Bum-first babies are not being difficult or awkward, they are simply comfortable. This doesn't need to be "fixed".
Birth, Homebirth

Bum-first babies are wonderful!

Key points:

  1. Breech is normal and not something that needs to be fixed
  2. Birth works best, and is most predictable, when left well alone
  3. The statistics women are told about breech birth are all based on the hospital environment
Babies in breech positions are not being difficult or problematic - they are comfortable. This doesn't need fixing.

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:

Hands off that breech! | AIMS

Coalition for Breech Birth | Facebook

Breech Without Borders | Facebook

Breech Birth UK

Birth, Homebirth, Pool Hire

Why is the deadline 30 weeks?

We recently made some changes to our pool hire service, and you might be wondering why. So here is a brief explanation of why we have decided to enforce a 30 week booking deadline. We know that not everyone will agree with our approach, and we’re okay with that – these changes have been based on our observations and what we have learnt from women over the past few years of running the service. We will continue to learn as time goes on and things may change again in the future, but for now here is our stance and why:
 
We started running this pool hire service back in 2020 and during that time we have learnt a lot. We included free support sessions within our hire because we recognised that so many of the pools were coming back unused because women were being coerced out of their home birth by the maternity system, and those women weren’t getting emotional support or accurate information from their midwives. We continued to book women in who were approaching us late on in their pregnancy, but we learnt quickly that women who are waiting until a certain point in their pregnancy to be ‘signed off’ or ‘given permission’ by a medical professional were also the ones who would accept that ‘permission’ being taken away again.
 
Sometimes women would take us up on the support session near the end of their pregnancy, around 34 weeks when suddenly “risks” started cropping up (like growth scans), and we were the first people to tell her that she gets to choose, that all of the appointments, measurements, examinations and procedures are optional, that she doesn’t need permission to give birth at home. It is heartbreaking to see that realisation dawn on her face when she is so far down the line that it feel impossible for her to do anything about it now.
 
Women who were looking for external reassurance from appointments, inaccurate measurements and scans, and permission were not wholeheartedly planning a home birth. They were hoping for one, but that hope was balancing on a jenga tower that could be knocked over at any moment by a medical professional. A medical professional who works within a system that doesn’t understand normal birth or the basic needs of a woman in labour. A system that builds its policies on fear of litigation rather than what women actually want or need. What we found was that women who were hoping for a home birth very rarely had one.
 
We understand why this is the current norm – we are brought up to believe that others know our body better than we do, and that we need “experts” to be able to give birth safely because it is a dangerous and unpredictable medical event. That’s why so many women do turn to midwives or doctors for external reassurance. We understand how hard it is to question that cycle or and it’s even harder to break it. It can be scary to take radical responsibility for our decisions, particularly when something is presented as a health issue/medical event. The truth is that birth is a normal bodily function, just like sex or having a poo, birth is incredibly predictable when left alone and we ARE the experts on our own bodies. 
 
Home is safe. It’s where we perform all of our other bodily functions. It is where the only bacteria around is the stuff we’re in contact with every day and are therefore used to. It is where we get to choose who comes through the door, and where we are free to move around and be ourselves. It’s also proven to be safe for birth through studies (and the existence of so many generations before us). Biologically it makes perfect sense – we are mammals, and other mammals find a safe, dark spot where they will not be disturbed or observed. Women need these basic things too, and none of these needs are met within a medical setting. Giving birth at home is the biological norm and is always an option.
 

You do not need someone’s permission, or for someone to write it in your notes, or to be ‘signed off’ to plan a home birth. It is your human right, and your birthright.

 
Our organisation is rooted in women’s rights and bodily autonomy. The maternity system does not respect these things. We will no longer nod along and stay quiet when a woman is walking through or into a system that is set up to fail her. The reason we no longer take bookings after 30 weeks is because we want to make it clear that women do not need to wait until after this point to start planning something that they know feels right for them. We want women to recognise that they can do whatever works for them, without checking with a midwife or asking for permission. This autonomy and critical thinking is necessary for having a good birth, because if a woman is deciding to engage with the maternity system (which is also something we assume is necessary but isn’t) then she is likely to have to assert herself at many points in her pregnancy, labour and birth. She is likely to be told that she “needs to” or “has to” do things that she’s not comfortable with (which is a lie, she never has to). She is likely to be coerced with emotive language instead of genuine evidence. She is likely to be told that she is “not allowed” a home birth because she is too “high risk” based on inaccurate information. 
 
We don’t write this lightly, and it is no way an attempt to scare you or place any blame on you. The dependence on the maternity system is something that is deeply ingrained and socially accepted, it’s not the fault of the woman who engages in it, the fault lies with the system itself. We feel it is our responsibility to be honest about the system and the way it treats women. We know that this doesn’t make us very popular (particularly with midwives) and can often feel confronting or upsetting for women who are still in that relationship with the system. But we hope that our reminder that women are completely capable, incredibly wise and are their own experts will plant a seed. We hope that women hear that they deserve to be treated with respect, rather than as a faulty piece of birthing equipment, that they deserve to feel strong and wise, rather than unsure and deflated, and that they absolutely don’t need anyones permission to give birth wherever they damn well want to.
 
I’m sorry that we are unable to offer you a birth pool after 30 weeks, but we hope that you are able to find one.
 

We are hopeful that this deadline will encourage women to question the care that they are and have been receiving that made her feel like she was “high risk” and had to wait for permission. Questioning this as early as possible (before or) during pregnancy is what will lead women to navigate or step out of the system in a way that works for them.