Posted by My OB said WHAT?!?.
Dec
28
Posted by My OB said WHAT?!?.
“I Wouldn’t Let My Wife Do It!”
“I wouldn’t let my wife do it.” -OB to mother who said she wanted to attempt a breech vaginal birth.
There are 28 comments to this post.
Can you give me the reasons WHY with evidence? I just want to see the stats. Also, CAN you do a vaginal breech, like, do you know how? That’s the concern I have with this one. I personally believe a lot of OB types now do not know how to handle breech well, and if they have very little experience, I would be uncomfortable doing it with one of them. I would ask for a person who is experienced in helping mom have a safe delivery with a vaginal breech.
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Jane Reply:
December 28th, 2009 at 10:17 am (Quote)
Ina May Gaskin in her most recent book said that OBs really need to learn how to deliver a breech baby vaginally because in an emergency,they may well need to do so without panicking. They need to learn to do so in “safe” breech situations, with supervision from experienced breech-deliverers, in order that they don’t do something stupid like try pushing a baby back up into the uterus in order do a c-section.
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What a stupid thing to say from an OBGYN if i were him and i had studied as much as “they have” i would tell them how proud i am that this mommy wants to try delivering her baby naturally, and it would be awsome to be there supporting the mom and doing the best i can with all my knowledge from SCHOOL were they taught me how to deliver BREECH babies… See More since i am an OB GYN and i know how to assist this baby’s presentation, RIGHT?! …….but i’ve heard this is NOT taught in their ob clasess huh why is that pleople why?????
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Sheva Reply:
December 28th, 2009 at 7:03 am (Quote)
Because they are trained SURGEONS, not natural childbirth facilitators. They aren’t trained to deal with natural childbirth, only complications.
There’s a quote, “To a hammer, everything is a nail.”
To these docs, everything is a complication.
I don’t remember who said this, a famous midwife, I think, but she said, “Breech birth is only a variation of normal.” As opposed to abnormal.
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Nicholas Fogelson Reply:
January 4th, 2010 at 6:09 pm (Quote)
Yes, but it is a more dangerous variation of normal. Even in skilled hands, breech vaginal delivery has more complications that vertex vaginal delivery. And more, there aren’t a lot of skilled hands around. As the current literature has demonstrated that term breech delivery is associated with a greater rate of fetal injury and death (Hannah et al) than cesarean, most residency programs no longer do term breech deliveries. As such, current residents rarely have the opportunity to learn the technique. Its not that hard to do it right, but learning to manage a difficult one takes practice, and when you only do a few breech deliveries in a 4 year residency, the skill isn’t there.
So I wouldn’t want my wife to have a breech delivery either.
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Kathy Reply:
January 5th, 2010 at 7:28 am (Quote)
Dr. Fogelson — you are right that a vaginal breech birth may be more complicated, particularly with an unskilled attendant. You’re also right that there aren’t very many skilled attendants. However, I have heard that there are serious problems with the Hannah TBT, so much so that the SOGC has reversed its position on VBB, and is now encouraging OBs in training to be trained on VBB, so that they can safely offer that to women with breech babies, rather than mandatory, automatic C-sections.
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Nicholas Fogeslon Reply:
January 5th, 2010 at 8:14 am (Quote)
You’re right – the Term Breech Trial had some methodologic concerns, and has been questioned by many. Still there aren’t a lot of training programs that are doing term breech deliveries. Most programs do second twin breech deliveries and in some cases very preterm breeches ( < 800 grams)
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Kathy Reply:
January 5th, 2010 at 9:02 am (Quote)
Wouldn’t the after-coming head of a very preterm breech baby be larger than the body, and so cause some of the same problems associated with a term breech baby? Obviously, the baby is much smaller, but it is possible for the cervix to dilate only so many centimeters to allow the body, and then to trap the head, right? Or is it thought that a preterm C-section would be harder on the mom, and the baby is likely to die or have problems anyway, so a C-section would not be indicated, even if it were marginally better for the baby?
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Nicholas Fogelson Reply:
January 5th, 2010 at 3:30 pm (Quote)
Yes – that is exactly the concern. The reason that early preterm infants would be considered for breech delivery is also exactly what you said – overall outcomes are poor due to early gestational age and fetal weight, so in some cases the small potential downside to the fetus in a breech delivery is outweighed by the downside of cesarean delivery for mother. Cesarean at 24-27 weeks is particuarly morbid, as it usually involves an incision on the uterus that precludes a future VBAC attempt (classical incision).
In general, a baby’s head is the biggest part of its body at any gestational age. This is the biggest concern with breech delivery, as the head can become entrapped. While this is not dangerous in itself, in some cases the umbilical cord can be compressed while the baby is entrapped in the vagina and cervix, compromising fetal blood flow for an inordinate amount of time. Most breech deliveries are successful, but head entrapment, though rare, can lead to serious problems if not managed quickly.
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Knitted in the Womb had this to say,
Dec 28, 2009 @ 10:19 am (Quote)
This was a comment I submitted, and it was a statement made by an OB that I generally consider to be one of the “good ones” to one of my clients. It really annoyed me. Because like many of you have pointed out…his desire to control his wife has nothing to do with the medical issues.
And I one of those crazy people who actually does believe a wife should submit to her husband. Go figure. 
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Knitted in the Womb Reply:
December 28th, 2009 at 10:22 am (Quote)
To answer some of the questions above…it was a frank breech, so optimum for vaginal birth.
The OB is knowledgable in vaginal breech, and even has a drawing of it as artwork in the hallway leading back to the exam rooms in his office.
But this was a first time mom, and this OB only “allows” vaginal breech in women with a “proven pelvis.” So 2nd twin, or someone with a previous pregnancy that resulted in vaginal birth.
To use such a “personal” phrasing is actually quite manipulative in my mind. It takes the client out of the position of thinking “he is just considering liability” to thinking “awe, how thoughtful and nice of him to care about me so much!”
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Michelle Potter Reply:
December 28th, 2009 at 11:10 am (Quote)
I’m one of those crazy people, too. Fortunately I’m married to a man who makes rational, logical, evidence-based decisions. Even if I didn’t agree with him, he could at least give me evidence-based reasons not to birth a child vaginally, not just crazy ranting.
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Kat Reply:
December 28th, 2009 at 11:15 am (Quote)
Is there another spot on that “crazy” couch? I am another one of those with a rational, loving husband. Part of that is when we have a major decision to make, we discuss it together. I try to be a respectful wife, but as I’ve said before I am nobody’s doormat! Nor would my husband want me to be, which I think is KEY.
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Nicholas Fogelson Reply:
January 4th, 2010 at 6:11 pm (Quote)
IMHO, thinking this statement means that the OB wants to control his wife is taking it way personally.
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Sarah Dorrance-Minch had this to say,
Dec 28, 2009 @ 10:40 am (Quote)
1) I am not married to an obstetrician.
2) Thank G-d.
3) Regardless of who I were married to, that partner would not be in a position to “let” me do anything. The last time I checked, nobody had any contracts detailing ownership of my body or the right to stand in loco parentis over me as if I were a minor.
4) Thank G-d…
Where is this woman planning to give birth? Roissy?
Fire the OB!
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I guess I don’t see this one as that bad. His policy is that he will only attend a breech delivery on a patient with a proven pelvis. I can see, when explaining to a patient who desperately wants a vaginal birth, that he doesn’t feel comfortable attending that birth that he wouldn’t even “let” his own wife birth that way, isn’t a “I control my wife” statement, but an attempt to explain that he’s just not comfortable with it.
Women should be able to choose how they give birth, but providers should also be able to say, “I’m not capable of providing the necessary care in this situation.”
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Morgan Reply:
December 30th, 2009 at 7:39 am (Quote)
Then they need to say “I’m not capable of providing the necessary care,” instead of using misogynistic scare tactics.
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Michelle Potter Reply:
December 30th, 2009 at 11:40 am (Quote)
Exactly. When I was pregnant with my first, I was unable to get any prenatal care for the first four months because of an insurance snafu. When I was finally able to interview OBs, many told me that my lack of prenatal care made me “high risk,” and they don’t accept high risk patients. (Yes, I know, back-asswards.) If OBs are willing to turn away patients for that, why won’t they refer patients who want vaginal births to someone who can do it? (IE, someone who understands how to support a mom through a normal vaginal birth, and is comfortable doing so without trying to control the whole process with unnecessary interventions.)
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Heather (qtberryhead) had this to say,
Dec 28, 2009 @ 12:30 pm (Quote)
My first thought was “Yes, my husband should be the one to decide the course of action my birth should take”…as if.
I did have a reproductive endo. say something along the lines of “If you were my daughter, I would advise against this”. Which was in no way condescending in that situation, and actually did help me make my decision.
Most OB’s really do not have the know how to deliver a breech baby, and I would want someone who had an idea as to how it is done.
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I don’t know. I completely understand the objections to this one, but I personally know some women who are not ok with a risk/benefits discussion with their doctor. They actually ask, “would you want your wife to do this or this?”
So maybe some women are demanding this kind of discussion or personal advice. I personally would much rather have an explanation of the risks and benefits of different options along with percentages.
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Michelle Potter Reply:
December 28th, 2009 at 1:02 pm (Quote)
I guess I could understand that. If a woman is unsure of what to do, and she trusts her doctor and wants to know what he would do if it were him (and since it can’t be him, his wife). I definitely think it should be accompanied and backed by medical facts, though.
If, as someone suggested, the problem is that this doctor just doesn’t have the skills to deliver a breech baby and therefore wouldn’t be comfortable doing it, he ought to be providing facts on whether breech is a good idea or not, and then if that’s what the mom wants suggesting a doctor who CAN do it.
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Add Your Comment.
“That’s why I didn’t marry an idiot.”
{Note: If he had a medical objection, the thing to say was, “In XX% of vaginal breech deliveries with the baby in a footling breech position, the baby becomes compromised due to ABC,and we run the risk of DEFG. In your case, blah blah blah.” But “I wouldn’t LET my wife do this” is not medical advice. It’s stupid blather.}
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Michelle Potter Reply:
December 28th, 2009 at 9:45 am Michelle Potter(Quote)
So true. Most of the time, there’s no medical reason why a woman can’t at least attempt to deliver her breech baby vaginally, and with knowledgeable support, no reason why she can’t succeed. Personally, with a *footling* breech baby, knowing the medical risks and concerns, I would seriously consider a c-section. But whether the doctor would let his *wife* try it or not would not be part of my consideration. (And having unintentionally delivered a footling breech baby vaginally, I know it can be done.) Mothers should be given the medical facts and the chance to make an informed decision WITHOUT scare tactics!
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Jane Reply:
December 28th, 2009 at 10:15 am Jane(Quote)
We don’t know from this snippet of dialogue what kind of breech it was, but I agree.
BTW, it’s driving me nuts — I know you from somewhere online. Were you in Hopeful Parenting in 2001 or thereabouts?
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Michelle Potter Reply:
December 28th, 2009 at 11:02 am Michelle Potter(Quote)
I’m kind of a message board addict, LOL. I’ve probably been a member of every parenting message board on the internet at some point or another. 2001 was when I when pregnant with my first, so it’s possible.
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