We need more OBs to support vaginal breech deliveries

Dr. Howard Vogel, Third From Left, Is Assisted...

“Recent studies reaffirm earlier World Health Organization recommendations about optimal cesarean section rates. The best outcomes for mothers and babies appear to occur with cesarean section rates of 5% to 10%. Rates above 15% seem to do more harm than good (Althabe and Belizan 2006).

The national U.S. cesarean section rate was 4.5% and near this optimal range in 1965 when it was first measured (Taffel et al. 1987). In more recent years, large groups of healthy, low-risk American women who have received care that enhanced their bodies’ innate capacity for giving birth have achieved 4% cesarean section rates and good overall birth outcomes (Johnson and Daviss 2005, Rooks et al. 1989). However, the national cesarean section rate is much higher and has been increasing steadily for more than a decade. With the 2007 rate at 31.8%, about one mother in three now gives birth by cesarean section, a record level for the United States.”  ChildbirthConnection.org

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One in three births are cesarean?

Okay, so I have shared that my soul is at peace with my cesarean. Spiritually, I can use this experience to learn and grow. I trust that life brings me what I need when I need it.

But I think some clarification may be needed: I am still a great believer in natural birth and continue to think the political and economic pressures (well, I am talking insurance, mostly) as well as well-meaning concern from doctors (who live at the edge of where ‘everything could go wrong’) can sometimes lead to unnecessary interventions – meaning mother and child would have done just fine without them but it made everyone feel better that ‘everything possible’ was done. Yes, there is a place for intervention – but I still believe they should be a very last, break-in-case-of-emergency resort. And stats tell us it is not so. 5 to 10% of women medically need cesareans. 30% of women birthing in the US have cesareans. Shocking, right?

In fact I may be one of the cases where no intervention was *needed* as such and where arguably having the surgery did more harm than good. There was no medical emergency. Baby was breech but otherwise all was well. Labour was progressing. Baby was not distressed. I had even had a cat-scan (after much agonising – as nobody takes an X-ray of their pregnant belly, lightly) that proved my hips were wide enough to birth a breech baby, naturally. Indeed, millions of women have delivered breech babies vaginally, perfectly safely (including my mom – I was a breech footling). There is a slight increase in the risk of complications, yes, but most women birth breech babies just fine. The ONLY reason they stopped my natural birth process (after over 20 hours of labour) and said it was time to go to the OR is because it was 8 o’clock on New Year’s Eve and the only doctor with a specialty that includes vaginal breech deliveries (out of 5, I think, on the whole West Coast – all 5 in this one, fab hospital, UCSF) she was the only one who was even in the area during the hols and she was now off to her own New Year’s Eve party. As I say, I feel at peace with this. I believe God gives us the experience we need, in order to grow. But in purely practical, human terms it is pretty sad that there is only one hospital in the Bay Area (and allegedly in the whole of Western USA – covering, nearly 100,000,000 people) that will even consider doing vaginal breech deliveries, now – which really should be the mother’s choice, wherever possible, in my view. It is crazy that if your labour starts on the ‘wrong’ day, you are automatically scheduled for a cesarean whether it is in your child and your best interest or not. Parties and leave days come first. Not that I begrudge doctors their time off. I think they deserve and NEED it. I just wish there were more qualified doctors assisting this kind of birth so that the schedule could be fully covered!!

Why not use a home midwife, you say? Why, I had one of those. If you remember, I was planning a homebirth but my midwife, lovely as she is, had never taken the lead on supporting a breech delivery and did not feel qualified/experienced to do so on her own, without calling in back-up, and it turns out that was not easy to find. So, here too: please midwives do not neglect this important skill. Make sure you can confidently identify a breech baby in the womb and that you have the experience you need to deliver a breech baby vaginally, please!

Cesareans, as we know, decrease chances of successful breastfeeding – which in linked to all sorts of things from improved immunity, higher IQ and even decreased behavioural problems. Cesareans are major surgeries with risks for the mother – and even if it goes well it takes time and care to heal properly and completely. And cesareans deprive children from the final ‘inoculation’ of good bacteria that other children acquire passing through the birth canal, such that cesarean born children are two to eight times more likely to have allergies, later in life. Natural birth also gives babies a ‘massage’ that stimulates their whole skin and pumps out the lungs – cesarean babies miss out on this and can be born with water in the lungs. Cesareans should never be a given, don’t you agree?

So, yes, modern medicine can be a life-saver, literally. But in this case, it more saved a doctor’s chance of seeing the New Year in, in style. My plea: please train more midwives and OBs in normal, natural, vaginal deliveries of breech babies. Our babies deserve a chance at natural birth and all the health benefits that come with that!

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the spiritual teachings of a cesarean

Imagine if an angel kissed you and it left a mark on your flesh. That is kind of how I feel about my scar. Anya was born by cesarean. This was not the plan… at all. In fact we had envisaged a homebirth, had midwifery care, at home, throughout, hired a birthing tub, the whole shebang and then it turned out Baby was breach and would not – NOT – be turned. We tried everything every culture had to offer and baby was staying put, butt down! We even tried for a vaginal breech delivery but that didn’t pan out either.

So it came to pass that I had a highly medicalised, surgical birth and I am fine with it. I am surprised to say, I feel super-fine about it. Not that I would choose it again, of course not, just that I found my peace with it and am confident that my daughter’s birth, her arrival on this Earth and outside my womb was a blessed, magnificent occasion – and the means doesn’t really concern me.

I know many of the mama bloggers I ‘hang out with’ online are very political about this. And I get that. I have read Ina May, seen ‘The Business of Being Born’ and read ‘MisConceptions’. I am all for natural births and that would have fit in with my lifestyle and choices so well. But I am also for accepting what is, meeting it on the path – greeting reality as it comes hurtling toward you – with a smile, wherever possible. And hey, if my reality included some violent, unexpected feelings in reaction to this intervention-filled birth then that would be welcomed, too (eventually, at least). You can only take it one day at a time, see what comes and ‘eat the food on your plate’, right?

There are things that catch me out, don’t get me wrong. There are experiences I find harder to take in my stride and accept, zen-like. But this, even though it was seemingly against everything I stand for, felt just as it was meant to be. I credit my Birthing from Within classes for this, largely, actually. Birthing from Within is a pre-natal preparation course (summarised in a book of the same name). It is a bit wu-wu in nature (which is probably why I was drawn to it). They had us doing art as a couple to express our fears and hopes about the upcoming birth both verbally and visually, they got us to hold ice (the closest they can come, legally, to inflicting pain on us) to practice different breathing, relaxation and pain-management techniques and, crucially to this story, they encouraged us to visualise our worse-case scenarios and then re-imagine the same situation but with everything that we need to be able to cope with even this, our biggest fear. So, though we didn’t know for sure if Baby was breech at this point, I imagined that she was. I realised that didn’t freak me out that much after all, so I took it one step further and imagined I had to have, *gasp*, a c-section. And in that moment, even in the round when we had to imagine the ‘bad version’ of this story all I could see was my baby, coming out of me and onto the Planet – and nothing else mattered. I saw the doctors extracting her from my belly and the moment looked glorious, triumphant to me. I could see the energy and it looked and felt beautiful. And that was it, the fear was gone – discarded right there and then. [If only I had prepared this well for other things.]

What is more, I think this ‘crisis’ was (as the Japanese characters for this word point to) not just a risk but an opportunity. I took this as a huge hint from Life that it was time to make peace with the medical establishment. Yes, I like natural/traditional medicines and yes that is all I have used in this lifetime (up until now) but I acknowledge not just in theory but in action that there is a place for modern medicine in my life, too. That these two modes of healing are, truly, complementary. Now that was a lesson worth opening to (even if, frankly, I had no choice!)

So, now still, when I look down and see that scar on my belly I smile. I see beauty. I questioned this many times in the months after the birth: was I repressing some dark unexpressed feelings about this? Was I kidding myself about being okay with this? No, I really don’t think so. It has been 16 months now and I am still fine with it. That scar is where my angel came out of me and into the world and that ‘kiss’ is cause for celebration, nothing else.

Turning a Breech Baby (and Empowering an Expecting Mother)

This is one awesome post with information about choices and paths for mothers carrying breech babies. If you find out your baby is breech (like mine was), read this before doing anything else and know that you do have choices, beyond cesarean, which may suit you and your baby more:

KellyNaturally.com | Techniques for Turning a Breech Baby.

Thank you Kelly for writing this. This is both beautiful and practical.

What cesarean babies miss out on

Here is a hotch-pot of things I have heard or read about cesarean babies:

1) They often find it harder to breastfeed (not having benefited from the release of pro-nursing hormones such as oxytocin and prolactin, plus they may come out still stunned from the pain medication, which can reduce the suckle reflex).

2) Cesarean born babies need to be held more. The theory I read – in one of Ian White’s books – is that because they didn’t get that final massage, as they descend through the birth canal (which also expels the excess water from their lungs), they are born with a higher than usual need for touch and massage, to make up for it.

3) Cesarean children are up to 8 times more likely to develop allergies and intolerances, especially if the mother has a tendency toward them. I couldn’t find the original article where I read this, so I googled it. Oh my! There are simply loads of references and research that pop up in response to this search criteria. It turns out this is old hat: cesarean babies are more likely to have allergies. The reasons why seem up for grabs. The article I originally read put it down to babies being exposed to beneficial bacteria found in the mother’s birth canal that helped their incipient, forming immune system. Here is one of the many articles I found in this most recent search: http://www.sheknows.com/articles/804431/cesarean-deliveries-may-increase-allergy-chance

We didn’t feel we had a choice as to mode of delivery… but I still find it interesting to note the differences. Perhaps by being aware of them I can act to counteract some of the down sides of being born cesarean. For example, I can make sure I give my little one lots of skin-to-skin contact, massages and breastfeeding, the latter because it is positively correlated to low allergies and intolerances. Maybe the one can help cancel out the other :) I was lucky with breastfeeding. I credit both my midwife and my yoga teacher for giving me tips that helped that (see ‘Anya’s Birth’ for more details).