Friday, February 20, 2009

Slow Birth Breech

"Can we stop on the way and pick up a Big Mac?" asked the woman.

"Sure," said the man, as he turned into the drive-thru...

I was standing at the hospital entrance, wondering what was taking them so long. M was my very first client, and she was in labour. Her baby was frank breech (that's bum first). It was 1988.

M's family doctor was driving her to the hospital because they couldn't reach her husband at work. (Remember, this was life before cell phones and voicemail.) Charles, the doctor, worked out of a little home office in a small beach community, only minutes from her home. They were friends. She told me that he used to be a specialist in rural BC, hence his ability to roll with whatever came his way.

So, back to the scene. The doctor's car pulled up to the Emergency entrance, and out tumbled my client with a half-eaten hamburger in her hand. He parked the car and followed us into admitting.

(Okay...wait just there! Do you think this scene would EVER happen today? It was laughable then, but not completely absurd.)

We arrived at the maternity ward, and settled in. We could see the beach and the sparkling ocean from the window. There was a rocking chair in the corner, beside a full-length antique mirror. There were no monitors or equipment in the room. The nurses would set up in the hallway and only roll in the carts just before the baby was born. There was no disturbance.

"These contractions are nowhere NEAR as bad as our rowing sets!" M had been on the Canadian national women's rowing team. "Our training sessions were brutal!" (Perception is everything in birth.) I stroked her and she moved her baby down.

Now, I don't remember how long it was before her baby was born, but I do know that I was still breastfeeding my one-year-old son, and I didn't miss a feed!

There was no fear in the room, no increased anxiety because her baby was breech. The birth was allowed to happen in its own time. It was graceful and slow. The doctor just lifted up the baby's body as it was born, and out popped the head.





Now, you have to remember that the family doctor used to be a medical jack-of-all -trades in Northern B.C. He knew what to do at a breech birth. He knew that he had to trust the woman's need for food in labour - it would give her strength. He trusted birth.

Think about it!  That was the very first birth that I attended as a doula.  It was the first of so many Slow Birth lessons.

Over the next decade or so, I attended many breech births without worry. I knew I could trust the caregivers to be skilled at any and all maneuvers required. Dr. Woolley told me that he loved breech births. "At least you have something to grab on to!" Dr. Bagdan told me that breech births are often much less painful - "It's a soft bum, you know," and I remember seeing him catch two breech babies gloveless, just because they'd always come so fast (those two mums were breech themselves!) I also remember Dr. Thomas sitting on his hands and saying, "Jacquie, the key to breech births is to watch the flow of the labour. If the labour continues to progress without a hitch, then it will be fine. But, if the mother senses a block, then we'll do a cesarean when she gives the word." I saw him catch so many breech babies, and only one woman had a cesarean after she said, "It's not going to come." This was Slow Birth. It honoured the rhythm and messages of the body.

I don't know when that breech wisdom died, but after we lost Drs. Woolley and Pendleton, and Dr. Thomas retired, and the breech trial stopped vaginal breech births in their tracks, that was the end of it.

Sure, there were a couple of brave doctors (Go, Henry!) who would agree to attempt a vaginal breech birth, but that would be only if they were on-call on the day that a woman went into labour. Timing was everything - if the "breech" doctor was away, the baby would be born by cesarean.

A few years ago, my daughter asked what her options would be, if she was pregnant and her baby was breech..."Well, I'd have to drive you to Ina May Gaskin's "Farm" in Tennessee, or fly you up to Yellowknife to see Dr. Kotaska." (Recently, I told a doctor that, and she laughed, and said, "Yes, I'd do the same!")

So, you can imagine that I was thrilled to discover that BC Women's is hoping to start a Breech Clinic, which would ensure continuity of message, informed choice, and 24/7 vaginal breech capabilities. What a wonderful way to reduce cesarean rates! I hope the clinic opens soon.

I only wish that some of the new doctors could see how it used to be done - slowly, simply, and with such infinite trust in the body. Breech birth - the Slow Birth way.

Here's hoping that we can reclaim the old wisdom.

(Update April 3/09: Any woman in the BC Lower Mainland whose baby is breech, and wishes to explore the option of a vaginal birth, and whose current physician does not offer vaginal breech births, can now be admitted to BC Women's for care by a "participating" obstetrician. Thanks to all those involved for this fantastic policy change!)

- Jacquie Munro, Vancouver Doula, Slow Birth, Slow Planet


Anonymous said...

Just wanted to tell you how much I've enjoyed your slow birth posts. As a pregnant doula, no one understands when I say that I hope my birth isn't a fast one. I want to savor it.

And, I have also joked (well, no joke really) that I would be heading to the Farm if I found myself with a breech...

kate c said...

WOW!! That would be an amazing change for BCW!!

ThyHandHathProvided said...

I am very excited to find you. I am pregnant with my third child (due late May) and have hopes to become a doula once my kids are older (we homeschool).

I am only 26 weeks, but can tell this babe is not head down and, for some reason, have a lot of anxiety about the baby being breech in the end.

Reading what you've written about slow birth is encouraging and I see midwives I trust, but I fear breech means C-section and that it scary to me.

Wow. I really rambled. Just wanted to say 'thanks':-).

Andrea said...

I really enjoyed this post Jackie. I agree with everything you had to say. I am a LDRP RN in Vancouver and I always feel sad when someone with a breech baby comes in in labor and we head right to the OR. I think, from what I see happening, we are having less MD's practicing the art of breech birth and it is slowly fading away. I still work with on OB who feels comfortable doing breech deliveries but only if it is twins and the first comes head first. I think breech birth can make a come back. It would be grand!

Haven said...

nice post.thank you...........