“But it’s not a guarantee against shoulder dystocia and it would be pretty irresponsible if midwives and OBs stopped there with ways to resolve it. Being at home with a midwife, not having an epidural, and not having an IV is not a magic charm against SD, hemorrhage or cord prolapse.”

Which is why most homebirth midwives ask their clients to make a backup plan in case of a need for emergency transfer, including directions to the nearest hospital (most people these days live within half an hour of a hospital, and half an hour is the time recommended for maximum wait time for an emergency c-section).

No, having your baby at home is not a magic charm against anything, not even incompetent or rude care providers (homebirth midwives have been given a place of “honour” here before; the quote I remember most vividly is the one from a midwife who told her client that she was having birth complications because of her “sin”).

But it sure helps. Mothers who labour and birth at home get to eat or drink when they feel like it, labour however they feel like it (including the option of whether or not to have cervical “checks”), wiggle around to make themselves more comfortable (which can often turn a malpositioned baby) and birth in the position that is most comfortable (which is often the position that is easiest on the baby depending on its position and size).

Shoulder dystocia in particular is rare even under hospital conditions, rarer still at a homebirth for the aforementioned reason of maternal freedom making birth easier. And when it does happen, it’s rarer still to have it unsolved by flipping the mother over onto her fours. Not unheard of, but extremely rare, rare enough that it’s arguable that the same problem would have an equally scary outcome under hospital conditions, because in true shoulder dystocia, the head has already come out and can’t be pushed back up inside the mother’s uterus without causing grievous damage to the baby, which is why it’s so dangerous a birth complication. Again, that problem would happen at home or in the hospital. Having it happen at the hospital does not make it a better problem.

Birth emergencies do sometimes happen. They happen more often with babies who are in awkward birth positions, but the key factor in determining survival and health in general is not that the baby is born in a hospital (by surgery or otherwise) but whether or not the care provider has the training and experience to deal with the emergency wherever it happens.

Today, most babies in a breech position (footling or otherwise) are probably best sectioned out, but not because it’s an inherently risky position. The problem is that obstetricians are almost never trained to deal with vaginal breech birth, and midwives are trained less due to liability reasons. If birth were treated as a healthy family event that only goes wrong under very rare circumstances, and unusual baby positions were treated as variations rather than as deadly emergencies, more professionals would get the appropriate training. The fear of negative outcome has to be put aside, or there will be more negative outcomes. It’s a vicious circle we’ve created.

At any rate, if the mother has a care provider who does have the training and experience to deal with a footling breech birth, she’s safe, and so is the baby. It’s an awkward position, but not an impossible one. The mother should be the one to make the call. She should not be called insane for choosing vaginal birth. Nor should her care provider.

BTW, I’m American, but I got in the habit of using British spelling when I was at Oxford, because I was trying VERY hard to go native – I was considering emigrating, and I wanted to fit in. Since I was over there for several years, I picked up certain idioms and an accent, too. The accent went away. The spelling and idioms are more or less ingrained, I think.

Nope, not referring to Marsden, referring to the author of the Midwifery Today article.

I mean this with no snark. Your philosophy seems to be that breeches turn out best if they’re not touched, yet then you say that breech is ‘perfectly safe’ if you have someone trained to catch. So as a provider, I’m hearing that if it doesn’t end well, the catcher messed up. It sounds like you don’t really think there’s a risk at all. I’m seriously wondering why you think anyone should attend breach births, since by your logic interference would just mess it up. Wouldn’t a mother be better off with a doula?

If you ask for help once the baby’s head is caught within the uterus or against the pubic bone, the help would consist of the use of instruments that make forceps look comfy, and cutting the cervix. That’s reality. And it does not necessarily mean anyone screwed up, it means you came up on the losing end of the gamble.

I did read Peggy Vincent’s book, and there were so many really happy stories, and then there was the cord prolapse that resulted in a severely brain damaged baby and the end of her career because of a LAWSUIT against her, from someone who realized that trusting birth doesn’t pay for upkeep of a brain damaged child.

To be honest, I’m a baby nurse-midwife, a new grad, and I have always, always wanted to attend home births. But I’m going into it with open eyes and anyone I serve will do the same, because I don’t want to go out like Peggy Vincent, and I don’t want to be held responsible for something that is completely out of my hands. I know that birth has its own path. And fact is that there ARE complications in which you don’t have 30 minutes to get to the OR or to advanced lifesaving equipment, or you need a full medical response team. Ask Lisa Barrett, who was present at the birth of a double footling breach in one of those videos. She had a 24 minute shoulder dystocia that resulted in a dead baby, at home, none of those things that can cause a shoulder dystocia like vacuum or forceps, or being restricted in movement, or anything. See, there are anecdotes on both sides. (And 24 minute shoulder dystocia is horrendous btw.)

Those excellent homebirth studies consisted of _appropriate_ homebirth and midwifery candidates. Unlike most MDs I believe there is definitely such a thing as a good homebirth candidate, but there’s also such a thing as risking out. If you don’t respect midwives enough to take their judgment seriously when they say something is not safe, why do you use them at all? And why would you then expect them to tell you against their better judgment that everything’s going to be fine?

For some reason your most recent post is blocked from reply.

My philosophy is that birth is best done under circumstances that the mother feels most comfortable with, because a distressed mother tends to have more problems.

I am as close to preferring unassisted birth for myself as it’s possible to get – like that one lady in Vincent’s memoirs, I see a midwife as kind of like a fire extinguisher. Leave me alone, I’ll call if I need help. I’ll endure intermittent monitoring if I must, but other than that, nothing for me, thanks. I found that out during my third birth, which went so fast that the baby arrived before the midwife and the doula. I think a doula’s presence would actually hinder me. I like to be alone.

Other women need comfort, support, etc. They would not like labouring alone like me; they would find it miserable and frightening. In birth stories in books I’ve read, I see a lot of negative stories from mothers who found one of the worst parts about hospital birthing to be the lack of human attention and reassurance, and their husbands/partners were almost as distressed if they weren’t “birth junkies” because there was their partner, labouring, in pain, in a situation usually framed by society as fraught with danger, and nobody was reassuring them any more than they were reassuring their partners. That probably stalls a lot of labours right there.

Some women feel most comfortable in a medical setting with as many bells, whistles, and drugs as can be offered to them. That, despite being presented with evidence that other ways work just as well, if not better. I think they’re nuts, but the feeling is mutual, so that’s all right. Really, they just have different needs. If they can’t birth without epidural pain relief and the reassurance of continuous electronic monitoring and medical staff on call, then they shouldn’t try.

My philosphy regarding breech birth, in particular, I have already listed a couple of times: It is safe – provided the midwife or doctor who is to catch the baby HAS ADEQUATE TRAINING. Nursing school, like med school, is unlikely to train midwives in how to catch all breeches, most likely due to liability issues, as most of the CNMs I know are quite open minded about birthing variations. Although some nursing schools may simply have a more medical philosophy. Medical schools for obstetricians can vary in philosophy, too – Georgetown and Johns Hopkins are big on pushing surgery, I’ve heard.

A midwife who wants to learn to catch a footling breech is probably best off apprenticing herself to a direct entry midwife (CM, CPM, etc) because they’re about the only people willing to assist at such births these days.

If the art completely dies, then no, birthing a footling will not be as safe as houses. It will be a lot riskier.

I believe that mothers deserve options; categorically declaring something too risky to be done out of a hospital setting when it has, in fact, been done safely outside of hospital settings before is based on fear (of birth, or liability – does it matter which?) rather than evidence. That limits the options of the mother unnecessarily. I think it is critical that birth providers be exposed to more variations of normal, and more approaches to birth than what insurance companies consider to be best practice. I don’t want to see options wither away due to red tape.

Note: I read Laura Shanley’s book on unassisted birth, including her description of her unassisted footling breech birth, and I think that would push my own risk buttons a little too hard – I’d want a good midwife to help me out with that sort of situation. However, it was her choice how to birth her own baby, and if she did it with open eyes, that’s what matters.