Breech Birth: No Cesarean Needed

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Breech birth is one of the most misunderstood and controversial subjects when it comes to women’s pregnancy and delivery. A breech birth occurs when the baby has its head positioned up instead of down in the uterus. Therefore, coming into the world butt or feet first. Most women will never have the option to decide what they want to do when faced with a breech baby. A planned cesarean section is performed for 94% of all breech babies.

If your provider is an OB, DO, or hospital CNM, you most likely will not be given a choice. Breech births can be successfully carried out without a cesarean. In this blog, we will be discussing the different methods used to deliver these babies without a forced cesarian section. 

How Breech Birth Can Be Fixed Internally 

You may be given the option to try to turn your baby in a procedure called ‘external cephalic version’, or ECV. (This is a procedure where the provider attempts to shift the baby from head up to head down using a deep massage technique.) It can be quite painful, or not, depending on the provider’s technique and how difficult it is.

This procedure is about 74% successful and most people who have a successful ECV will go on to have a vaginal birth. For those whose baby doesn’t turn, the majority (88%) will have a cesarean birth – either by choice or because they are forced as they cannot find a provider willing or able to help them birth their breech baby vaginally.

Most hospital providers have not been trained in physiologic breech birth. Rather, they may have been trained in a procedure called “vaginal breech extraction”. This is where the pregnant person is on their back and the baby is pulled out using various maneuvers and ending with a forceps delivery of the head. This is dangerous and often results in damage to the baby, mother, or both. No wonder most providers are unwilling to provide vaginal birth as an option for clients with a breech baby.

How Breech Birth Can Be Done by Changing Position 

In contrast, there is a technique that uses the gravity of the baby moving naturally through the mother’s pelvis. Called “physiologic upright breech birth”. As the name implies, the client is either standing, kneeling, squatting, or on hands and knees. The baby births itself most of the time. A skilled provider will know if the baby needs any help and when to apply which maneuver.

There have been multiple studies that have found no differences in the long-term outcomes between planned CS or planned VBB. Some studies have found a slightly higher risk for the baby between pVBB and pCS. Although, some studies found no difference. The unknown factor is the skill level of the provider

Why Breech Birth is Usually Solved by a Cesarean 

There is almost no option for having a pVBB in the hospital, in the United States. Many people seek alternative options for the birth of their breech baby. Even though this is not their first choice. Home breech birth has been shown to have poorer short-term neonatal outcomes compared to hospital breech birth. But, we don’t know what really causes these poorer outcomes. Anything from an inexperienced provider, possible congenital anomalies, delays, or miscommunication during transfers are all potentially at fault. It’s very possible that home pVBB outcomes could be significantly improved by improving provider training for breech birth.

By eliminating the option for a hospital birth for pVBB, lawmakers, hospital administrators, and Obstetricians are effectively forcing people to have cesareans. This goes against state and federal rulings that protect a person’s right to refuse surgery, as well as moral and ethical mandates to respect bodily autonomy.

Breech Without Borders 

At Midwife360, Fadwah has been trained in the art of VBB and has attended a handful of pVBB in and out of the hospital setting, as well as several breech births in the hospital during twin births where the second baby is coming breech. She has attended and is working with Breech Without Borders Breech Pro Workshop to add to her skill level and to bring this valuable training to other providers in our community. All birth providers – CPM, CNM, OB, DO – are welcome to attend.

As a birth worker, there is always a risk of a person showing up in advanced labor with a breech baby. Rather than trying to rush into the OR for a cesarean that carries its own set of risks (not only for this birth but for the next birth and baby) why not learn the art of physiologic vaginal breech birth to assist the process safely? Go to midwife360.com to learn more about the upcoming Breech Without Borders workshop.

What If I Have Group B Strep (GBS) While Pregnant or in Labor?

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Group B Streptococcus or GBS is a common bacterial organism found in about a third of people. This bacterial organism is most commonly found in the intestinal tract. However, it can move through the body and colonize the rectum, bladder, and vaginal tract of women. Colonize meaning the bacteria is present, but not infecting the tissues or causing symptoms.

GBS has the ability to give anyone an infection. However most adults, due to having a healthy microbiome, will keep any harmful bacteria in check and will not cause an illness. 

What’s The Big Deal About GBS During Pregnancy?

Decades ago, GBS was the leading cause of infection in newborns and infants. This infection can have devastating effects on a fragile new life, including pneumonia, sepsis, and meningitis. It can cause bladder, uterine, or urinary tract infections. It can also cause miscarriage and increase the risk of premature labor and rupture of membranes. GBS can also cause stillbirth. 

Newborns can get GBS infection in utero, during birth, or even from healthcare workers and family members. Handwashing is important for anyone who will be holding a newborn baby to prevent spreading GBS or other harmful infections.

The Risks to Baby  

When a baby is exposed to GBS in labor or during birth, he or she has a 50% chance of becoming colonized with GBS. Nevertheless, a small percentage of babies exposed to GBS will become infected and sick.  

Most often, babies become infected through exposure in the birth canal during birth. As well as from bacteria migrating upwards once the water has broken. 

Testing For GBS

As of 2020, the American College of Obstetricians and Gynecologists (ACOG) now states that the best time to test for GBS presence is between the 36th and 37th weeks of pregnancy.  This test is done by swabbing the vagina and rectum to determine if GBS is present.

There is also an FDA-approved rapid test that can diagnose GBS in roughly an hour. 

GBS Treatment

To prevent GBS infection in babies antibiotics are used, however, there are associated risks. Many of us know antibiotics are detrimental to our microbiome. Babies receive significant benefits from their mom’s microbiome when birthed vaginally. In turn, affecting the baby’s entire life in a positive way. 

In order to mitigate infections overall, if a laboring mom has prolonged rupture of membranes, a fever, or other infection risk factors, antibiotics will be prescribed even if GBS testing was negative. The treatment is typically IV antibiotics for a minimum of 4 hours before the baby is born. Of course, the time of birth is hard to predict, so typically the hospital will start the antibiotics upon arrival to the hospital.

Treatment has been very effective for lowering the number of newborns who develop GBS infections. There is some controversy concerning antibiotic use during labor and how this can affect babies. 

Is Treatment Harmful For Baby?

Some studies suggest that antibiotics during pregnancy and delivery can decrease the presence of beneficial bacteria in a newborn. Breastfeeding and probiotics can help to boost a newborn’s microbiome. 

Antibiotics can cause problems for mom, including yeast infections or nipple infections. This can complicate and disrupt breastfeeding. Sometimes newborns can develop thrush as well. Allergic reactions are rare, as long as your healthcare provider is aware of any allergies. 

Taking a probiotic during pregnancy and after birth can help to prevent thrush or yeast infections.

Can I Reduce My Chance of Testing Positive for GBS?

Healthy vaginal and gut flora can prevent infection, which could affect the presence of GBS. 

Whether or not it will decrease your risk of GBS, there are other benefits to a healthy microbiome. Mitigating the risk of miscarriage, preterm labor, vaginal and bladder infections during labor, are all benefits. 

Steps to boost your microbiome include:

  • Stay away from processed sugar and junk food
  • Implement 8 servings of leafy greens, fruits, and vegetables into your diet
  • Take prenatal vitamins (zinc, vitamin D, vitamin A, vitamin C)
  • Eat more Lacto-fermented foods (example: sauerkraut, yogurt, cucumber, sourdough bread)
  • Reduce stress
  • Use oral and vaginal probiotics throughout pregnancy

Taking all of these into consideration and doing your best to check every box may not change the status if diagnosed, however, it can help to protect against GBS-related prenatal complications. If you are doing all of the necessary steps and have not tested positive before this can help to prevent GBS colonization and the need for antibiotics.  

For More Information, Contact Midwife360

Midwife360 has been providing holistic gynecology and pregnancy services in South Florida since 2014. The founder of Midwife360, P. Fadwah Halaby CNM, takes pride in offering holistic evidence-based practice for all midwife services such as women’s care, family planning, pregnancy care, and birthing. If you have any questions contact Midwife360 today.

A Complete Guide About Shoulder Dystocia

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What is Shoulder Dystocia?

Shoulder Dystocia is a birth complication that happens during vaginal delivery. When this occurs, one or both of the baby’s shoulders get stuck inside the mother’s pelvis during labor. This causes a stall in the delivery process, which can be life threatening. In most cases, babies born with this complication are delivered safely. However, it can cause problems for both the baby and mother. 

Shoulder dystocia happens in 0.2 to 3 percent of pregnancies, and sadly, is unpredictable and unpreventable. When complications happen during labor, doctors turn to urgent cesarean delivery or surgery to avoid further issues. Although this may work in most cases, urgent cesarean delivery or surgery cannot correct this condition. 

Continue reading below for answers to all questions regarding this topic. 

Frequently Asked Questions:

What Does Shoulder Dystocia Look Like?

When Shoulder Dystocia occurs, the fetal head is delivered but the shoulders are not seen and are not being delivered with normal maneuvers. In other words, this delay in labor causes the baby to be trapped mid delivery. When this is happening, your midwife or provider tries to move your body and baby into better positions to continue natural delivery. 

The shoulder of the baby normally gets stuck behind the mothers pubic bone or sacrum. During this delay, the baby cannot breathe and the umbilical cord may be squeezed or wrapped around the baby’s neck. It is dire that everyone stays calm but acts quickly and efficiently to prevent further complications. The midwife will ask the mother to cease pushing so she can reposition her and the baby as needed.       

Why Does This Happen?

Shoulder Dystocia can occur during any vaginal birth, and without warning. Some of the most common causes for this are that the baby is too big, the baby is in the wrong position or the mother being in a restricting position. Oftentimes, your midwife or provider will change the mothers position to help free the shoulders from the pelvic area. 

It is nearly impossible to predict the risk factors of whether or not your baby will have this complication, but there are some things that can make it more likely. This includes:

  • Shoulder Dystocia occurred during previous pregnancies
  • Fetal Macrosomia (having a larger baby)
  • Having twins or multiple babies
  • Mother is overweight
  • Mother has diabetes
  • Labor induced 

Although these factors may increase the risk of a baby being born with Shoulder Dystocia, it is not clear why some pregnancies experience this complication while others do not. One statistic states that women with a history of having a delivery with Shoulder Dystocia are 10- 20 percent more likely to have a recurrence. 

What are the Complications?

Although most mothers and babies may not experience any further issues regarding this complication, it can bring about further issues. When delivering a baby with Shoulder Dystocia, a midwife or provider may have to break the baby’s collarbone to help with removal of the shoulders. This is a last resort, but may be necessary. This is only one risk that may come from this condition. 

Further risk for the baby may include:

  • Fractured collarbone (clavicle) or arm
  • Fetal brachial plexus injury
  • Lack of oxygen to the body
  • Brain injury due to lack of oxygen (this is rare)
  • Loss of baby (this is rare)

Further risk for the mother may include:

  • Maternal hemorrhage/ postpartum hemorrhage
  • Repairs for episiotomy or tearing during delivery 
  • Uterine rupture

Can You Prevent or Treat Shoulder Dystocia?

Like we touched on above, Shoulder Dystocia is extremely unpredictable and there is very little prevention. Being mindful of potential risk factors like diabetes and watching your weight during pregnancy are all things to help lower your chance of complications during labor. At Midwife360, we recommend our mothers to give birth lying on their side or on all fours to help natural movement of the delivery process. This will help prevent complications like Shoulder Dystocia. 

It is important to inform the expecting mother about the complications and risks of Shoulder Dystocia.  As well as reassure her that, as a midwife, we are trained thoroughly on how to deal with these complications in the safest and most efficient way for the safety of you and your unborn child.  

If You Have Further Questions

If you have any questions unanswered or need more information contact us at Midwife360. At Midwife360 we provide holistic gynecology and pregnancy services, including home and water birth to women throughout South Florida. Our mission and practice is designed to meet the individual needs of each woman and expecting family we care for. We believe women should be informed and educated about their healthcare options for routine care, family planning and birthing.