Key points:
- Breech is normal and not something that needs to be fixed
- Birth works best, and is most predictable, when left well alone
- The statistics women are told about breech birth are all based on the hospital environment
Women engaging in NHS care are sometimes being told the position of their baby every time they have a scan, and focus is regularly being put on the position from as early as 33 weeks. Despite the fact that the entire function of labour is to move your baby down and into the best position for them, this information is being sought way before labour without any thought to how it might impact a woman’s confidence – or have they actually put a LOT of thought into that and that’s WHY they do it? The same seems to be true for “low-lying placentas”. Women are being told at their very first ultrasound that their placenta is “low-lying”, which means it is within 2cm of your cervix, but this isn’t the same as placenta praevia which can be one of the very few true birth emergencies. According to the NHS, placenta praevia affects 1 in 200 pregnancies, which is 0.5%. But who knows what they actually include in that statistic if they’re also scaring women with “low-lying” placentas that are not and will not become an issue.
I got off on a bit of a tangent there (that didn’t take long, did it?) but there are so many similarities between the “concerns” that come up towards the end of pregnancy that it’s hard to talk about one without referencing others. Anyway, back to breech. Let’s just think for a moment about the space your baby has to occupy when they are still inside your body. They are pretty snug in there, and they are likely to move around a lot in order to stretch out different parts of their body in different ways. Apparently, most people change positions in their sleep 10 to 40 times each night, and for 50-70% of people their instinctive posture is flat on their back, but that leaves a significant number of people (up to half in some studies) who feel more comfortable, instinctively, in a different position. There is no normal, or right, or “optimal”. Breech has been used as a tool to scare women, break down their confidence and ultimately medicalise their birth.
Birth needs very basic things for it to go smoothly. The woman, like any other mammal, needs to feel safe, warm, undisturbed and unobserved. She doesn’t need to understand the mechanisms that are taking place within her body, much like she does not need to know the technicalities of an orgasm for her to experience one, and she doesn’t need to know what position her baby is in. Birth is safest when these basic needs are met, in any situation, so when we remove these basic needs (by going into a hospital for example) we are making birth less predictable. Why would it make sense to ignore these basic needs when there is a concern about the baby or the mother? The basic needs are not a cherry-on-top, if all else is well kind of thing, they are the very foundation of birth going smoothly.
There are lots of statistics about breech births, and they are often used to scare women into a scheduled caesarean (major abdominal surgery) purely because healthcare providers are scared. The studies that produced these statistics were carried out in hospitals, where women’s basic needs were not being met and they were surrounded by fearful care providers. So what does that actually tell us? Not much, except that interfering with birth is dangerous. I would be much more convinced by the data if it was comparing outcomes of mothers and babies (not just physical but emotional) who gave birth in hospital or at home with medical staff present, versus those who had freebirths. That would give a true picture of the impact of pathologising a baby’s position.
Okay, so let’s just talk about the way women are treated in the system when they have a baby who is bum-down. Firstly, she is told that this is a problem that needs to be fixed, either by attempting to forcibly move her baby the “right way up” by applying immense pressure to her bump, or by “admitting defeat” and booking a caesarean section at 38 weeks (before her body has chance to go into labour naturally).
External cephalic version (ECV) is a procedure that is designed to “fix” a breech presentation. This procedure can take up to 2 hours including monitoring and carries a risk of premature rupture of the membranes, placental abruption, preterm labour, foetal distress and vaginal bleeding, all of which would lead to more interventions. But don’t worry, one clinic reassures us by stating; “ECV is typically performed near an operating room in case an emergency c-section is needed.”, so if they cause an emergency at least they can solve it quickly. Women often endure this ECV procedure in the hope that they will then be supported to give birth vaginally, but the truth is that the fear of care providers will have a huge impact on the way they treat a woman during labour, and you can bet that her basic needs will not be met.
What can you do to avoid the position of your baby being a barrier to the birth you want? Don’t give that information away. When asked if you would like to have your belly palpated or measured, consider what information they are looking for and if it would be helpful for you (and them) to have it. When going for a scan recognise that they WILL see which way up your baby is and that regardless of how many weeks pregnant you are, this information might be used to scare you. What is the purpose of that scan? What are you getting from it? Could you get what you want in a different way? If you’ve already been told that your baby is in a “difficult position”, what are you doing to protect yourself from further fear mongering? How can you reground yourself and build your confidence back up?
A few ideas:
1. Surround yourself with women who believe that birth is normal, whatever way round your baby is, and have complete trust in you and your intuition
2. Practice saying no to things that do not serve you – the more you shut out the external voices, the easier it will be to listen to your intuition which will keep you and your baby safe
3. Come along to one of our groups and speak to other women who might have been in a similar position to you, or might have birthed a baby in a breech position completely unassisted
4. Speak to us about how you can navigate the system, or step away from it
Useful resources:
Coalition for Breech Birth | Facebook
