S. Tenuta 11-17-24
Is having a breech birth safe? Here is breech discussed.
Breech was considered normal for all the years that preceded the hospital management of births. In many countries, it was even considered normal in the hospital with the study of breech as one of the pre-doctor offerings during a regular university medical training. That was thoroughly changed in many places after the article that was called Term Breech Trial. This article suddenly put a damper on breech birth in many countries. Suddenly women who had a breech diagnosed were told they had to have a cesarean section.
What changed this was the sudden fear factor that was portrayed in the Term Breech Trial article. The problem with this article is that there have been many errors with the data presented for this Term Breech Trial. It was published in 2000. Examples of inadequacies follow.
1. Data was used that had been predetermined not to use for the trial. For example, randomized criteria and recruitment of women was not fair. Some women were recruited during active labor. This does not give the woman time to even think about her decision.
2. Accidentally twins were included in the study and a cephalic baby was included.
3. Then it was learned that untrained personnel were delivering breech babies for the first time. This is not even fair to the woman or the physician in such a setting of a breech study.
4. Also, there were 13 in the vaginal group and 3 in the cesarean group that were linked to complications or births that should have been excluded from study. It was discovered that one malformed baby was included in the study. There was one with spina bifida, and 1 cephalic still born baby. These violated the pre-determined breech study protocols.
Studies done since that time have actually contradicted the Term Breech Trial study. The PreModa study has contradicted the article. This was done by doctors that get trained in breech protocols in their medical trainings. They are from Sweden and Belgium. Their experience did not support the Term Breech Trial Article. Instead, they found that breech was a normal and safe way to have a baby under their care.
People tend to wonder what are the risks for birth? First of all, there is always a risk involved in being pregnant. To have a vaginal cephalic birth at 39 weeks or later, it is a normal risk of 1/2000 babies will have trouble. This is quite a low risk. For breech birth the risk is 1/1000. This is still low. The stats come from RCOG 2017, Greentop Guideline Management of Breech Birth. This information was used because it is careful data that is regularly collected in England. In the USA, the ACOG guidelines are not such that they are based on evidence. Instead, ACOG guidelines are based on a few doctor opinions, and the people giving the opinions are not even trained in breech births. Thus, the US guidelines can hardly be considered evidence based or truthful.
When guidelines are generated by such inadequate evidence, it is really not giving mothers a chance to review unbiased data to make decisions for themselves or their babies. This is just not right. We birth professionals would like to see more mothers be empowered by their labor and birth journey, not traumatized by someone else making decisions on their behalf and then mothers needing to journey through a traumatic experience of birth which caused them depression or surgical or emotional scars.
For mothers who decide to give birth by cesarean section, or it was decided for them to have a cesarean section, the good news is that most mothers survive a cesarean section and babies generally have good APGAR scores. Mothers who had the surgery do have more short term complications such as blood loss, fever, infection, anemia, or death. The bad news is that mother would have possible complications for future pregnancies. The increase of acreta since the 1980’s has quadrupled. Babies do remember their births subconsciously, thus possibly affecting their reproductive years. Also, the babies born by cesarean section have been found to have morbidities. These morbidities include asthma, Type I diabetes, allergies, altered gut microbiome, and autoimmune diseases.
The Term Breech Trial gave the idea that it is safer to give mother a cesarean section rather than birth a baby vaginally. A cesarean section is a surgery. Evidence now shows that the complications for mother after she has had a cesarean section increase exponentially. With 8500 cesarean sections given by choice, the cost is 4 women die from childbirth or childbirth complications. Nine babies die from the uterine scar complicating labor. There are 104 complications from having the surgery. This is quite normal for anyone having a surgery in the hospital. Added to this is the increased addiction of women to opioids. Other common morbidities for mother are hemorrhage, uterine ruptures, placental abruptions, and hysterectomies. These studies are done where hospitals are present.
When a person studies cesarean complications in countries that don’t have hospitals available, then it is more risky. 1/100 women will die from surgical complications.
So is breech safe? Discussing breech, it is important to determine who is being studied? What is mom’s frame of mind? What experiences has mother had with birth? Is she fearful? Is there a reason for her to be fearful? Is the provider trained? Is the provider fearful of breech birth? Many thoughts need to be weighed to get the answer for any one individual.
As a provider for birth, I believe the natural process of birth can cause breech birth to be safe. I have the knowledge training but would need to have more hands-on training to feel fully confident in protecting this sacred space for the mommy to birth her breech baby. Believing the body knows how to birth is helpful. Giving mother the freedom to move as she labors and tunes into her baby gives this process its success and gives mother her intuitive empowerment.
Let’s discuss breech. Let’s allow it to become a common woman to woman discussion topic. Let’s get to know it, and allow breech and natural, physiological birth to be welcome. Let’s do our part to reintroduce breech as a natural event for labor and birth. No more unnecessary cesarean sections for breech. Cesareans are necessary only when they are necessary. They are not a good diagnosis for a woman who has a breech baby or a baby with a dropped foot. Let’s discuss breech and change the culture so providers are trained to birth breech babies and trained to see breech as another normal way to birth a baby.
For more information, check out Breech Without Borders.
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