MIDIRS Essence > February 2012 > MIDIRS

Focus on physiological breech birth

Originally posted on Feb 2012

In this month's edition of Essentially MIDIRS, Jane Evans will be describing what to expect during a physiological breech birth. Here is a sneak preview of her article...

Understanding physiological breech birth by Jane Evans

"Since the release of the Term Breech Trial (Hannah et al 2000) many women, midwives and obstetricians have been concerned about the increase in caesarean section operations for breech presenting babies, and the apparent lack of choice as the skills required to safely assist a breech birth are lost.  The follow-up to the Term Breech Trial (Hannah et al 2004, Whyte et al 2004) acknowledged that the trial ended before any conclusive evidence was found and yet, still, the original research paper is used, in many units in the UK, as a reason to advise women to have a planned lower segment caesarean section (LSCS) if their baby is in a breech presentation at 38 weeks’ gestation.

The skill of the birth attendant has been shown to be the most important factor in the outcomes of vaginal breech birth (Maternal and Child Health Consortium 2000, Hannah et al 2000, Robinson 2000/01).  As well as planned breech births there will always be undiagnosed breech presentations that deserve knowledgeable practitioners to facilitate safe birth in all circumstances.

I have attended many breech births during my midwifery career, particularly during the 20 years I have practised as an independent midwife, and have observed the spontaneous movements made by the woman and the baby that facilitate a successful vaginal breech birth when they are not sedated and are free to move around during labour.  I was taught by older, more experienced midwives to observe and not interfere unless help was required, and that a breech birth could be ‘normal’; an experience that is now hard to replicate within the UK’s National Health Service (NHS). With my colleagues I have studied many sets of photographs, and the occasional video of a breech birth, and have again observed the spontaneous movements made by both women and babies. Whilst working with a doll and pelvis, and being aware of the anatomy and physiology of the pelvis and pelvic floor, it became clear that these movements, as the baby travelled through the pelvis, facilitated spontaneous birth.  With further research I found that many of these movements had been described previously, some in historical papers (Johnstone 1951, Plentl & Stone 1953, Myles 1975) but that a complete description has not yet been published..."

Article Reference:

Evans J (2012). Understanding physiological breech birth. Essentially MIDIRS 3(2):17-21.

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