Variations in Birth The Breech Baby & some other variations on normal (including Prematurity)

Babies that are in a position other than optimal (head down facing mum’s sacrum) may be turned by various means (such as homeopathy, acupuncture, moxibustion, visualization, external version and belly dancing) before 36 weeks, however some babies choose to remain in this position no matter what and for the most part they can still be birthed vaginally as this is just a variation on normal. For example, if baby is in a breech position in a healthy mother at term. This occurs in 3% of all births.

Issues surrounding breech:

• Because the head is the biggest part, it is possible that the body (or a leg –‘footling’) can be born before the cervix finishes dilating. When the umbilical cord has air contact it can congeal which slows and stops bringing oxygen to the babe, the cord may get pinched between the baby’s head and the pelvis also cutting off oxygen. In these cases you have about 8-10 minutes to birth the baby’s head so she/he can breathe with their lungs. However, according to some experienced midwives ‘If it does appear that the baby's oxygen supply is compromised, for whatever reason, an airway can be established even before the head is born by holding the vaginal tissues away from the baby's face to establish an airway while waiting for the cervix to finish dilating and the baby's head to mould appropriately.’ 
• In some rare instances the placenta can also come away before the head is born cutting off blood/oxygen supply. In these cases – babe may be born without a heartbeat & would need to be resuscitated on birth.
• Cord prolapse may also occur because there is more chance it has room to slip through. However, the pressure on the cord may also not be so great & it may not be as immediately life-threatening.

So how to birth a breech vaginally, given these issues…….

• Relax. Continue to trust in the birth process. This is just a variation.  Labour & birth instinctively, just as you would if your baby was in a head down position. From the Pure-birth website; 

“Birth in a hands and knees position (all fours), or standing up with one foot propped up on a low stool or the side of the bathtub. Mothers left to birth as they please will instinctively choose the best position to birth her breech baby in.

This will allow for gravity to work on the baby's body as well as the downward movement of the mother's body birthing. Make sure you have your hands ready to catch your baby as he/she is birthed but do not support your baby's body.

Allow your baby's body to hang freely so their weight will help them out.”

• Opt to have a waterbirth. Waterbirth involves a gentle transition for baby from the watery womb to the world outside. The baby’s body will be born into conditions that are familiar (as in to being in the uterus) and the cord would have no reason to congeal. While there are still some issues that the cord may be pinched, in a waterbirth the mother is generally more relaxed, this includes her tissues and ligaments. In the DVD “Lotus Birth: The birth of the Malcolm Twins” – Davini (the mother) has a waterbirth at home. Her second twin is a breech. Her attendants are very hands-off and afterwards she describes the experience, that she insisted that no-one touch the baby’s body (even though it was under water) because she could feel her cervix quivering as she relaxed into pushing the baby out, she surrendered and trusted the process. In surrendering and allowing her body to do its job there was a release and she was able to birth her breech baby..
  
  Advice given in "Emergency Childbirth" by Gregory White, MD says that due to the danger to the mother and child due to rough manipulation and excessive force, it is best to leave well enough alone - "When in Doubt, Do Nothing".
  No birth attendant should EVER attempt to do anything to assist birth of a breech baby until after the navel appears and the mother has had two more contractions accompanied by bearing down efforts and you have asked her permission first.

Cord Wrapped Around Neck:   It is actually very easy and commonplace for baby to get tangled up in his cord, especially if it is long. The cord is quite slippery and designed to slide easily over the baby’s head. It is a rare occasion that Mum or Dad are not able to untangle Baby by slipping it over his head. When this is not possible baby's head may be held next to Mum's vagina creating a somersault effect as the rest of baby's body slides out and is untangled at that time.

Shoulder Dystocia: A "stuck" baby will usually free itself as the mother changes into a different position or creates buoyancy by getting into a tub or pool of warm water. If Mother is unable to move easily or Baby does not cooperate it sometimes helps for Father to reach in, hooking his finger under Baby's armpit and rotate it slightly until Baby and Mother's uterus are able to resume their dance.

Support people – remember your role…to encourage & offer unconditional love to mum.

Prematurity

Prematurity refers to babies being born before term (term is 36-44 weeks gestation). Each country has its own laws determining when a foetus is ‘viable’ (or when the medical establishment will aid in life support). In Australia it is currently 24 weeks, although there is some lobbying to change this to make it earlier.  Regardless of the age of prematurity, these little babies all greatly benefit from ‘Kangaroo Care’. 

While it is standard practice for premature babies to be placed on life support in an incubator with minimal physical contact with his/her parents, this model is beginning to change to incorporate methods of Kangaroo Care.  Kangaroo Care places the mother as a ‘human incubator’ (and is not that different to attachment parenting). The babe wearing only a small nappy/diaper and a cap on his head is held against the bare skin of his mother beneath a t-shirt or specially designed wrap. It is also called ‘skin to skin’ care for this reason. Again with this model we see that the mother’s heart rate and breathing rhythm begins to regulate that of the baby. Her own body heat warms the baby and often she is able to express breast milk which if the babe does not yet have a sucking reflex is able to be fed via a supplemental tube. The delicate nerve endings in the baby’s skin also develop faster and efficiently because they have been stimulated by the constant touch of his mother’s skin. Although Kangaroo Care shows the greatest benefit when ‘skin to skin’ is maintained 24 hours/day, most neonatal units only allow several hours of contact. While this is certainly more optimal and beneficial than having the baby in a humidicrib untouched, hooked up to tubes of antibiotics and formula and alone the whole time, as parents I urge you to do your research on Kangaroo Care to make this standard and established practice for as long as you and the baby need.

A very very small number of women around the world, whether well educated by our Western standards, or simply tribal women who follow only their instincts choose to birth their premature babies in the comfort of their own environment and employ Kangaroo Care 24/7. It is do-able, practical and it does take a lot of courage in our western world and a strong faith and confidence in your knowledge, understanding and beliefs. However, evidence is beginning to show that benefits of following this instinct-led common sense approach far outweigh routine medical procedures. Premature babies who have enjoyed Kangaroo Care also enjoy faster and more consistent growth and less developmental and health concerns later on in life. 

Again, I urge you to follow up with the resources linked to for further information about prematurity and your options.