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Breech History

We were convinced that breech births posed special problems and were inherently dangerous.  We believed this because we didn’t take the time to do much research, and instead listened to brief explanations by a few professionals.  What we heard from them was a result of their education, which took place in the 1980’s and 1990’s when misinformation about breech was common and mostly unquestioned.

For all of human history women have been giving natural, normal breech birth. The vast majority of vaginal breech births throughout history have been as safe as other vaginal births.  No researcher disagrees with this.

Researchers also tend to agree that to assist a breech birth, it helps to have special training.  In North America in the late 1970s, as physician preference for Cesarean sections increased, medical student education and obstetric residencies focused more and more on training doctors to perform C-sections.  To many obstetricians, Cesarean sections seemed like a good answer to every situation that seemed challenging.  At many medical schools it became easier to teach this single procedure than to teach students enough anatomy and technique so they could properly attend the various situations that birth can present. The rate of breech presentation at full term is only between 3 and 4%. With so much to cram into medical education is it really worth it, they reasoned, when C-sections are so simple?  In the 1960s a high C-section rate was considered suspicious, perhaps a sign of incompetence, but by the late 1990s planned C-sections had become routine.

Meanwhile, researchers were compiling data that showed a link between breech birth and neonatal mortality and morbidity, and between breech birth and cerebral palsy.  Obstetricians began fearing that parents of brain damaged or dead babies would sue them for not insisting on a C-section.

In the first decade of the 21st century the prejudice favoring surgical birth started to be questioned in the North America.  It’s turned out that it isn’t so easy to make C-sections perfectly safe.  Maternal mortality rates in the US have been climbing for thirty years, in part thanks to C-sections.  C-sections are surgery, and surgery always poses serious risks.

New research into brain injury pointed out that very premature infants are typically breech, and they should have been excluded from the data in previous studies.  Other data compared breech babies born naturally and surgically and determined that brain damage is more likely a cause of breech presentation than the other way around, and that breech babies born either way had similar rates of brain damage.  One large study that compared results two years post-birth showed slightly better results for babies born vaginally, suggesting that C-sections may help unhealthy babies to live somewhat longer. Canadian obstetricians have now revised their guidelines to encourage vaginal breech birth. Our home state of Arizona recently re-expanded lay midwives scope of practice to allow them to attend breech births in the home.

Henci Goer, in her review of the current research concluded that depending on the surgeon,  surgical birth may be safer for the child, whereas vaginal birth, depending on the attendant, is safer for the mother, but that rates are so similar either choice is a reasonable one.  This is where the research stands at present.  Our experience and anecdotal evidence takes us a little farther…