Breech deaths are vanishing; why would anyone want to bring them back?

Sad mother missing her daughter

The folks at VBACFacts are shocked, shocked that breech vaginal birth is discouraged.

It’s time to summon all that passion you have for patient autonomy and take some action!

Let’s support Dr. Annette Fineberg and flood this hospital with letters!

The following is copied from a fellow birth advocate in California:

“I’m so sad right now. Like in tears.

Dr. Annette Fineberg at Sutter Davis is being pressured to stop supporting vaginal breeches. She’s by far our best option around.

She’s asking for our help collecting stories to convince the administrators to continue to allow her to openly offer this option. This is huge! …

Dr. Fineberg is one of very few OBs within driving distance of the Bay Area skilled in breech birth. She’s also the only ‘local’ OB breech expert who actively supports/encourages people with breech babies to birth in non-lithotomy positions and labor in the tub prior to stage two — and she is the only one who doesn’t pressure them to get epidurals.

According to Dr. Fineberg:

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]The death rate from vaginal breech is more than 1000% higher than the death rate from SIDS.[/pullquote]

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.

Why is Dr.Fineberg being “pressured”? Because breech deaths are vanishing and no one wants to bring them back.

What’s the death rate from vaginal breech. It is approximately 6/1000. That sounds like a small number, too small to be concerning, right? Not exactly. The death rate from vaginal breech is more than 1000% higher than the death rate from SIDS. It doesn’t sound like a trivial risk of death when you put it like that, does it?

We have spent literally millions of dollars trying to change the habits of parents and caregivers in order to prevent SIDS deaths. We’ve heavily promoted a regimen of putting babies to sleep on their backs even though that does not happen in nature, leads to poorer quality sleep, and has created an epidemic (200,000 cases per year) of tiny babies wearing tiny helmets to correct iatrogenic plagiocephaly (flat head syndrome).

We think that’s entirely appropriate in order to prevent deaths from SIDS that occur at the rate of 0.54/1000 babies. Doesn’t it make sense that we would want to prevent the much greater (6/1000) risk of death from breech birth?

There’s even greater urgency for hospitals and malpractice insurers to prevent death from breech birth. When a baby dies fo SIDS because a parent or caregiver put the baby to sleep face down, there may be recriminations but there is generally no one to be sued. In contrast when a baby dies as a result of attempted breech birth, there’s always someone or several someones with deep pockets (including neonatologists and others who had nothing to do with the decision) who can be sued.

While parents might not sue for a baby who dies, they will almost certainly sue for a baby who sustains severe brain damage because the costs of caring for such children are astronomical. No matter how much the mother avers that she understands the risk, no matter how many consent forms she signs, she will insist in her lawsuit that she didn’t understand that it could happen to her baby and she certainly didn’t understand the aftermath of caring for a severely disabled child. When hospitals prohibit breech vaginal births, they aren’t merely protecting babies; they are protecting themselves and their staff.

Does a mother have a right to have a breech vaginal birth? Of course she does, just like she has the right to lay her baby face down to sleep. Neither is illegal and both are fully within the purview of autonomous adults. But that doesn’t mean she has a right to force hospitals and doctors to attend her while she attempts that breech vaginal birth just like it doesn’t mean that she has the right to force daycare centers to put her baby to sleep facedown.

If you met a mother who proudly told you that she ignores the “back to sleep” recommendation because the risk of SIDS is tiny, would you be impressed? Would you consider her a brave, transgressive proponent of maternal autonomy or would you be horrified that she was willing to risk her baby’s life? I suspect that most people would be horrified.

So why would anyone be impressed with a mother who wished to to expose her baby to a 1000% times greater risk of death at vaginal birth? Breech deaths are vanishing; why would anyone want to bring them back?