Birth Matters. Speaking at the Improving Birth National Rally for Change, 2012. Photos by Sweetness and Light Photography.

If you know me at all, you know that I am passionate about birth. I grew up in a more conservative part of the country where birth is highly medicalized (OK, that is most of the country) and let’s just say that I am happy that I was able to grow past that and make up my own mind about birth. But it did take a (medically unnecessary) cesarean due to breech presentation to really kick me in the pants and start my search for the truth about birth.

What do I think is the truth about birth? I’m not sure how to put it all into words. I know now that it is nothing to be afraid of. Birth is wondrous. The pain of natural childbirth is something to learn from, not run from, and birthing naturally, free of interventions and medications, is absolutely the best for mother and child. I believe a pregnant mother should do everything in her power to educate herself about all of the options for prenatal care, labor, and delivery, and her care providers should do everything in her best interest, not theirs or their insurance carriers. Care providers should help enhance a woman’s ability to birth naturally. I believe our current, widely accepted model of medically managed childbirth needs to be re-evaluated.

I also believe that births do not always need to be done in hospitals or even birth centers. Birthing at home, or wherever a mother chooses, is her right as well. As is picking who she decides will best assist her in her delivery, from an OB to a CNM or CM, to LM, DEM or doula, to just her partner. Or, GASP, just herself. Unassisted birth is actually more common than one would think. But I digress and the hippie in me is probably scaring some people away.

I believe that there is definitely something wrong with our society and our hospitals if we think a national average of 32.8% cesarean rate is acceptable. It is mind boggling to think that nearly one-third of the 4,000,279 babies born in 2010 were born via c-section, higher than rates in most other industrialized countries.

And the rate is even higher in many states, ahem, and the highest being 39.6% in Louisiana.  Especially when the national average was a mere 6.5% in 1965. The greatest jump was between 1996 and 2007, when the rate rose by 53 percent. Why the jump? Babies and mothers did not all of sudden need to born surgically. Studies show that a 5 to 10% cesarean rate would be optimal and the World Health Organization (WHO) recommends a rate no higher than 10 to 15%, so why the drastic increase from the 60s until now? Many reasons. And even more reasons. And more. Among the most appalling reasons, the shocking fact that many doctors are no longer trained to deliver breech babies due to hospitals no longer carrying insurance for breech births based on old studies, and that many hospitals go against current recommendations and do not allow VBACs, more concerns over possible malpractice lawsuits and insurance related issues. Why are the insurance companies telling women how to birth babies?

I’d like to start with this statement about breech birth: “The management of preterm and term delivery of fetus in breech presentation is one of the most disputable issues in modern obstetric practice.”

And I might add that VBACs are also quite controversial, though neither should be.

If you are thinking, “Wait. What? Surely the doctors and the hospitals are right. It is widely known that VBACs and a vaginal breech deliveries are not safe and c-sections are the safest way to deliver those babies. Everyone knows that babies are saved by c-sections!” I have some happy news for you. Although I do agree that many babies ARE saved by medically necessary c-sections, many do not actually need medical interventions to be born.

Crazy, right??

Evidence points towards vaginal birth being just as safe, if not safer, than cesarean birth in the case of breech and VBAC. Want some proof? Let’s work through breech and VBACs separately. This study on breech deliveries finds “there is no difference in neonatal mortality and morbidity between the having a vaginal breech birth and a cesarean, and there were fewer maternal complications in the planned vaginal group than in the elective cesarean group.”

The term breech trial that concluded that cesarean delivery was safer for breech babies has come under question. The data was flawed and the study recommendations, that breech deliveries are safer under the knife, is just plain wrong and thus has harmed thousands of mothers and babies by putting them in a dangerous situation, forcing an unnecessary major surgical procedure that includes serious risks to mothers and babies, and thinking there are no long term effects. “Most cases of neonatal death and morbidity in the term breech trial cannot be attributed to the mode of delivery,” because “there was a lack of adherence to the inclusion criteria. There was a large interinstitutional variation of standard of care; inadequate methods of antepartum and intrapartum fetal assessment were used, and a large proportion of women were recruited during active labor. In many instances of planned vaginal delivery, there was no attendance of a clinician with adequate expertise.” 

What does this mean? The deaths attributed to the mode birth, for vaginal breech birth, are not black and white. Many of the deaths were not, in fact, because of the baby’s presentation at birth. They were for many, many other reasons. And most of those reasons were probably preventable.

As for VBACs, they are safer than having repeat cesareans. Period. Worried about uterine rupture? Don’t be. Out of 114,933 deliveries in this study, there were NO maternal deaths. And although there were 2 infant deaths (2 0f 114,933 deliveries is a 0.0017%), one of the deaths the mother had a previous cesarean, one had no previous cesarean. A uterine rupture can happen to a mother with or without a previous cesarean and the fear of having one shouldn’t deter a mother from pursuing a VBAC.

All of this is very interesting, don’t you think? After reading a few more birth studies on VBACs and breech births, I was interested to read in one of the breech birth studies, where it lists guidelines for the doctor on how to deliver a breech baby naturally, that the medical world, in theory, knows that “a woman’s choice of delivery mode should be respected.” It continues, saying that if a mother turns down a cesarean and chooses to labor and birth naturally, she has “a right to do so and should not be abandoned. They should be provided the best possible in-hospital care.” The study asserts that not only should a mother’s choice be respected, the doctors should be trained better to assist her. “(III-A) 26. Theoretical and hands-on breech birth training simulation should be part of basic obstetrical skills training programs such as ALARM, ALSO (Advanced Life Support Training in Obstetrics), and MOREOB to prepare health care providers for unexpected vaginal breech births. (III-B).”

If a baby presents itself in breech position at birth in 4% of all pregnancies, shouldn’t all doctors and birthing professionals be trained in birthing breech babies? Of course!

I whole heartedly agree that it is a tragedy to lose a baby during birth. But it happens. It is a part of life and death. But what If something can be done to save a baby? A mother should do whatever she can to save the baby right? Well, yes, I’m not saying she should ignore a live saving procedure but it is one thing to have an emergency during labor that actually requires this type of intervention and another to have a doctor tell a mother a cesarean is necessary when it is not. I am thankful that I have never felt the pain and heartache of losing a child during pregnancy or birth but I am not inexperienced with pain and loss. I have lost a mother. I have felt the pain of cesarean. The anger, heartache, and anguish from feeling like I was not respected and not informed by my doctors of my rights during labor. It was my right to choose the way I gave birth to my first child, my breech baby, and it was taken away before I even knew it was mine. I was not able to birth the way I wanted because the doctors informed me of their recommendation like it was medically necessary. It was NOT. That is called coercion, my dear readers. And we all know lying is bad. A breech birth is absolutely normal and natural. Just ask the women who have been giving birth for millions of years. And those brave mothers today that still birth their breech babies, despite having the cards stacked against them.

One of these days, perhaps decades from now but hopefully by the time my daughters are ready to give birth to their own children, doctors will actually follow their own written word, respect a mother’s choice, and know that 33% of babies do not need to be born with scalpels. Or that home birthing will be more accepted, perhaps account for 50% of births in this country instead of 1%. We should take notes from the Netherlands, where home births are a common option for women with low-risk pregnancies, and 30% of all births occurred at home in 2004 (Euro-Peristat, 2008).

Birthing naturally should not have to be a fight. Birth is beautiful. Here’s to looking forward to a brighter future.

Resources & Good reading:

• Latest Birth Statistics - CDC / National Vital Statistics System
• Identifying barriers and facilitators towards implementing guidelines to reduce caesarean section rates in Quebec - World Health Organization (WHO)
• Statistics and indicators for 30 countries. Health at a Glance 2011: OECD Indicators, Caesarean sections - Organization for Economic Co-operation and Development
• Vaginal birth after cesarean delivery: results in 310 pregnancies (1998) – NCBI, Pub Med
• “A trial of a VBAC significantly reduced the rate of cesarean sections.”:
• Repeated VBACs are safe; repeated cesareans are not - Review of Obstetrics & Gynecology (2008) study – Tina Cassidy
• Vaginal delivery of breech presentation (2009) – NCBI, Pub Med
• Planned caesarean section for term breech delivery (2003) – NCBI, Pub Med

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