You are 36 weeks pregnant, and your midwife thinks your baby is breech. You’ve been planning a natural birth, at home, or in a beautiful midwifery-led unit . Your plans are now turned upside down. You have a lot to organise, and a limited amount of time to do it.
You read up on your options: download Jane Evan’s Breech Birth: What are my options? on Kindle.
You read about the breech conferences occurring around the country and realise a movement is afoot.
But what about you? What is best for you?
Then you attend your consultant clinic appointment.
The bedside scan confirms that your baby is definitely breech. Everything else is normal, but the consultant (who may actually be a registrar, but you’re not sure) informs you that if your baby remains breech you will need to have a caesarean section. You ask about the possibility of a vaginal breech birth, but the conversation is redirected to external cephalic version (ECV, turning the baby in the womb). An ECV is scheduled for early next week without much discussion.
What now? How do you access support for a vaginal breech birth in an NHS hospital, or even an opportunity to explore your options in an open and supportive way? No one can perform a caesarean section without your consent, but in the face of resistance from the gatekeeper, the task ahead is daunting.
However, it can be done, and you are not alone.
Top tips for engaging the support you deserve:
1) Become involved with a peer support network. Several Facebook groups offer support for women considering breech options. You can learn from each other, and may find some leads for local support. What was best for one woman may not be best for you, but it will help you explore the possibilities.
2) Ensure you have spoken with a Consultant Obstetrician, ideally the Labour Ward Lead. This professional will be the most likely to have the skills to support you and other professionals caring for you, and the most likely to be in a position to offer you support without resistance from their own colleagues.
3) Ask to speak with a Consultant Midwife, or a Supervisor of Midwives, or both. Consultant Midwives are highly experienced midwives, many of whom are responsible for promoting normality in the units where they work.
Supervisors of Midwives have a responsibility to support both you and your midwives’ skill development.
4) Ask for continuity. If the hospital you plan to give birth in is not regularly supporting planned breech births, or if you want to plan an upright breech birth and the staff have minimal experience of upright breech, a small team of people who are properly prepared is miles better than presenting an unusual birth plan to whoever happens to be on duty the day you go into labour. Continuity enables you to establish trust with your caregivers, and enables them to brush up on their skills in preparation for your birth, which makes it safer for everyone.
5) If you have not been able to arrange continuity, or feel you need more, engage external support. You shouldn’t have to do this. But breech-land is a lonely place to be without support, and you may want a second opinion. Some forward-thinking Trusts have given bank contracts to Independent Midwives with breech experience, enabling them to fully support the woman as part of the multi-professional team; this requires a high level of trust, communication and open co-operation. You may also be able to find a doula who has experience supporting planned breech births.
6) Ask the hospital what they are doing to prepare. Each hospital is required to rehearse breech emergency scenarios, so what better time to have a few live role plays on Labour Ward than when preparing for your birth? It’s an excellent time to have a mini-training session as well, which will help staff to be prepared, especially if you are planning an upright birth for which they have little formal training.
7) Write your birth plan and practise the ‘broken record technique,’ and/or employ Mary Cronk’s assertiveness phrases as you and your partner calmly make clear the plan you have decided upon.
When your baby is in your arms and the dust has settled, don’t forget to feed back to the hospital about your experience – the good and the bad. Copy the letter to the Lead Obstetrician, the Head of Midwifery, the Maternity Service Liaison Committee and any service within your local hospital responsible for monitoring patient experience. Your voice and your experience may really help make the road easier for women in the future. And since you have almost a 10% chance of having another breech baby, you may even be doing yourself a favour!
Part 2: Focusing on you – considerations when planning a breech birth will discuss what your birth plan might include, and general safety considerations.
Shawn Walker is an independent midwife researcher and breech specialist midwife. Working with feedback from service users, she developed the Heads Up Clinic in an NHS hospital, providing continuity throughout the breech care pathway. She currently does consulting work for a variety of NHS Trusts, and supports breech births where requested by staff or individual women, and she helps to disseminate breech skills through teaching work nationally and internationally. Her research concerns the development competence and expertise in upright breech birth.