One of my favorite modules. I really, really want to feel competent at vaginal breech deliveries. It's really becoming a lost art but it's definitely something all midwives should know, in case of a surprise breech.
There's a crazy long list of risks to the baby from a breech delivery, meaning it can be much more dangerous to be born that way. A lot of the risk, however, seems to depend on the skill of the person who is attending the birth. On YouTube, there are all kinds of really bad breech videos where the doctor is literally yanking and pulling on the baby's body because they don't know how to deliver the head and they panic. Last time I checked, there wasn't even a good breech video posted on YouTube.
After watching the correct way of how to deliver a breech (at Casa last year), I took a weekend-long training from the midwife who did the delivery. Then, a few months later I took her training again. It's partly my need to seek perfection, but the muscle memory exercises of walking through the delivery with a doll and a pelvis again and again and again were so helpful.
The interesting thing about breech babies is that they often have a very good reason for being breech. Not all babies are meant to come out head down. I don't think we give babies enough credit for having knowledge or instinct about how they are supposed to be born. If a baby just won't turn head down, despite all kinds of ways to help it, maybe it is for a good reason. Maybe the baby knows it has a short cord and would be strangled if it turned. Maybe the placenta is in a spot that makes it impossible for the baby to turn. Who knows. But, this is one lesson I took from the training and why I'm not so quick to say to a woman with a breech baby, "Oh, just go get acupuncture." There's usually a lot more going on.
Palpating a breech (using my hands to feel the baby through the mom's belly) is cool. But, they're also easier to miss than you'd think. Sometimes, the butt can feel very much like a head. It's definitely a skill I want to be better at.
I had an interesting conversation with my grandmother not so long ago. She birthed her 10 babies in a time when there were still doctors who were trained in vaginal breech deliveries, so it wasn't such a big deal as now to find someone willing to attend the birth. I was asking her if anything unusual had happened with any of the births. She said all casually, "No, nothing unusual. Oh, well, except for your dad who came out feet first." She was so nonchalant about it and I was like, "WHAT!? Really!?" To me, it's cool.
As for twins, I don't have the same interest in attending that type of birth as I do for breeches. I suppose it would be great to see, though. The local standard is to have four midwives at every twin birth at home (and yes, it is legal in CA to deliver both breeches and twins at home). There are two midwives for the mother and one midwife per baby. Add in assistants/students, the dad, family members, and maybe a doula, and you've got a party. I've been to a handful of twin births in the hospital but so far none at home.
As part of my assignment, I had to create a list of doctors who are willing to attend breech or twin births in the hospital. Basically, the list is very short. Based on personal experience and that of other midwifery students I trust, I came up with one Kaiser doc and one at Alta Bates. Doctors at UCSF and Stanford will do breeches and twins but they require that you deliver in the OR. There are, of course, midwives who will attend both twins and breeches at home, but it's not exactly advertised, even though it's legal.
I just really want to be able to offer women who can't access the limited number of doctors willing to help them and who want to avoid a mandatory cesarean. Options are always good to have.
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