Posted by My OB said WHAT?!?.
Jul
28
Posted by My OB said WHAT?!?.
“…Your Baby Could Become Decapitated…”
“Breech births aren’t even done in America anymore. In fact, they don’t do them anywhere….except maybe in Africa. Your baby could become decapitated. If she’s still breech at 36 weeks we’ll schedule a cesarean for 39 weeks. It’s not the end of the world. Women come in asking for cesareans now!” -OB to mother with a breech baby at 29 weeks.
There are 76 comments to this post.
Scare tactic. Seen it done on youtube in water with babies born intact. I have searched out info on the KC area and found that there are a few docs who still do births breech in hospitals even vaginally. I know midwives do the catching at homes around here. My midwife did tell me she wasn’t allowed to at my hospital, and I’d likely have to have a c-section if baby didn’t turn but it did send me on a search so I would know if we had docs in the area who would allow an attempt to birth vaginally.
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DECAPITATED!!????
Seriously!!??????? OMG, what is the world coming to!?
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Mama Mirage had this to say,
Jul 28, 2010 @ 3:47 pm (Quote)
DECAPITATED?! Seriously trying not to laugh here… that’s definately up there on the list of dumbest things I’ve ever heard.
Oh and my son was born at 40 weeks 2 days, I know his date was right because I was charting, TTC, and we were only able to um… “try” once during my fertile phase that month. So his due date was exact. He TURNED AT MY SECOND TO LAST APPOINTMENT. Yes, he had finally turned head down at my second to last appointment before his birth, roughly about 38 or 39 weeks. He’d been sideways before that. So my 8 1/2 pounder can turn himself that late in the pregnancy, and my friend’s daughter turned while she was IN LABOR, and plus what the hey is an external cephalic version for? Coulda sworn that’s what they call it when they TURN THE BABY manually. Um yeah.
And if all else fails, how in the name of common sense is being born feet first going to cause decapitation?! Unless the doc plans on doing the decapitating…
On a serious note, I have a hard time believing the doc was genuinely this dumb. Rather he or she believed the mother to be gullible, or unexperienced, or uninformed enough… or simply blinded by awe of his white coat… that she would believe such a blatantly nonsensical scare tactic. 
And it is so very eerie and speaks so negatively of obstetrics that they are always so eager to schedule a surgery for a baby when it’s not even term yet. They haven’t even let the mom and baby go near enough to the due date to have given the natural course of things a fair chance before they are booking the OR.
The March Of Dimes should educate women about the dangers of cut-happy O.B.’s. That would cut down on alot of premature births right there.
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Elizabeth Reply:
July 28th, 2010 at 4:53 pm (Quote)
“Unless the doc plans on doing the decapitating…”
Actually OBs used to do that before C-section was very common. If a footling breech is half-’delivered’ and the women never gets to 10 the head can get stuck above the cervix and the baby suffocates. The term for it is embryotomy and includes any dismemberment to allow removal through the vaginal opening. Its pretty gruesome but one of the few ways to save the mothers life when c-section killed more than it saved.
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Mama Mirage Reply:
July 28th, 2010 at 5:59 pm (Quote)
That’s disturbing in the utmost. I wonder how many of those circumstances could have been avoided by doing away with unnecessary interventions and letting things take their course… I can’t imagine a baby would turn easily with the mom drugged and strapped down as used to be the common practice (oh wait… it would seem it still is in some places… ugh!) or that a drugged mom’s body would function optimally or that she would be able to push as effectively. Also wondering how often docs jumped the gun if the head wouldn’t come out right away. *shudders* K now this is gonna give me nightmares…
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Nicholas Fogelson, MD Reply:
July 30th, 2010 at 8:43 am (Quote)
She absolutely correct on that. Breeches do get stuck to the point of fetal death. Its rare, but it does happen. That’s one of the reasons that breech delivery is more dangerous for the fetus than a vertex delivery. The head is the largest part of the baby’s body, so in some cases the head can get stuck. There are maneuvers to help this, but it is a risk.
In the past, decompression of the head was a technique used to effect the delivery of a stillborn breech stuck in the vagina. No lie.
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Sarah Dorrance-Minch Reply:
August 1st, 2010 at 4:31 pm (Quote)
Although MOST breech births do in fact turn out just fine.
It all goes back to what philosophy of birth the mother is comfortable with. Does she want to treat her birth – yes, even if the baby is breech – as a normal family event, unless proven otherwise in the middle of the birthing? Or does she want to assume high risk, and treat the birth as a dangerous emergency situation until disproven by having a healthy baby after all?
And who gets to decide for the mother – do we trust her to make her own reproductive decisions, or do we treat her like a mentally incompetent person just in case that is the best thing for the baby?
I think everybody here knows where I stand on the issue.
Also, I have to reiterate her, as I have in other threads, that the art of catching breech babies might not be taught much in medical school anymore, and some nurse-midwifery colleges steer clear of teaching it due to fears of liability or to inability to pay huge insurance premiums to cover said liability, but schools of midwifery that train direct-entry midwives (CMs and CPMs) and experienced midwives who take on apprentices can, and do, teach trainees how to assist at a breech birth to keep mother and baby safe. The art is endangered, but it’s not dead yet. Mothers benefit by shopping around for an experienced care provider. The experience and training in breech birth can make all the difference in the world.
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*watching my fully intact, non-decapitated 6 year old DD make a salad right now*
Nope…no decapitation here.
Dear doctor,
I would much rather hear “I’ve never delivered a breech baby before, I don’t actually know a lot about it. I am more comfortable scheduling a C/S for just before your due date if your baby hasn’t turned by then.”
Then some crazy, baloney about decapitation. Please don’t insult my intelligence. And I will do you the same favor; instead of telling you we’re moving to Africa to let the pigmies deliver my breech baby, I will simply tell you that I will be looking for a more skilled provider, or at the very least, one who is willing to learn.
Sincerely,
A pregnant woman no longer in your care
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I have heard that in ye old days, when a breech birth automatically meant forceps delivery of the head to protect it (from what, I’m not sure), that there was at least one occasion where an unskilled ob did decapitate a breech baby during the birth.
However, this was ENTIRELY due to the management of the birth, and not in any way inherently due to the fact that the baby was breech.
Why can’t doctors just let mom’s birth their baby’s without sticking something up their vaginas to help the process along.
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Jane Reply:
July 28th, 2010 at 4:47 pm (Quote)
I can’t even imagine the mechanism by which a baby’s head would get ripped off in the birth canal if the doctor left the baby alone. I understand that the baby’s bottom may not dilate the cervix sufficiently to deliver the head, but then the damage of getting the baby out would seem to happen to the mother’s cervix and soft tissue rather than the baby’s spine and head. (And of course, if the baby were trapped too long, fatal damage to the baby. But not decapitation.)
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First point: The baby’s head could get trapped. Not ripped off: trapped.
Second point: 29 weeks is far too early to talk about sectioning for breech. Babies turn right up until labor and sometimes during (sometimes multiple times during labor) and there are non-invasive things a mom can do to encourage the baby to turn. At 36 weeks the doctor should be allowed to talk about sectioning for breech, but not before.
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Brittany G. had this to say,
Jul 28, 2010 @ 4:46 pm (Quote)
Although this OB was using this as a scare tactic, it actually can happen if the birth isn’t done properly. A few years ago in my town a mother had this happen. The baby was breech and got decapitated. The cervix can shrink after the largest part of the baby passes through (which is generally the head). Since the baby was breech her cervix needed time to re-open a but before passing the head but it wasn’t allowed to do so. The baby was decapitated en utero. It was her first child. Very sad, but true.
If she had been allowed to dilate again, the entire the could have been avoided.
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Kayla Reply:
July 28th, 2010 at 5:45 pm (Quote)
Wow! What a terribly sad story. I never knew that was even possible. I thought the OB was absolutely idiotic for even suggesting such a horrid thing. (even though it is idiotic to use scare tactics against patients).. I mean c’mon, the op was 29 weeks! Plenty of time to turn. But wow, that story makes me sad
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Brittany G. had this to say,
Jul 28, 2010 @ 4:50 pm (Quote)
Sorry, that should say “reopen a bit” not “a but”. And this is a true story, I promise. It’s not common, but when stupid or impatient OBs are involved this kind of thing can happen. Or perhaps this OB had heard horror stories and was tying to relay this information to mama in a way that would make her do what he felt was safest for her and her baby. Either way, I hope this mama found another OB and got her birth!
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Aron Reply:
July 29th, 2010 at 6:26 am (Quote)
HOW did the actual decapitation occur, though? The soft tissue of her cervix may have closed rapidly and effectively strangled the baby because of cord/head entrapment, but I’m struggling to see how the mother’s own body separated the baby’s head from his shoulders. It sounds more like a case of severe entrapment made worse by poor forceps intervention or pulling on babe’s body. Either way, I’m so sorry this mama had to experience something so awful.
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Jen Wilson had this to say,
Jul 28, 2010 @ 5:08 pm (Quote)
Somehow my complete-breech daughter managed to get here undecapitated. It took a lot of work on the part of the midwife to keep the baby in until I was fully dilated, but she made it.
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Heather Reply:
July 28th, 2010 at 8:04 pm (Quote)
Why did she stop the baby? Just old school where she thought that babies shouldn’t be born before a 10 or specifically because of breech presentation?
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Jen Wilson Reply:
July 29th, 2010 at 4:49 pm (Quote)
Specifically for breech presentation. It actually is a concern with full- and footling-breech to have the body come out too early and have the head get seriously stuck, which is bad because the umbilicus would already be out and getting squished in all the contractions. Some breeches, such as transverse and partial should not be attempted vaginally.
If you want my birth story, here’s a link: http://butterflyskitchen.wordpress.com/2010/07/29/the-caterpillars-birth/
It can be done, but it is a lot more of a time-consuming and hands-on event than most medical professionals are willing to participate in.
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Heather Reply:
July 30th, 2010 at 3:03 pm (Quote)
Thanks for sharing your story! It was a wonderful, inspiring story 
While yes, it can be risky, it can also be just fine: http://www.midwiferytoday.com/articles/ruleof10.asp
http://www.youtube.com/watch?v=jD5939e5PZ8
Of course, so much knowledge has been lost and so much fear put in place in the art of baby catching that it’s hard to tell when to allow what any more It’s wonderful to see stories such as yours still happening! Congratulations on your little girl, btw
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I’ve just taken a look at four old OB textbooks (from 1943, 1941, 1914, & 1947). All discuss decapitation, but not in relationship to breech presentation, but as it relates to *neglected* transverse presentation. There were other, equally disturbing, destructive operations done when a breech baby was unable to be born, back in the day.
Thirty years ago, my OB would not schedule a cesarean for my breech birth, because he had seen a breech baby turn during labor, documented on x-ray pelvimetry. Baby was breech on the first film and vertex on the second! I was mad as a wet hen at the time, since I just wanted to get it over with and enjoy my baby. (I knew she wouldn’t turn, as she was and still is a stubborn little thing.) But, I have to admit, he was right and I would have always wondered if she would have turned if I’d had a scheduled cesarean.
Really, it was worth it, though, just for the look on the unit secretary’s face when I walked into L&D at 9:30 on Saturday night and announced, “My name is Teapot. I’m one of Dr. M’s patients and I’m here for my cesarean.” She looked at me like, “Oh, honey, you just don’t have a clue, do you?” Well, three hours later, I had my baby in my arms, after a cesarean. I don’t make flat statements like that unless I know I’m right!
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The other factor to consider is the “stargazer” breech position, when the baby is feet-first and his/her head is tilted upwards. Yes, in this EXTREMELY RARE scenario it could happen, and vaginal breech should not be attempted. But you would KNOW AHEAD OF TIME. Besides, it is dishonest of this OB to make it THE reason that docs won’t do vaginal breech births.
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Birth Unplugged had this to say,
Jul 28, 2010 @ 5:50 pm (Quote)
Leaving out the scare tactic, this is still wrong on many levels.
Actually, doc, vaginal breech births are done in lots of places besides Africa. In fact, Canada is taking a lot of effort to ensure that women have this option. Also, just because some women are asking for cesareans it does not make them a hot item that everyone should want.
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I’ve just discovered this site and am expecting my first baby. At my next appointment I’m going to give my OB a great big hug for being so wonderful and forthright.
I just can’t understand why so many doctors feel the need to lie to their patients. Why not just say “Sorry, I don’t feel comfortable delivering a breech baby. The risks are too many for me.” Then tell the REAL risks. Why all the “They aren’t done EVER” statements or the worst case scenarios first? It’s so childish.
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Mama Mirage had this to say,
Jul 28, 2010 @ 6:40 pm (Quote)
Yeah I just watched a lovely breech birth in which the body was born and the head was in there 5 minutes longer. A home water birth. No doctors, no decapitation. http://www.mybestbirth.com/video/home-waterbirth-breech
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THe Deranged Housewife had this to say,
Jul 28, 2010 @ 7:12 pm (Quote)
Without going into details, Google this and you’ll see that while rare, it has happened, unfortunately.
But I think this doctor is an idiot for even bringing it up. 
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justathought had this to say,
Jul 28, 2010 @ 10:58 pm (Quote)
1st off, congratulations on a great site and an introduction to an open discussion. many posters raise important points. (1) the OB misidentified the reason that vaginal breech delivery is not supported in the OB community. (2) the conversation about route of delivery is premature at 29 weeks as the vast majority of babies who are breech at that time will still turn. (3) while decapitation can occur, it is an extremely rare event and obstetric (or midwifery) management may contribute to this truly horrific outcome.
That said, I would discourage the group here for reasoning against the doctor by citing something you saw on youtube or just identifying the doctor as “an idiot”. This site has the potential to be a great forum for dialogue but comments like this don’t foster responses from the OB community.
Cesarean for breech presentation is recommended largely based on the results from a trial published in 2000 in the lancet, a leading medical journal, by Mary Hannah. The title of the article is “Planned caesarean section versus planned vaginal birth for breech presentation at term: a randomised multicentre trial. Term Breech Trial Collaborative Group”. The trial included 2083 women who were assigned to either cesarean section or planned vaginal birth for breech presentation at term and followed both outcomes for babies and moms. The trial found that for the health of mom, the two approaches were not significantly different. For the baby, however, the risk of death or “serious neonatal morbidity” , the risk was significantly increased in the vaginal delivery group (5% vs 1.6%). This difference is statistically significant.
I know. The first thing I jumped on in this study was “serious neonatal morbidity”. What is that? Well, it the authors did a good job of identifying serious issues: brain bleeds, spinal cord injury, skull fracture, baby requires tube feeds for more than 4 days or intubation for more than 24hours. And, yes, all deliveries were performed by experienced clinicians.
Now this trial has flaws that have been well explored. The trial may underestimate the harms that can be associated with cesarean section. This has been documented elsewhere and to cite the maternal risks as equal raises questions as to possible bias in the study or perhaps uncovers excess harms that exist for mothers undergoing trial of labor with breech babies. Certainly, the trial did not figure the longterm sequalae of cesarean on future deliveries. Others critique lumping baby death and serious baby injury together. That said, while death was rare, there were 13 deaths in the vaginal delivery group, 3 in the cesarean group.
Other outcomes in the vaginal delivery group that alarmed me were the number of cord prolapses (14 vaginal, 0 CS) and abruptions (6 vaginal, 0 CS). Both should be considered obstetric emergencies that risk the life of the baby. While these outcomes are tragic and rare, they do exist and the discrepancy between the two delivery routes is notable and significant.
Bottom line, I believe it’s the responsibility of every provider who offers a breech delivery at term to educate your patients so that they understand your reasoning. The OB noted by the original poster obviously did not succeed with this patient. But given the quantity of people who rebuttal the OB with anecdotal evidence of the “I saw a breech on youtube and it went ok” variety, most providers are not educating their patients sufficiently.
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My OB said WHAT?!? Reply:
July 29th, 2010 at 9:35 am (Quote)
Thank you for tins reply. This type of dialogue and discussion is very welcome. It would be enjoyable to have this type of dialogue, discussion and information on other posts as well. Our readers and commenters would welcome and appreciate it, as would we at MOSW. No name calling allowed!
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Tracy Reply:
July 29th, 2010 at 11:14 am (Quote)
I would think the other flaw in the study would be the level of interference from the “skilled clinician” “performing” the breech “delivery”.
How many of these complications to the baby were caused by something the doctor did?
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Rae Reply:
July 29th, 2010 at 11:25 am (Quote)
If I remember right, they didn’t account for interventions doctors made during vaginal deliveries. I think they also didn’t account for whether or not the doctor was experienced and I think that they also didn’t account a difference if the baby was dead and/or injured before labor even began.
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Justathought Reply:
July 29th, 2010 at 4:19 pm (Quote)
Tracy & Rae, Thanks for comments. It is certainly causing me to read the trial closer. So, the Term Breech Trial Group -did- account for physician experience. The physician had to be vetted by the chair of the dept as a experienced clinician. They also excluded fetal anomalies and stillbirth.
They did not examine other interventions during labor (or, as Tracy says “interference”) and this certainly can play a role.
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Rae Reply:
July 29th, 2010 at 11:22 am (Quote)
It’s so funny that you mention this study.
It was one of the two studies we learned about in our first class of Statistics for Psychology course.
It was used to illustrate that studies and stats can mislead.
I remember there were numerous things wrong with the study, it was presented along with the study about babies being smarter if they listened to Mozart.
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Brige Reply:
July 29th, 2010 at 3:15 pm (Quote)
If I am thinking of the same study, it forced hospitals to have a certain percentage of vaginal breech deliveries attempted/done, and therefore many of the leading hospitals who had experienced dr.s and staff with breech knowledge opted out as they didn’t feel comfortable “forcing” a woman to have a vaginal breech delivery to fulfill a percentage group…
So you had the leading hospitals choosing not to participate in the study, and hospitals and staff with little to no breech experience contributing to the study… of course you are going to have bad outcomes right?
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justathought Reply:
July 29th, 2010 at 4:05 pm (Quote)
That is interesting! I had not read that through the commentary on the study. Do you know if that is written up anywhere? It’s a very valid critique. As I said initially, this study has many flaws. However, it is the largest trial we have to date and I think part of reading the literature is trying to take what you can from each study — even a study with some design flaws.
I have issue too with randomizing people to this intervention (trial of vaginal breech or CS). Most experienced clinicians would prefer to individualize their approach. For example, we know that footling breech babies will be at higher risk for cord accident at which point, an experienced clinician may want to rediscuss with the mother.
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Birth Unplugged Reply:
July 31st, 2010 at 9:56 am (Quote)
I’m a bit late with this, but I wanted to share this site, which has links to several critiques of the Term Breech Trial: http://breechbirth.ca/Research.html
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justathought Reply:
August 1st, 2010 at 11:06 pm (Quote)
Thanks for the link. Great resource!
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justathought Reply:
July 29th, 2010 at 4:15 pm (Quote)
Reminds me of mark twain “statistics don’t lie, people do”. The sad part of this study is that it has really forced the hand of the ob community. I don’t see it as much as that the study was intentionally misleading but it realized conclusions that may have been different with different study design.
A better example of misleading conclusions drawn from a study is the breast cancer and postmenopausal hormone data from the Women’s Health Initiative.
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Jane Reply:
July 29th, 2010 at 4:01 pm (Quote)
Justathought, thank you.
Did the study account for WHY the baby was breech? I’m a moderator on an anencephaly support forum, and we’ve found that there seem to be a larger number of breech babies there than in general, in part because the baby’s head doesn’t swing down to engage in the pelvis (being smaller) or possibly because the baby feels too much pressure that way and stays head-up. Obviously an anencephalic baby would die after birth regardless of the method of delivery. I’m sure there are other birth defects that are more likely to result in breech presentations, as well as defects of the uterus (I know that badly placed fibroids or a bicornate uterus can result in breech and transverse lies). Were those accounted for in the study?
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Justathought Reply:
July 29th, 2010 at 4:09 pm (Quote)
Jane, thanks for bringing me in on the discussion. Most trials of this sort exclude fetal anomalies. Fetal anomaly is a well-established risk factor for breech and infant death. From my understanding, this trial did enroll babies with birth defects but noted their outcomes separately. The results I quoted above exclude fetal anomaly.
They did not, however, report on other causes for breech (altered uterine anomaly, multiple gestation, etc).
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CCindy Reply:
July 30th, 2010 at 6:59 am (Quote)
justathought, welcome to the discussion. I read about a study about a year ago that compared breech home birth with midwives and rates of transfer and such and the final result was 1 out of 40 breech babies died. That being said 39 out of 40 lived (or were fine-sorry it has been awhile) and I believe this must be presnted as the mom’s choice. I’m the trust mom’s gut lady. I would be interested to see a study where the mom’s self selected rather than where they were “forced.” I would predict a better outcome for all.
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Wendy Reply:
August 1st, 2010 at 6:43 am (Quote)
That you all for providing me with a fascinating and civil conversation to lurk in on! If you’ll permit me one nitpick, Justathought, I did take issue with one statement: “.. . I would discourage the group here for reasoning against the doctor by citing something you saw on youtube or just identifying the doctor as “an idiot”.”
Did I miss the post citing YouTube? Can you point me to anybody, at any time on this site, who has cited YouTube? Because all that I am seeing in this discussion and others are well-educated women who have not only done their research. And from the discussion that has ensued from your post, you’re seeing it, too. 
I make it my mission to challenge the simplistic dichotomy of “know-all physician v. ignorant lay public.”
I agree that when a woman is exercising her legal and fundamental right to refuse a medical intervention, she should ideally being doing so on stronger grounds than, “My doctor’s an idiot.” But even if she doesn’t, it is nonetheless her right. I’ll concede that the name-calling on this site does get excessive. But after enduring countless invasive and anti-evidence interventions in our maternity “care,” of course we’re going to feel angry. I’m not justifying some of the comments on this site…just explaining them.
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Justathought Reply:
August 1st, 2010 at 11:24 pm (Quote)
Point well taken. By my comment, I in no way meant to represent the readership here as ill-informed. To the contrary, the replies here are fantastic and the discussion is both informative and interesting.
There was a youtube reference though. I’m sorry to single out “Heather” of 7/30 3:03pm who did link a youtube video as evidence that breech delivery could also be “fine”.
However, there are ample links/references and discussion here for someone to inform themselves so that they can make an informed decision and discussion with their MD/DO/CNM/LDM/etc.
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llamacroft had this to say,
Jul 29, 2010 @ 12:16 am (Quote)
Breech birth still occurs in the UK, as it should! Met a MW last month who attended a home water birth of a breech baby. Shame on them for naming Africa in that way implying its somehow backward!
OH was breech, yep , he definitely has a head.
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Decapitated?!! Aye, babies have to run a game show gauntlet through the ‘Birth Canal of Terror’ leaping out in order to avoid the chopping knives lodged at its exit.
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Sarah Dorrance-Minch Reply:
July 30th, 2010 at 12:49 pm (Quote)
On the up side, it’s a perfect form of defense against sexual assault and unwanted, unneeded medical procedures.
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I’ve just read the comments and I am not googling decapitated breech babies, so I will take your word for it that it’s possible.
However, I do not think it is possible for a baby to be decapitated by a cervix or vagina! That would have to be caused by a meddling OB.
To pp asking about the midwife waiting to deliver a breech baby: panting/breathing through the urge to push as long as possible is the attempt to ensure that the cervix won’t clamp down before the head is delivered.
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Our baby was born breech two months ago – at home after a very, very short and quick labor and no medical personnel around (this was not a planned, unassisted home birth – we had no time to make it to the hospital). He came out breech (I had a prenatal appointment with my midwife abt 18hrs prior to the birth where baby was still head down – thus had turned shortly prior birth). Baby is doing great , no problems at all due to be born breech, nor without medical assistance (once again, this was NOT what we had wanted) and fortunately not due to him being premature (he was a 6 lbs nevertheless). His head is still were it belongs to be.
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Wow. I never knew the vagina was a guillotine. As for breech birth, the only reason doctors don’t want to deal with them is because C-sections are more convenient and make them more money. Breech at 29 weeks is no big deal. There’s plenty of time to turn but why let the mama know that? It’s much easier to make her anxious the rest of her pregnancy and use that fear to get whatever you want during the final weeks and *if* she allows herself to experience labor instead of turning her body over to cut the baby out.
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Margarett the Oklahoma Midwife had this to say,
Jul 29, 2010 @ 6:07 pm (Quote)
Geeze! I have caught over 15, all have their heads and all other body parts!!!!
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Sarah Dorrance-Minch had this to say,
Jul 30, 2010 @ 12:48 pm (Quote)
I turn my back for one day (and no, I’m not in labour yet, alas) and what do I miss? Two REALLY cool Thoughtful Thursday quotes, and this bit of idiocy.
Oh my!
Decapitated?!? REALLY? I never heard of that (and at twenty nine weeks, it’s really early to determine the baby’s final position – heck, at thirty six weeks, that’s still jumping the gun – babies can and do flip at the last minute).
It must be my vagina dentata. I bite at the slightest provocation. Which reminds me, about those cervical checks…
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Staring at my footling breech Baby A who was born, head intact, 35 minutes before her posterior vertex little brother. 
Story is here for those interested in a twin birth at home:
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Here’s a little food for thought:
http://www.lamaze.org/Research/WhenResearchisFlawed/VaginalBreechBirth/tabid/167/Default.aspx
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justathought Reply:
August 1st, 2010 at 11:49 pm (Quote)
Thanks Wendy. As you may have guessed, I’m really very interested in this topic. I hadn’t logged in for a bit but saw BirthUnplugged’s linke to http://breechbirth.ca/research.html as well as your Lamaze link. I would favor the breechbirth site as their research is very good and a little more balanced (although they are proponents of breech birth). The Lamaze site unfortunately suffers from some “flawed research” of its own.
They site an article from “Su 2004″ which is likely the secondary analysis of the Term Breech Trial by Min Su (BJOG 2004). In this, she explored the outcomes to classify the adverse outcomes to attribute them to labor type, delivery, or other factor. While the lamaze site portrays Su’s findings as if she concluded favorably for breech delivery, Su concludes “Planned caesarean was associated with a lower risk of adverse outcome due to both labour (RR 0.14, 95% CI 0.04–0.45, P < 0.001) and delivery (RR 0.37, 95% CI 0.16–0.87, P= 0.03), compared with planned vaginal birth. Prelabour caesarean and caesarean during early labour were associated with the lowest risk and vaginal birth was associated with the highest risk of adverse outcome due to both labour (0%, 0.4% and 2.2%, respectively) and delivery (0.2%, 0% and 3.1%, respectively)."
In the two readings of the Su 2004 article I've done. I really can't find where Lamaze has based their claims. Nowhere in the study is mentioned anything about the ("7 (13.7%) were attended by clinicians with 'no experience'"). Rather, to be included in the study, clinicians had to be vetted as 'experienced in vaginal breech delivery' by their dept chair.
Additionally, lethal abnormalities were excluded in all analysis and the findings still stand.
I also believe the Term Breech Trial has significant flaws but not for the reasons cited by the Lamaze group. The breechbirth.ca site has a great index of journals and their conclusion without misrepresentation that argues very nicely for attempting breech birth. The comments and links on this topic here are also convincing.
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Wendy Reply:
August 3rd, 2010 at 5:19 pm (Quote)
Thanks for the feedback, Justathought (mouthful of a username, btw! ) The Term Breech Trial was the one I was focused on, but I’ll have to take a thorough look at the Su study, of which I have only seen the abstract. I’m intrigued especially about the “no experience” factor. How do the authors define “adverse outcomes?” I would agree, for example, that a broken collarbone from a either a cesarean or a VBB would constitute an adverse outcome. But what does the research tell us re: differences in neonatal mortality? I have more, but my little girl just woke up. To be continued…
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prochoice doula had this to say,
Aug 5, 2010 @ 2:28 pm (Quote)
DEAR LORD SOMEBODY PLEASE GET THIS DOCTOR A MEDICAL TEXTBOOK!! Even if you don’t support vaginal births for breech, there is NO way to say something that outrageous just to get your point across.
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Dang, how did all those breech babies born back in the “dark ages” manage to live??? Doc, if you’re gonna give a risk list, at LEAST make it real. Yes, there are risks with breech births, but decapitation isn’t one of them. This is probably his/her way of saying “I have no clue how to do a vaginal breech delivery, since they didn’t teach that in med school/residency”.
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Cara Reply:
July 28th, 2010 at 3:12 pm Cara(Quote)
And, way to worry the Mom about something that isn’t even a concern yet! It’s not time to worry about breach presentation until 36 weeks (roughly). And to top it all off, there are several ways to turn a baby!!! My niece was told her baby was breach, they scheduled her c-section, and hey whaddya know, when they cut her open the baby was… head down.
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Jen Reply:
July 28th, 2010 at 3:50 pm Jen(Quote)
They didn’t do an u/s to verify position before cutting her open?! WTF?
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Elizabeth Reply:
July 28th, 2010 at 3:17 pm Elizabeth(Quote)
Have you seen ancient obstetrics? Just google “Embryotomy”. For the weak of stomach, I’ll leave it at that.
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Vanessa Reply:
July 28th, 2010 at 3:39 pm Vanessa(Quote)
Ya, breech does not mean “unable to deliver naturally”. This practice is still used today in many third world countries. It’s most often because of ACTUAL “failure to progress” and “small pelvis” which makes it impossible for a woman to give birth no matter what the baby’s position is. This condition is most often caused by malnutrition in childhood leading to women of extremely short stature and who’s body’s have not developed properly (for instance in countries where women do most of the physical labor from as early as they can walk and can carry more than us or our husband’s probably could by the time they are 8 years old!)
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jim dorey Reply:
July 31st, 2010 at 1:19 am jim dorey(Quote)
yah, and considering most of that failure to progress is doctor caused, and nearly all small pelvis cases are outright bullcrap, it’s just more reason for doctors to grab a scalpel.
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Sarah Dorrance-Minch Reply:
August 1st, 2010 at 4:23 pm Sarah Dorrance-Minch(Quote)
Here it is. We forget what conditions are like in non-Westernized third world countries.
In the third world, malnutrition is a chronic problem, and often the mothers have ricketts, beri-beri, and other diseases that can deform the pelvis and make childbearing impossible without assistance.
Even without a ratchety pelvis, malnutrition is a serious problem in pregnancy and birth.
The babies can be low-weight and experience problems of their own; the mother can develop congestive heart failure if she is very badly starved, and she is at much higher risk for placental abruption, placenta previa, haemorrhage after the birth, and other serious problems. Because her skin lacks elasticity, she is more likely to tear in her cervix and/or perineum, and tear badly at that.
The babies are often stillborn due to lack of adequate nourishment in the womb. Sometimes the mother fails to go into labour, and the dead baby is trapped inside, and it is too late in the pregnancy for it to be reabsorbed into her body.
The procedures doctors often like to inflict on Western women who are obviously not at risk for these problems because we generally eat better and lack the health problems of chronic starvation and nutritional deficiency – even those of us who are poor, unless there are unusual circumstances (hi, I’m unusual; I researched this in the wake of a medically indicated abortion I had sixteen years ago, to try to cope with my grief and make sure it was really necessary or at least arguably necessary since I’d been suffering from malnutrition at the time and developing heart problems) are generally unnecessary in context.
The problem isn’t that the birth interventions are inherently bad, it’s that they are applied universally, when most of the time in affluent countries, they are not needed.
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Serene Reply:
August 2nd, 2010 at 2:08 am Serene(Quote)
I have a strong stomach, but *hurl*
Wrong on so many levels, but the transverse lie… Kinda not surprised there, nothing else could be done 150 years ago! If it happened nowadays though… yet another reason I dont like theatre!
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