, within the context of the most well-equipped facility to back up a potentially dangerous situation.

A birth professional at the event stated that she didn’t even know that it was lawful to give birth vaginally to a breech baby in a hospital. She thought it was not allowed because it was against the law.

Marie-Paul Baxiu concludes: “This information should be made available to the parents who don’t know what is actually possible and are only offered a few different choices that are restricted by people’s skills in medical profession, which often don’t include options that are more holistic and safer for all involved.

“Bottom line: Mother and baby should be allowed to give birth and be born breech if this is how they chose to come to the world.

“Let’s not forget that babies are conscious beings and that skills can be acquired not just by midwives and passed down from one another but by the elite of birth professionals such as obstetricians and gynecologists, who indeed will create a safer heaven for these babies to enter this world.”

Marie-Paul Baxiu
888-218-4614
310-901-9440
www.easybirthing.com

Dr. Stuart Fischbein, MD OB/GYN
www.birthinginstincts.com
10309 Santa Monica Blvd., Suite 300
Los Angeles, CA 90025

310 282-8613 Ask for Krissy
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