This topic has become very important to me since giving birth to a breech baby last year, and I'd like to share some of my thoughts on the subject with anyone who cares to read.
Laws in many states require that mothers whose babies are in a breech or transverse position be under the care of a physician and give birth in the hospital. In cases in which the mother is planning a vaginal birth, this usually means a change in plans and a scheduled c-section. If the mother is planning a home birth with a midwife, this means changing her care to an OB and planning a hospital birth (again, most likely a cesarean section).
Why?
There are ways to try to turn a breech baby into a favorable position before birth. My blog post above describes some of these, and there is also an excellent online resource called Spinning Babies that gives great information about breech babies and how to attempt to encourage a fetus to turn into a vertex (head-down) position. Sometimes the baby moves on its own or with help and the mother is able to plan a normal vaginal birth. Sometimes however, the baby stays breech, and the mother must seriously consider her birthing options at that point.
A recent study was done which found that the risks of c-section outweigh the risks of vaginal breech delivery: C-Section Not Best For Breech Birth. The study states that vaginal breech delivery is the preferable option of birthing breech babies, and that doctors should be trained to support women in this option.
The sad truth is that doctors are no longer trained in vaginal breech delivery. With cesarean section becoming more widely used, it has become the common method of delivering a breech baby. Unless you have an older doctor who has had experience with vaginal breech births, your doctor is likely unqualified to support you in birthing your breech baby if you want a vaginal birth. With many midwives, however, the skill of vaginal breech birth is still being taught and passed down.
The laws however, do not support the evidence. Automatic transfer of care of breech babies, in my opinion, should NOT be required. I feel the laws should allow for the care provider and the expectant parents to make an informed choice in how to birth their baby.
As explained in my blog post above, there are different types of breech presentation and some are more risky than others. For example, a full-term baby in frank breech position is the best candidate for a vaginal breech birth, and a woman with a baby in this position should be given the option of vaginal birth with a provider who is skilled to support her. This could be a midwife or a doctor, as long as he or she has the proper training, and depending on the woman's preferences and choice of birth place. If the baby is a stargazer (looking upward) there is a great risk to the spinal cord if a vaginal delivery is attempted, and experts agree that a c-section is warranted. These are just two examples of breech presentations.
Transfer of care should be a case-by-case decision based on the precise presentation of the baby. A woman should be informed of her options of attempting to turn the baby, as well as the risks and options associated with her infant's presentation and all proposed methods of birth.
This may not be a realistic expectation with current trends, but I hope that in time changes can be made. If doctors are not trained in their regular curriculum about breech birth, then perhaps additional training should be made available to those who are interested in learning and offering the service to their patients. This training should be evidence-based and consistent, and available to midwives as well. Perhaps a certificate could be given, such as with CPR and NRP (neonatal resuscitation) training. Ideally, it would be a requirement for all birth care providers, as basic as any other training they receive.
