Wednesday, May 09, 2018

Obstetric violence--where #metoo births birth

Obstetric violence is a real thing. It's a form of physical and sexual assault. It comes in many forms--from little things like clamping the cord when the mother has specifically said "no," to big things like non-consensual episiotomies or cesareans. I've seen it happen as a doula, and I've written about it in my PhD dissertation.

This recent article by Sarah Yahr Tucker knocks it out of the park: Doctors Frequently Abuse, Coerce, and Bully Women in Labor, Doulas Say.


If you want to make a difference, please donate to the "Mother May I?" documentary. If you donate today or tomorrow, a generous donor has offered a $5000 matching grant. Only 6 days left to fund the documentary!
Read more ...

Tuesday, May 01, 2018

Announcing...Breech Without Borders

I'm excited to announce a new nonprofit initiative called Breech Without Borders (www.breechwithoutborders.org).

Breech Without Borders is an organization dedicated to disseminating knowledge about breech pregnancy and birth. It helps information cross linguistic, geographic, and knowledge borders by:

  1. Translating existing material about breech into multiple languages
  2. Supporting breech research, publication, conferences, lectures, and training workshops
  3. Making information about breech more accessible and understandable to both health care providers and to the public


Our website is a placeholder site until we can get a professionally designed site created. We already have a few translations done in French, German, and Dutch.

If you have a skill that you would like to contribute to Breech Without Borders--illustration, graphic design, translation, accounting, grant writing, etc--please get in touch with me.

Here are a few things we need help with specifically:

1. Someone to serve as Treasurer on the Board of Directors--preferably with accounting experience and/or familiarity with the financial requirements of US nonprofits.

If you can help in this capacity but don't want to be on the Board, I'd love you bring you on as an adviser to the Treasurer. (We have one volunteer already for the position, but she isn't familiar with US nonprofits, so I'm still open to finding a person with the right background).

2. Someone with medical illustration skills. I have several projects that need a series of illustrations.

3. Translations! We can always use more volunteer translators.

I'm in the process of writing the articles of incorporation and registering the nonprofit with state & federal governments. I'm really excited to get this project started!
Read more ...

Monday, April 30, 2018

Illustrations of the breech mechanisms from a 1908 French textbook

This textbook by Farabeuf and Henri V is over a century old, but the illustrations are still some of the best I've ever seen. The attention to detail, the lifelike appearance of the fetus...beautiful.

These are the complete set of illustrations from the chapter on the mechanisms of breech birth. There are other chapters on how to diagnose type of presentation by touch, interventions (maneuvers), and how to perform but full & partial breech extractions.

To reflect today's increased interest in upright breech birth, I have rotated some images to keep the maternal spine consistently upright.

















Read more ...

Friday, April 06, 2018

10 mechanisms of upright physiological breech birth

This short video shows 10 key mechanisms of a normal upright breech birth.

1. Buttocks/feet emerge sacrum-transverse
2. Body restitutes to sacrum-anterior as trunk is born
3. Legs release spontaneously
4. “Cleavage” indicates arms are not behind head
5. Baby does tummy crunches to bring down arms & flex head
6. Arms release spontaneously
7. Full perineum = head is flexed
8. Head releases spontaneously
9. Baby passed to mother
10. Cord left intact even if resuscitation is needed

When these mechanisms are present, there's no need to do anything other than catch the baby. Approximately 70% of upright breech births will occur spontaneously with no need for any hands-on maneuvers. See Louwen 2017 for more information.



The original footage is taken from a longer video of a Brazilian couple whose planned homebirth ended up at a hospital due to breech presentation. I wrote about it several months ago here.

Read more ...

Wednesday, April 04, 2018

Need help starting a breech-related nonprofit

I have an idea for a breech-related nonprofit organization. I think it's an amazing idea, and it dovetails nicely into the work I've already been doing with breech.

Illustration by Eloïse R. and used with permission

Here's a brief vision of what this nonprofit would do:

1) Translate breech knowledge across languages & geographic borders. This could involve translating research articles, presentations, lectures, blog posts, birth stories, guidelines, etc. I want to do English to multiple languages and vice-versa.

2) Translate medical knowledge and research about breech into information that regular people can understand.

3) Make research and information about breech more accessible to doctors and midwives--most of whom don't have the time or interest to do all the heavy research and analysis.

I have an amazing name already picked out, but it's SUPER SECRET for the moment.

If I were to get this going, I'd need help with the following:
  • setting up the 501(c)3 nonprofit
  • website creation & hosting
  • graphic design (because looks are important!)
  • managing finances/accounting
  • people willing to serve on the board of directors
  • grant writers
  • $$$ to help fund all of the above
And most importantly...translators!!!

I want to start with French, Spanish, German, and Russian and then add as many other languages as I can find translators for.

If you're interested and/or can contribute in some way, please PM me on Facebook (preferred) or send an email. I'll add you to a Messenger conversation and we'll go from there
Read more ...

Wednesday, March 14, 2018

Ski week at Vialattea

We got back from a week skiing in Vialattea, an inter-connected group of ski resorts in Italy & France (Sestriere, Sauze d'Oulx, Pragelato, Claviere, Cesana, Sansicario, and Montgenèvre).

We had lots of misadventures:

1) Our 2004 Opel Zafira broke down just as we got onto the freeway. The clutch was toast. We had to hobble back to Nice in 1st gear with the engine smoking. The repair would have cost far more than the car was worth, so we ended up buying a new (to us) car.

2) As Eric was packing the skis into the back of the (new) car, someone opened up the front door and stole his purse: wallet, phones, French visa, driver's license, credit cards, everything. What audacity. The thieves got away with a grand total of $30 USD, a book by Dan Chaon, and a nice leather purse that I made Eric several years ago. I'd rather pay people money NOT to steal his wallet as it's a pain to replace everything.

3) We got stuck in an icy parking lot and had to use our chains to get out. It was the only time we needed the chains, though, despite huge snowfalls right before we arrived.

4) The back of Zari's ski boot broke off while she was skiing in powder. I've never seen this happen before! She had to go down the mountain on one ski and buy new (used) boots.



Even when we weren't on the slopes, we had fun during our ski week.



Ski bloopers

Read more ...

Friday, March 02, 2018

Happy 7th birthday Inga!

A smile full of new teeth coming in, boundless energy and enthusiasm, solitary at times, talkative at other times--that's our Inga.




Inga's birth story, part 1
     Part 2: Reflections
     Part 3: Resuscitation
     Part 4: Final reflections
1st birthday
2nd birthday
Inga's weaning party
3rd birthday (which I missed because I was in Seattle with Eric and Ivy...)
4th birthday
Read more ...

Thursday, February 15, 2018

French advice on nonfrank breech birth: apply counter-pressure to the emerging foot/feet

I'm wading through obstetrical literature of the 1980s & 1990s to discover information relating to type of breech presentation and the associated risks/outcomes.

In a 1981 article by J. Dubois, Some present aspects of the problems of breech presentation and delivery, he gives advice on attending nonfrank vaginal breech births. From p. 489:


#6. The nonfrank breech. We have already seen how it can pose some particular problems. If one decides to attempt a vaginal breech birth, one should take, at a minimum, 3 precautions: keep the membranes intact until full dilation; be on guard for cord presentation or cord prolapse; at the moment of expulsion, slow the emergence of the foot/feet for at least a little while by pressing one hand against the vulva.
By implication, the last precaution refers specifically to breeches emerging feet-first, aka footling breech, and perhaps also to a complete breech with the foot/feet slightly in front of the buttocks. The French obstetrical nomenclature doesn't generally have a specific term for footling, just nonfrank (siège complet) and frank (siège décomplété).

The last part struck me, as it echoes a technique proposed by Russian obstetrician Tsovianov, the Tsovianov II. This maneuver converts a footling breech into a complete breech.

Antonín Doležal. Porodnické operace. 2007

Dubois' recommendations do not mention the goal of converting leg position, but that could be a side result of counter-pressure against the feet. This technique could provide additional time for the cervix to dilate, if not already fully dilated.
Read more ...

Monday, February 05, 2018

Severe acute maternal morbidity (SAMM)

Severe acute maternal morbidity (SAMM) is a maternal life-threatening event shortly before or after childbirth, often referred to as a "near miss."

Mantel et al (1998) describe a near miss as "a patient with an acute organ system dysfunction, which if not treated appropriately, could result in death." In other words, "A very ill pregnant or recently delivered woman who would have died had it not been that luck and good care was on her side."

In 2010, van Dillen et al published a study about severe acute maternal morbidity in The Netherlands. Following all pregnant women nationwide, they found that SAMM occurred 6.4 times per 1000 after elective cesarean section, compared to 3.9/1000 after planned vaginal birth. The risk of SAMM after a cesarean section persisted into the next pregnancy. The authors report: "Women with a previous CS were at increased risk for SAMM in their present pregnancy."

I created an infographic that represents those findings. Whenever a woman faces the possibility of a cesarean section, the short- and long-term risk to herself should be part of the discussion.


Read more ...

Friday, February 02, 2018

Can we predict the likelihood of a successful vaginal breech birth?

How likely is a woman to have a cesarean when she is in labor with a breech baby? Is there any way to predict her chances of a vaginal birth based on how dilation and estimated fetal weight?

A teaching hospital in Liverpool compiled data on all singleton term and near-term breech babies born in their unit between 1988 and 1991. Nwosu et al (1993) calculated the likelihood of having an in-labor cesarean based on both estimated fetal weight and cervical dilation at admission. They explain:
Recently Chadha et al (1992) have shown that women admitted in labour with breech presentation at a low cervical dilatation (less than 3 cm) are more likely to be delivered by caesarean section. This is in agreement with our study. Using our results for all vaginal and emergency caesarean deliveries, we are able to tabulate the likelihood of caesarean section corresponding to various values of cervical dilatation on presentation and estimated fetal weight. These results are presented as Fig. 1 (Callygram), which could assist the clinician on the labour ward in counselling the woman, and in the choice of the best mode of delivery. It must be stressed that the tabulated (percentage) probabilities of caesarean section for given values of cervical dilatation and fetal weight are derived from our sample which has not specifically addressed the question of augmentation of labour [this unit did not induce or augment] and intrapartum external cephalic version (with or without tocolytics).
As you can see, the likelihood of a successful vaginal birth increases significantly with higher cervical dilation at hospital admission. EFW also plays a role, but that difference nearly disappears at both extremes of cervical dilation.

Cervical dilation at admission depends on how long the mother waits to go in, so this is a tricky thing to use as a predictive measure. There is no automatic set point at which women go to hospital (or, at home, call their midwife). A woman's likelihood of a vaginal breech birth also varies widely by hospital and by provider. But this does suggest that a rapidly progressing labor is a strong positive indicator of a successful vaginal breech birth.

Read more ...

Monday, January 29, 2018

How does the 2000 Term Breech Trial compare to more recent evidence on term breech?

Recent studies do not support the findings of the 2000 Term Breech Trial, a randomized controlled trial that enrolled 2,088 women.

Two large multi-center studies in France and Belgium found no difference in perinatal/neonatal mortality between planned CS and planned vaginal birth. These studies--one prospective, one retrospective--followed a total of 10,200 women and had 174 & 175 participating hospitals.

Some national registry studies have found no significant differences between planned CS and planned vaginal breech birth.

A meta-analysis and other registry studies have found some advantage to planned CS, but the advantage is significantly less pronounced than in the Term Breech Trial.


Read more ...

Sunday, January 28, 2018

What would happen if all Dutch women had a planned c-section for breech?

Each year around 6,490 women in the Netherlands (40%) still plan a vaginal breech birth. This number is significantly lower than it was before the 2000 Term Breech Trial, where roughly 75% planned a vaginal breech birth and around 50% overall gave birth vaginally to their breech babies (see Rietberg et al 2003).

A national registry study by Vlemmix et al (2014) calculated the anticipated neonatal benefits if these remaining 6,490 Dutch women all planned c-sections.
If all women who nowadays still undergo a planned vaginal breech birth were to receive an elective cesarean, 6490 more elective cesareans would be performed. This would lead to an additional annual reduction of 10 neonatal mortalities, 116 neonates with low Apgar scores and 20 neonates with birth traumata.
This calculation only considers short-term neonatal benefits--not long-term neonatal outcomes, not short- or long-term maternal outcomes. Here is another way of understanding these numbers:

In several national registry studies, planned CS for breech leads to small but measurable improvements in short-term neonatal outcomes (mortality and morbidity). However, these improvements are consistently much smaller than the Term Breech Trial's findings.


This pressing question remains: at what point do the short- and long-term risks of routine cesarean begin to outweigh the short-term benefits to the baby? How many elective cesareans are justified to save 1 baby? What if women are forced into having these cesareans?

A policy of routine cesarean for breech does not allow women to decide what the acceptable risk/benefit trade-off is.

Read more ...

Saturday, January 27, 2018

Hike to Villefranche and Mont Alban

Last Saturday we hiked the Circuit du Mont Alban. So many stairs!

Read more ...

Friday, January 26, 2018

Risk-benefit calculus for breech presentation

Making a decision about how to birth a breech baby involves a complex risk calculus. Women have to weigh the short- and long-term benefits to themselves, their babies, and their future pregnancies. This graphic (created for me by Lauren McClain of Better Birth Graphics) shows how planned CS for breech has affected women and their babies in the Netherlands. Verhoveen et al (2005) discuss the effects of the increase in planned CS since the Term Breech Trial, and the results show a risk trade-off.

Between 2001-2005, 8,500 women in the Netherlands had a planned CS for breech. This increase in pCS saved an estimated 19 babies, but it also led to 4 direct maternal deaths, 9 additional babies dying in future pregnancies due to the uterine scar, and 140 additional life-threatening maternal complications in future pregnancies.


Alternative version of the graphic with text embedded in the image:



Read more ...

Sunday, January 21, 2018

Perinatal mortality in term breech birth

In preparation for my Jan 24th Indie Birth webinar--Is vaginal breech birth safe?--I wanted to share this series of graphics I have created. These will be explained in more detail during the presentation.

This first illustration shows neonatal and/or perinatal mortality rates from the Term Breech Trial, two large multi-center studies in France & Belgium (PREMODA and Vendittelli), a meta-analysis of several single-center studies (Krebs), and then a series of national registry studies.

These are all studies of term breech births of singleton fetuses alive at the beginning of labor with congenital anomalies excluded (exception: the TBT also included antepartum stillbirths).

On the right of the graphic is the type of mortality studied:
  • PNM/NNM: intrapartum deaths + neonatal deaths up to 28 days
  • PNM: intrapartum deaths + neonatal deaths up to 7 days
  • NNM: infant deaths through 28 days; intrapartum stillbirths excluded

For Vlemmix, Vistad, Hartnack-Tharin, and Vistad, I included only the data from the later time periods (usually post-TBT).

The next slide shows the same dataset, adding in planned cephalic births (vaginal & cesarean)  analyzed in two of the registry studies.


The last slide shows the relative samples sizes of the various studies. On the right side, you can see the sample sizes of the pVBB and pCS groups.


Read more ...

Thursday, January 18, 2018

Is vaginal breech birth safe? Jan 24 webinar

On January 24, I will be giving a webinar about term breech: Is vaginal breech birth safe? Come join me!


This presentation reviews research on term breech that has emerged since the 2000 Term Breech Trial. From a PubMed search of “breech” and “pelvic presentation” in the title & abstract, I extracted over 1,900 articles published between 2000-2017.

I examine the evidence on term breech broken into several categories: neonatal morbidity, perinatal/neonatal mortality, long-term childhood outcomes (1-18 years old), short-term maternal morbidity, maternal mortality, long-term maternal outcomes, and outcomes for the mother’s future babies. I examine where the evidence falls for term breech in developed versus developing countries and for breech birth at home. I present research updates on other relevant topics, such as upright breech birth and the role of maternal positioning in altering the dimensions of the pelvis. I also discuss how vaginal breech skills help make cesarean sections safer for head-down babies that are deeply wedged in the maternal pelvis.

I finally put all of the evidence together—short- and long-term for both mother and child and the mother’s future babies—and demonstrate the complex risk calculus involved in answering the question, “Is vaginal breech birth safe?”

Time: Jan 24 at 3 pm EST (12 pm PST, 9 pm in Western Europe) or listen later to the recording
Cost: $30
Duration: approx 90-120 minutes, including time for Q&A

If you can't listen live, you will also be able to access the recording. Please register today!
Read more ...

Wednesday, December 20, 2017

Indie Birth podcast on my breech research and my birth stories

I recently did a podcast with Maryn Green of Indie Birth: Restoring women's choice for vaginal breech birth: My chat with researcher Dr. Rixa Freeze.

In the first half, I talk about all of the breech-related research projects I'm working on. And then I tell my four birth stories. Come listen!


Read more ...

Saturday, December 16, 2017

We need your letters to support vaginal breech birth!


Dr. Annette Fineberg, an OB at Sutter Davis Hospital, has requested letters of support from women who have had breech babies. She is experienced in vaginal breech birth but has encountered significant roadblocks from her hospital. She has also been unable to get privileges at a nearby tertiary hospital to do breeches there.

Please write letters of support for keeping the option of vaginal breech birth available! More details below from the OB:
I need to ask a favor from anyone who

1) had a vaginal breech birth in the hospital,
2) had one at home because that was your only option, or
3) was pressured into a cesarean because it was not an option due to hospital policy or lack of experience of attendant

I am getting a lot of pressure to stop attending breech and despite my best efforts to get privileges at a tertiary care hospital with neonatology, it is not happening.

Please send your impassioned pleas and experiences to:

Sutter Davis Hospital Birth Center
2000 Sutter Pl
Davis CA 95616 
Thanks!
[And please also send me a copy of your letter so I can forward it on to the OB!]
Read more ...

Wednesday, November 29, 2017

Can a breech baby be turned during labor?

When a woman has a singleton breech presentation at term, she is usually presented with one or more of the following three options:
  • Planned cesarean section (universally offered)
  • External cephalic version, usually at or after 37 weeks (sometimes offered)
  • Planned vaginal breech birth (rarely offered)
However, a fourth option exists: an external cephalic version during labor. While this is usually done on a breech 2nd twin after the 1st twin is born, it also works for singleton babies.

Image source 
Intrapartum external cephalic version (IP ECV) is strategy for avoiding both a cesarean and the risks of vaginal birth in a singleton breech presentation, especially for unfavorable presentations such as footling breech.

Kaneti et al (2000) analyzed a prospective series of in-labor ECVs for unengaged term footling breeches with intact membranes. Of 21 eligible women, 8 chose cesarean section and 13 chose IP ECV. 12/13 versions were successful and 10/12 women gave birth vaginally. Of the two failed vaginal births, one was for cord presentation and the other for arrest of labor. The babies were turned between 2-8 cm dilatation.

All women were multips; the physicians would have been willing to attempt IP ECV in primips as well, but never had the opportunity. The ECVs were done in the OR with Ritodrine and regional anesthesia when possible. The woman with an unsuccessful ECV went straight to cesarean while the twelve women with successfully turned babies received amniotomy and continued their labors in the labor ward. The one failed ECV was with a woman at 8 cm whose membranes ruptured at the beginning of the version. There was no maternal or neonatal morbidity, and all Apgars were 9 or 10.

Ferguson and Dyson (1985) report on a similar series of 15 women in labor with term breech presentations and intact membranes. Earlier in the study period, they had attempted IP ECV on women with ruptured membranes, but with no success. The authors do not specify type of breech presentation, other than that the women were not considered good candidates for vaginal breech birth. 6 were primips and 9 were multips.

They followed a similar protocol to Kaneti’s (versions were done in the OR under tocolysis between 1-8 cm dilation; successful versions were returned to the labor ward). 3/15 had epidural anesthesia during the version. 11/15 versions were successful (2/6 for primips, 9/9 for multips) and 10/11 women gave birth vaginally. The one failed vaginal birth was due to arrest of labor in a primip. Maternal and neonatal outcomes were good.

Leung, Pun, and Wong (1999) mention performing IP ECV on 5 out of 28 undiagnosed breeches in early labor, of which 2 turned successfully and both ended in vaginal births.

Belfort (1993) includes a case report of a multiparous woman presenting in labor with an unengaged complete breech with both feet palpable through the intact membranes. When she was 5 cm and 70% effaced, an IP ECV was performed in the delivery room with IV nitroglycerin. The procedure was successful. The woman received amniotomy and oxytocin to restart contractions and had an uneventful vaginal birth 8 hours later.
Read more ...

Monday, November 20, 2017

Consent for a forced cesarean

This summer I was listening to Dr. Stu's Podcast while repainting the windows on my carriage house. (Whenever I listen to something memorable, I also distinctly remember the location where I was listening--does the same thing happen to you?) It was an episode about Consent for a forced cesarean.

In a blog post, Dr. Stu explains why he created a consent document for women being forced into having an unwanted cesarean section due to hospital policy banning breech, VBAC, or vaginal twins. The consent form is brilliant.



If all women being forced into unwanted cesareans asked their hospitals to sign this consent form before their surgery, hospital bans on vaginal birth for breech, twins, and VBACs might change overnight.

The consent form documents that the woman does not consent to the surgery, that ACOG's guidelines allow for vaginal birth in these situations and forbid the use of force or coercion, and that the hospital will be responsible for any complications due to the surgical birth, both short- and long-term.

Dr. Stu has invited everyone to download, edit, and distribute his consent form widely.

ps--I would suggest adding ACOG's 2016 Committee Opinion on Refusal of Medically Recommended Treatment During Pregnancy to the list of references.


Read more ...

Sunday, November 19, 2017

Happy 11th Zari!

We had a relaxed birthday party this year. I didn't even try to do something as amazing as last year's outdoor obstacle course. This time we baked cupcakes and bought lots of toppings...and that was it! The kids played indoors, since it was raining the entire day. They slid down the stairs on a mattress, danced with a strobe light, and played hide & seek and sardines.



Zari's birth announcement and birth story
1st birthday
2nd birthday and 2 years old
3rd birthday
4th birthday and 4 years old
5th birthday
6th birthday
7th birthday
8th birthday
9th birthday
10th birthday
Read more ...

Wednesday, November 08, 2017

Reflections on Russia

What an amazing week I just spent at the Life Birth Pelvis conference in St. Petersburg, Russia! It was challenging and overwhelming (in a good way). This is the 8th international conference that Katerina Perkhova has organized.

Some thoughts, in no particular order:

Breech knowledge doesn't always cross political or linguistic borders
I gave two presentations on breech birth: one on the history of maneuvers from 1609 to the present, the other on evidence on term breech since the Term Breech Trial. Everyone involved with breech birth in North/South America, Europe, Australia/New Zealand, and many parts of Africa and Asia is familiar with the Term Breech Trial. But not Russia! "What is this Term Breech Trial you are speaking of? We have never heard of it." I had to explain the background and significance of the TBT in order for my presentation to make sense.

Conversely, Russians were quite familiar with Tsovian, aka the Tsovyanov. I suspect they were surprised we didn't know about him! I have now discovered 15 obstetric journal articles about his methods in Russian, Czech, Hungarian, Polish, and--in one case--Spanish. I also found contemporary Czech textbooks that mention Tsovian (spelled Covjan--sneaky Czechs making it harder for me!) and a Dutch article examining whether Bracht's or Tsovian's methods came first.

I am so excited that I get to help breech knowledge cross political and linguistic boundaries! My wonderful translator Alesya is excited to translate the articles and book chapters I am working on. And perhaps some of my breech conference summaries...

Hot & Cold Water
I was puzzled at how hot and cold water were frequently suggested as remedies. Your newborn needs resuscitation? Use hot and cold water! Is your premature baby having a hard time nursing? Hot and cold water!

I didn't fully understand this concept until I did a full Russian sauna on the last night of the conference. This includes going naked into the sauna, being beaten with bunches of oak leaves (it feels heavenly, like the heat is being beaten deep into your body), and then plunging into an ice-cold pool of water. And then doing it again several times. After the fourth cycle, I got the biggest endorphin rush of my life--comparable to being in labor. You know the dizzy, buzzing, high feeling you get all over your body between contractions? That endorphin rush. It lasted for about 2 hours.

And then I got it. Hot and cold water as therapeutic? As a way to maximize health and well-being? Yes, for sure! I have a friend here in the States who is a Russian translator, and she says that Russians often use the expression "tempering the baby," as one would temper steel with repeated applications of heat and cold.

In Western (is that the right word?) obstetric practice, we're concerned about getting the baby warm and dry immediately. Allowing a baby to be cold and/or wet is absolutely verboten. Maybe we could learn something from the Russian use of hot and cold water.

Right brain, left brain
This was the most right-brained conference I have ever attended. We had one "normal" conference room with rows of chairs and a projection screen for Powerpoint slides. This is where I gave my two breech lectures, a talk on unassisted birth, and a session on newborn resuscitation with Sister Morningstar.


But our other conference room was a Red Tent room. The walls were draped with red fabrics, the chairs were replaced with bean bags, and candles and incense and altars took the place of projectors and pointers. The floors were covered with intricately embroidered fabrics. In the corners were private alcoves for doing yoni steams, draped on all sides with red fabric.





Days were partially left-brained, partially right-brained, but evenings and nights turned magical and mystical. Sometimes intimate and sacred, sometimes raw and brutally honest, but always healing. Having Sister Morningstar, a Cherokee midwife, to lead the evening sessions was an honor. I've been quite cynical about religion lately, and these five days were a reminder that women have tremendous spiritual power and that spirituality in its widest sense is so much grander than anything one religion can offer.






Read more ...

Wednesday, November 01, 2017

Breech updates: Recent evidence on term breech & maneuvers for upright breech birth (Portland, Nov 12)

If you're in or near Portland, you might like to attend this event I am speaking at on Nov 12. Space is limited, so you must RSVP to reserve a spot. Details below.

~~~~~

Breech updates: 
Recent evidence on term breech & maneuvers for upright breech birth
Rixa Freeze, PhD

Sunday, November 12, 2017 from 4-6pm

Cost: Free (donations gladly accepted by Rixa to fund ongoing research)

Location: private home of Hermine Hayes in SW Portland, near Lewis and Clark College
(exact address will be provided to those who RSVP)

RSVP to: Jesica Dolin - jesicadolin@yahoo.com

This session will share information regarding the history of breech maneuvers from 1609 to the present. The presentation begins with a historical journey through obstetrical maneuvers for breech presentation. It documents every maneuver that has been uncovered by Rixa's research, tracking them back to their original inventors and dates, when possible. Next, she looks at current innovations in upright breech birth. The presentation tracks how knowledge about upright breech birth emerged and converged over the past several decades. Rixa will describe the key principles of upright breech birth and the physiological mechanisms of normal breech birth. She'll then review the maneuvers that have been invented to deal with stuck heads and arms when the mother is upright. The session will also cover the evidence on term breech since the 2000 Term Breech Trial.

Jesica Dolin, BSM, CPM
www.HiveCE.com


Read more ...

Friday, October 13, 2017

Michel Odent on breech

Whenever I pull Michel Odent's book Birth Reborn off the shelf, it feels like phoning a dear friend after a long absence. We catch up on life and I remember why I enjoy this person so much.

Michel Odent is a French surgeon and obstetrician who was in charge of the Pithiviers Maternity Unit for over 20 years. At a time when cesarean rates were rising and births in France were highly medicalized, Odent turned the maternity wing at his state hospital into a haven for undisturbed, physiological birth. Most of his changes were low-cost and low-tech: creating an environment in which women were private and completely undisturbed during labor. He replaced delivery tables with big, low mattresses and cushions, birth pools, and simple furniture to aid spontaneous movement. His maternity unit had a 6-7% cesarean rate during the 1970s and 80s, even though it accepted an unscreened population.

I just opened Birth Reborn after a good year or two and turned to a section on breech birth. In his words and photos (pages 103-105 in the 2nd edition):

~~~~~

Finally, within the realm of labor and birth, one quickly learns to expect the unexpected. Sometimes a woman will have a quick and easy labor when professionals believed only a cesarean was possible. For example, women who have previously had a cesarean are sometimes told that they will always give birth that way. Yet at our clinic, one out of two women who have previously had cesareans succeed in giving birth vaginally. Nor do breech deliveries always justify the operation, although this has, nevertheless, become almost the rule in many conventional hospitals. From our experience with breech babies, we have found that by observing the natural progression of first-stage labor, we will get the best indication of what to expect at the last moment. This means we do nothing that will interfere with first-stage labor: no Pitocin, no bathing in the pool, no mention of the word "breech." If all goes smoothly, we have reason to believe the second stage of labor will not pose any problems. Our only intervention will be to insist on the supported squatting position for delivery, since it is the most mechanically efficient. It reduces the likelihood of our having to pull the baby out and is the best way to minimize the delay between the delivery of the baby's umbilicus and the baby's head, which could result in the compression of the cord and deprive the infant of oxygen. We would never risk a breech delivery with the mother in a dorsal or semi-seated position.

If, on the other hand, contractions in the first-stage labor are painful and inefficient and dilation does not progress, we must quickly dispense with the idea of vaginal delivery. Otherwise we face the danger of a last-minute "point of no return" when, after the emergence of the baby's buttocks, it is too late to switch strategies and decide on a cesarean. However, although we always perform cesareans when first-stage labor is difficult and the situation is not improving, most breech births in our clinic do end up as vaginal deliveries.





Here is a brief video of a breech birth at Pithiviers. Notice that the baby does not rotate to sacrum-anterior after the trunk is born (the most likely culprit is a nuchal arm). Odent steps in right away and frees the arm. The baby is born very quickly.

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