Believe that some boundaries are meant to be crossed.
Following the light of the sun, we left the Old World.
CHRISTOPHER COLUMBUS
In 2000, following a single research study, an abrupt shift in clinical practice ensued, and term breech cesarean sections increased around the world. The pool of expertise in vaginal breech birth shrunk rapidly and today most midwives and obstetrician-gynecologists graduate with no experience with vaginal breech delivery.
The Term Breech Trial is the largest randomized clinical trial ever undertaken on term breech mode of delivery, and while it offered a wealth of information regarding breech birth, it also had a number of weaknesses which have been identified since its publication.
Inadequate case selection and intrapartum management, as well as grouping together maternity units with markedly different skill levels, lead to misinterpretation of the data and premature clinical changes. Most alarmingly is the conclusion that short-term morbidity would be an appropriate surrogate marker for long-term neurological impairment. In fact, four years later, the authors published follow-up results to the study, concluding, "planned cesarean delivery is not associated with a reduction in risk of death or neuro-developmental delay in children at 2 years of age."
More recent studies have supported the overall safety of breech birth when in judicious hands; however, the American College of Obstetricians and Gynecologists recommends cesarean section for breech presenting babies at term because of "diminishing expertise" in vaginal breech birth.
Penny Lane MSN, CNM, IBCLC of Believe Midwifery Services has acquired a level of experience and expertise beyond the norm for today's modern obstetrical practitioner. While only half of all women carrying a breech presenting baby at term prove to be an appropriate candidate for vaginal breech birth, our staff is well-prepared to support your informed choice.
Penny Lane is the mother of three breech babies. She is quite passionate about creating safe options for families facing breech delivery at term. As a nurse at the Indiana University Medical Center, Penny was witness to a handful of breech deliveries, both term and preterm. The first homebirth she attended in the support role was a surprise breech and another soon followed while she was employed as an assistant within a local birth center. After opening her own practice, Believe Midwifery Services, Penny became acutely aware that options for vaginal breech birth in the community were not only absent, but providers were without training for even those that might occur by surprise. She then attended the International Vaginal Breech Birth Conference in Ottawa, Canada in 2009 and later, in 2011, hosted a breech workshop in Indianapolis. This later training offered not only an intriguing discussion with Betty-Anne Daviss RM regarding her experience in Germany with up-right breech birth, but also offered a highly sought after simulation training with Canadian obstetrician, Dr. J Peter O'Neil. Penny had the pleasure of managing three simulated vaginal breech births as the primary midwife, assisting at three more, and observing an additional 86 vaginal breech birth deliveries. Birth of the second twin, when presenting breech, can on occasion require extraction. During the same workshop, Penny managed one breech extraction as the primary midwife via simulation, assisted with one extraction, and observed an additional twelve.
While we work to provide safe vaginal breech birth options, Penny is quite diligent in discovering breech presenting babies during the antepartum period so techniques can be utilized for turning baby into the cephalic presentation (head first). These techniques are effective and pose less risk that term vaginal breech birth.
