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Filtering by Category: birth

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: . 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

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

310 282-8613 Ask for Krissy
77 Rolling Oaks Dr. Suite 306
Thousand Oaks. CA. 91361

Achieving Successful VBAC: A Local Birthing Center’s In-house Study

Brian O'Neil

by Tonya Brooks. Tonya is a research scientist, midwife, educator and author of Giving Birth at Home, the Parent’s Guide to Perinatology. Through ACHI, she researched, wrote, and implemented training programs for Midwives, Midwifery Assistants, Doulas, and Childbirth Educators both nationally and internationally.

The prevention of cesareans or the lowering of the cesarean rate does not make much sense medically, unless one understands the why of it.

First, mothers trade off a few hours of pain in labor for at least two weeks of post-surgical pain that vaginal birth moms don’t have. Women who desire more children after a cesarean face the dilemma of a repeat cesarean or the risk of a VBAC (Vaginal Birth After Cesarean). If repeat cesareans are done there is an increased risk of placenta acretas (placenta grown through the uterine wall) and maternal morbidity and hysterectomy. If VBAC; the risk of rupture in labor is higher with multiple cesareans. So for women’s health and future fertility VBACs are important. They can be successfully accomplished if during pregnancy one works a little harder.

In June 2010, the Los Angeles Times, and prior to that the Sacramento Bee, reported a 300 percent rise in maternal mortality rates related to childbirth in the last ten years. Doctors attributed the increase in death rates to women such as “Well women are having babies later, more infertility treatments, more obesity and a rise in diabetes (too much sugar and fast food).” The controversy wasn’t just that maternal mortality rates tripled in the last ten years but that the rise went unreported…

The researcher from the California State Health Department reviewed the rise maternal deaths in the last ten years and found that while women are delaying child bearing and there is a rise in infertility treatments and obesity, these accounted for only a small rise in death rates.

The largest jump in maternal mortality was due to the doubling of our cesarean rate from about 25 percent in the 1990’s to 50 percent in the year 2009. Cesarean sections were promoted to women as safer for the baby, safer for the mother, less pain, less pelvic floor trauma, better timing and the danger of allowing women with previous cesareans even to labor.

These assertions, except for time in labor, were based on junk science and lies. Cesareans are major surgery. The abdominals connective tissue is severed; the uterine muscle is cut, as this occurs the patient morphs into a high risk patient for future births because of the uterine scar. Baby’s interest can be served but are not always and deeper maternal anesthesia can play a role in newborn issues like respiratory, depression and oxygen deprivation.

All of this was reviewed by the American College of Obstetricians and Gynecologists (ACOG) “steering committee”. ACOG then revised its stand on VBACs again. The Technical Bulletin which is the technical practice guidelines (standards) for obstetricians. In the 60’s and 70’s the rule was once a cesarean always a C-section. By the 80’s women were encouraged to try a vaginal birth(VBAC) even after more than one cesarean and doctors offered a trial of labor (TOL) to most women even with more than one C-section. The ACOG guidelines for VBAC stated that the obstetrician was to be readily available. ACOG reversed this guideline to state immediate availability by the 1990s. This required physicians to be in hospital during labor which most doctors are not willing or able to do. This gave rise to the doubling of our C-sections rates. It seems in this case long-term outcomes were not considered.

By 2011, when the scandal broke about maternal death rates (still low but a tripling of the numbers) ACOG reversed its stand again. Now ACOG suggests a trial of labor for women even with two prior low transverse cesareans. But real little information was given on how to accomplish these VBACS.

So I present to you our own in house VBAC Study occurring at the Gentle Birth Center in Glendale, now the Natural Birth and Women’s Center. This is the “how we did it” to produce safe labors, and great long-term outcomes and in fact better births.

The VBAC Study at the Birth Center
A total of 138 attempted vaginal deliveries after one prior C-section.
VBACs outcomes: 120 women delivered vaginally at the birth center without complications.

13 were transferred during labor to the hospital. Of the 13 transferred, 6 delivered vaginally. All six women were given epidurals and Pitocin. All had stalled labors but were at least 6 centimeters dilated when they were transferred.

Of those six vaginal deliveries, 3 babies were delivered by vacuum extractions. All six mothers and infants did well. There were no maternal hemorrhages and no neonatal admissions to the NICU.

7 of the transferred group were delivered by repeat cesarean. In that group, all but one had cervical dilatation greater than 6 centimeters at the time of transfer from the birth center. All cesarean mothers subsequently did well and there were no admissions of neonates to the NICU. Many of the 13 transfers had failure of the fetus to descend adequately into the pelvis. But in many of these women this was not linked to the previous reason for the previous C-section.

Our experience has a very high success rate of vaginal births after a previous C-section. 120 of these women achieved spontaneous vaginal deliveries without incident. The following information is how we achieved that remarkable success:

1)      All women wishing to VBAC were evaluated for an adequate gynecoid pelvis. These were the majority of women.

2)      All were put on strict diets tailored to each individual woman with her weight and food philosophy factored in. These diets were designed to build healthy babies, and muscle while controlling weight. These diets included a strong individualized nutrition component. The goal was to eliminate gestational diabetes, big babies, hypertension issues and maternal infection. All are diet related.

3)      A strict walking program was initiated to make sure babies were head down and deep in the pelvis. The goal was to ensure babies were born between 37 and 40 weeks. (This controlled fetal size to some extent and decreased the risk of babies being overdue and having meconium in labor.)

4) The cervix needed to be soft and pliable prior to labor (So that labors were not prolonged). If the cervix did not soften and efface (thin out) well prior to the onset of labor the mothers were supplemented with certain homeopathics. These homeopathic remedies should be given ONLY by the midwife delivering the baby as there are 53 different ones and they do not help or cause harm if the wrong ones are given. (DOULAS ARE NOT QUALIFIED TO DO THIS!)

5) The fetus was evaluated for general health with a “biophysical profile sonogram (BPP)” which measures fetal muscle tone, breathing, amniotic fluid levels, condition of the placenta, fetal heart rate and breathing motions. And although it is not part of the BPP, we also looked for descent of the baby (how deep in the pelvis) and the length and placement of the umbilical cord.

Adequate amniotic fluid suggests the placenta is functioning and the baby is healthy. Amnionic fluid is made by the baby and placenta. If the baby’s placenta is healthy and has reserves, the baby is head down, the cervix is soft, the labor is not extremely long or difficult, and the mother is otherwise healthy—this leaves only the mechanics of labor i.e., the strength of uterine contractions and descent and rotation of baby to worry about.

6) All VBAC women were monitored with an external fetal heart monitor intermittently during labor because fetal distress is the first sign of a rupturing uterus. Mothers were labored in and out of the shower (vertically) but monitors were used. This gave us a heads up if a scar was threatened. As a midwife with over 30 years of clinical experience I have seen ruptured ruptures and prevention must be addressed prior to labor.

Because VBACs do contain a small risk of uterine rupture we wanted short, fast labors without extra risk factors. We wanted no extra augmentation for labor, no drugs, hormones, or herbs. Just straight forward, natural labors, well monitored fetuses and mothers. If we did our job, with just a little cooperation of the baby, we had 120 successful vaginal deliveries at the birth center.

I believe VBACs are safe when the proceeding plan is carefully followed. Today at the Natural Birth and Women’s Center our tradition of safety and success with VBACs continues. 

Natural Birth & Women’s Center
20201 Sherman Way Suite 109, Canoga Park, CA
Tel: 818-885-1012Fax: 818-885-1017


How to Find a Doula

Brian O'Neil

by Rita L. Shertick RN, BSN, LCCE, CLE
Rita is a staff nurse at Downey Regional Medical Center’s Family Birth Center. She is a Lamaze certified childbirth educator and a certified lactation educator.

First thought: Yeah, we’re pregnant
Second thought: OMG, what are we going to do?

You know your partner wants to be your coach for this wonderful experience, but some experienced support would also be appreciated.

Many conversations later, with family and friends, you decide to find a birth doula. Who are they? Why are they available? What questions should you ask them? Where do you find one? You search, the birth and parenting resources of the Wet Set Gazette, have more conversations with family and friends, and finally you do some interviewing. To get you started, I asked questions of five birth doulas in our area. Below are their responses and recommendations for other questions you should ask when interviewing for a birth doula.

Tracy Hartley: 15 years experience, assisted 433 births
Giuditta Tornetta: 10 years, over 300 births
Margie Levy: 9 years, 264 births
Lysa Quealy: 2 years, 38 births
Emilee Benner: 1 year, 15 births

1). Any special skills?

Emilee: Kundalini yoga teacher, infant massage instructor, massage therapist, placenta encapsulation

Margie: Aromatherapy, hypnosis, pregnancy massage, Reiki, fetal positioning, working with abuse survivors, acupressure, and breastfeeding

Lysa: Certified massage therapist, aromatherapy

Giuditta: birth hypnosis, workshops on baby care, massage therapist, cook, baby usher, breastfeeding, also postpartum doula. Author “Painless Childbirth: An Empowering Journey Through Pregnancy and Birth”

Tracy: Birth Hypnosis for 12 years, diapering workshops, strong education in the birth process and navigating the hospital system, pregnancy massage, Reiki, optimal fetal positioning, working with abuse survivors, breastfeeding support.

2). How and why did you become a birth doula and what is your background?

Tracy: Lots of previous “people” jobs, among them: counseling Vietnam Vets, training dogs for people with disabilities other than blindness. Signed up for doula training 24 hours after hearing about it on a Today Show segment in 1996, knew it was the perfect job for me.

Giuditta: After being laid off from a TV producer/director job, I asked the Universe for guidance, and was lead to be a lactation educator and next a doula. I attended my first birth and it was love at first sight.

Margie: Raising my children, I knew I wanted to support women in birth but not in a medical capacity. When I learned about doulas, I knew I had finally found the right career.

Lysa: My first birth I took childbirth classes and felt informed but ended up with a caesarean. I felt I could have benefited from more support. My second birth was a successful VBAC (Vaginal Delivery After Caesarean), I made the decision based on information not fear, and now I want to give women the guidance and support not offered to me.

Emilee: Family and friends continually asked me to attend their births, I did it because I really enjoyed it and they seemed to benefit from my attendance. When I found out there was training to be a birth doula, I awoke to my calling. My goal is to help new parents feel comfortable, prepared and educated for this sacred passage.

3). Now you discuss the pros and cons of each doula. 

One of you likes the experienced grandmother type support, the other likes the calm motherly type, but the young bubbly one was very enthusiastic and had such positive energy. No scratch that, all of them had positive energy—the type of energy you want directed for your well being at this pivotal time in your life.

4). Time to consider the cost, what are the choices?

Some doulas have a pay scale for different levels of services offered. How many massages and classes do you think you’ll need? How many post partum visits? A friend had a doula for barter, a few months of free meals in their restaurant, or how about servicing her car. What can you offer in exchange for a doula’s services? And yes, she will have a contract for signing, it is a business transaction. Fortunately many insurance companies will now reimburse. If yours doesn’t, submit anyway, listing all the benefits you experienced. If you are looking for a birth doula in training, she’s $200.00 or less, budget not a problem, maybe up to $1,800.00. Generally a doula expects payment in full at least a week before your due date.

Contact Information:

Tracy: 818-448-081
877-436-8528, 877 I-Doula-U

Guiditta: free virtual doula service

Margie: 818-994-6800

Lysa: 310-831-5700

Emilee: 818-383-4213

Rita L. Shertick, RN, BSN
Downey Regional Medical Center’s Family Birth Center