Napalm grade stupidity on footling breech

How on earth can anyone trust clowns like these from the Coalition for Breech Birth with the lives of their precious babies?

Heather Shelley: Why is there such a fear of footling breech? Everything I read says don’t do it, but I have done two with primips and they have both been fine.
November 11 at 11:54am via mobile

Rhonda Tombros: I’ve also wondered this Heather Shelley. I think partly it is that they are the most rare and therefore attendants have least experience delivering them but I’ve heard a number of successful VBB footling stories. I think there is concern that the baby may descend before the mother is fully dilated. I don’t know what the real risks are of this though. I do know that even “breech-friendly” obs can put their feet down at the footling …

Heather Shelley: I have someone hold the feet in until we can’t hold them anymore, then let baby come. This helps with full dilation.

Wendy Jolliffe: Prolapsed cord is the fear, I believe. With a head, or a bum, it pretty much blocks the vagina. Not so much with feet.

Heather Shelley: That makes sense Wendy

Marieke De Haas-van Bommel: I’ve had a footling breech at home in bath without any real problems. After the first foot/leg it stagnated and after I started pushing along, the rest came out fine, until his head. He was jumping up and down the bottom of the birthing pool and hurted me badly so my contractions stopped. My midwives helped me deliver his head. But here in Holland they are overall scared for breech delivery and I don’t think that footling breeches come vaginally.

Amy Mokady: I know that even breech experienced practitioners do say that a footling breech is more likely to need a c-section even if you try for a natural birth. My understanding was that there is more risk of the baby getting into a position that will not deliver, and also in a footling position, the baby’s lower half is narrower than the head. I am not sure if the cervix sometimes does not dilate properly since there is not much pressure against it? In a complete or frank breech, the rounded part of the buttocks present, and in a full-term baby they are pretty much the same size as the head. Of course some footlings can birth completely hands-off, but they are more likely to need some kind of assistance/manoeuvres from the attending midwife or doctor.

Robin Guy: the SOGC guidelines say “there is consensus that footling breeches should be delivered by caesarean section.” In other words, there isn’t actually any evidence, just a widely held opinion.

Ghada Shereif: My last baby was a footling (was a frank until birth). Birthed beautifully on all fours. Left foot, right foot, left arm, right arm, and last but not least after I thought I was done :)… The midwives told me to push the head out. Ina May Gaskin and Carol caught my baby.

Lorraine Rigby-Larocque: What about footling with one leg still frank, from the baby’s point of view? When I think of being in that position myself, I cringe, but is it more dangerous for the baby?

Robin Guy: it’s not a footling if the bum is also down

Robin Guy: a presenting foot first doesn’t define it – if the bum is down WITH the feet it’s a complete, regardless of whether the bum or the foot actually appears first

Kavita Rosepetal: a footling breech could have also shortly before been a complete breech so it is hard to really say the presentation.

Maya Midwives: I have supported two footling breeches to birth naturally. I have supported a primip to give birth withl one led extended and one leg footling with no problems. Babies are flexible and designed to be born vaginally. There is no similarity to an adult adopting the same position. If the labour is progressing spontanously and without interventon then the baby will be born.

Rixa Freeze: (late to the conversation…) Cord prolapse (10% in footling breeches) is probably the biggest reason for the nearly universal contraindication for footlings, followed by the concern that extended hips won’t make as a big a diameter as flexed hips…make as a big a diameter as flexed hips…making the head possibly more difficult to birth. Not saying I necessarily agree with a universal CI for footlings, but there are definitely more risks involved because of cord prolapse.

Jan Tritten: Do them in water. You lots more time and prolapsed cord is not necessarily a problem. Ask Midwife Carol Gautschi and Cornelia Enning. Cornelia only does waterbirths for the past 30 years and has done many breeches in water. She is in Germany.

Rixa Freeze: There’s so much we still don’t know about breech…Jane Evans expressed reservations about doing breeches in water because the buoyancy interferes with gravity and changes the normal mechanisms of breech. We should see if Cornelia could come to the next breech conference and talk about her experiences!

Christie Craigie-Carter: My understanding is that although cord prolapse is a greater risk with a footling breech, it is also much less likely to be compressed for the same reason that you mention Rixa Freeze (the decreased diameter as compared to flexed hips). As a related aside, I still don’t know for certain whether my breechling was footling or complete and his foot popped out first (that part I know).

Christie Craigie-Carter: Another related aside–informed consent. First, let me make it clear that I have absolutely no qualms with how my midwives operated during our birth. But, honestly, 6 years ago, had I known he was footling, I *might* have made the choice to transfer for a cesarean because of the very fear that we are discussing. One of my midwives made a comment a couple of years after R was born that “most midwives would have called 911 when they saw the foot (emerging)”, which tells me that they didn’t know that he was presenting footling (I had several vaginal exams which I feel were prudent given an un-related issue).

Rixa Freeze: Yes, there is more room for cushioning with breech vs cephalic prolapses, and with footling vs. other types of breeches specifically. I remember that Andrew Bisits does not rule out VBB for a footling presentation before labor, because they can convert from footling to complete, etc. So they do an in-labor scan to verify position before making a final decision. Jane Evans doesn’t exclude footlings as a rule.

Christie Craigie-Carter: Sorry, hit return prematurely. There is a lot of talk about women taking risks in birth because of “the experience”. First, I always submit that mothers are not going to do something that they feel is blatantly more dangerous for their child than another option simply for an “experience” (considering that we are comparing two choices, each with risk). But secondly, why is the experience not only dismissed but disdained? I was a better mother for not having had PTSD/PPD after his birth (which I experienced after my 1st). In the end, it is a very personal decision between the parents and their care providers.

Nancy Salgueiro: One of the big keys is defining a footling. As Jane and Andrew mentioned just because feet come out first doesn’t necessarily make it a footling. If bum has passed through the cervix into the birth canal and then feet fall through, that is not a footling. Jane would tickle the feet so the baby curls them back in to stay warm. It is only a footling if the feet have come through the cervix before the bum. As mentioned above that would then present the risk for head entrapment. If the body falls through (possibly with the cord) before the cervix is fully dilated then the head may be trapped within the uterus for too long. Any delay in dilation at this point could be a problem which means it is extra important not to frighten mom or sphincter law could close up the cervix or delay opening. A bum won’t fall through a partially opened cervix so a complete or frank breech wouldn’t be cause for the same concern.

Nancy Salgueiro: My opinion of water birth for breech is that is would work with the buoyancy if the mother is in more of a squat or leaning back position, then it is like the maneuver used for a supine breech delivery. If on all fours the buoyancy works against gravity. So its just a matter of moms positioning.

Rixa Freeze: Great points Nancy & Christie.

Nancy Salgueiro: Christie Craigie-Carter I agree with you. This idea that mothers don’t matter in birth is my biggest pet peeve. Birth is not ONLY about the baby. It is the birth of a mother, the birth of a father, and the birth of a family. All of those considerations should come into play. Mothers are going to choose what they feel is best for their baby which also means having the best possible birth experience so they can have optimal bonding and physical recovery which directly impacts the long term outcome for that child. Even without the pyschosocial element of birth just breaking it down to physiology a natural birth is better for that baby. The exposure to oxytocin after and unmedicated vaginal birth physically changes the brain so the mother baby dyad bond and breastfeeding can get off to the best start. How do we not, at minimal, recognize that the “experience” of birth isn’t about having a life experience like going SkyDiving or on an amazing vacation, it is a process/experience that physiologically programs that family for life.
Then add in the sense of accomplishment, strength, and empowerment and the effects on that baby from having a mother who feels powerful instead of traumatized.

It is crazy to me that we are so dismissive of mothers when they are the key to that baby’s life experience.

With a death rate of 10% or more, footling breech birth is just as dangerous as holding a loaded gun to your baby’s head and playing Russian Roulette. But, hey, Heather Shelley delivered two and neither died, so that proves … NOTHING.

The stupid, it burns.