Breech Births: What Are Your Options and What Are the Risks with Rixa Freeze, PhD
Show Notes:
[1:40] Our Reviewer of the Week, caroline0523, said: "Best Birth Podcast! I am obsessed with this podcast! During my pregnancy I listened to every episode and I felt so much more educated on birth and prepared for it. Would recommend to any pregnant mom!"
[1:59] Our guest this week is Dr. Rixa Freeze, she has a PhD in American Studies from the University of Iowa. Her doctoral studies focused on the history of healthcare and medicine with specialization in pregnancy, childbirth, and maternity care. Her dissertation examined why women in North America choose unassisted home births. Her current research interests include human rights in childbirth, autonomy and informed consent, and vaginal breech birth. She recently published the article “Breech Birth at Home: Outcomes of 60 Breech and 109 Cephalic Planned Home and Birth Center Births” with BMC Pregnancy & Childbirth. Dr. Freeze is the founder and president of Breech Without Borders, a 501(c)3 nonprofit dedicated to breech training, education, and advocacy. She is the mother of four children, all born at home.
[5:05] Rixa shares about how she got into studying the field of birth and what inspired her.
[7:37] What is a breech baby? A breech baby is simply a baby that is head up rather than head down. You can have different things coming out, it could be the butt, feet or even rarely the knees. But it just simply means that the baby is head up rather than head down when it's coming out.
[8:07] What causes a breech baby? Most of the time, the answer is we have no idea. Sometimes we can point to factors that are probable causes, like a uterine anomaly, various kinds of septum in the uterus, some genetic factors, but most of the time, we don't know. Sometimes it's related to some abnormality in the baby, maybe due to Down's Syndrome or some kind of neurological condition that we don't know about. We might see an extremely short cord or a cord that is so wrapped up in the baby that it just didn't have the chance to turn because it was tangled. But a lot of the time, it's just a mystery.
[10:37] Are there things that you encourage moms to do or that you've seen that help encourage baby into a better position? Rixa talks about her focus, which is actually the skills of getting this baby out vaginally. There's a lot of stuff that people do and a lot of it, we have no idea if it's effective.
[12:44] Where can mamas find breech baby-versed care providers? Rixa has a provider directory on her website of doctors who are more well known that they do this. They also have a private directory that where Rixa will connect the provider and mamas. You can find the directory HERE. She also recommends networking with the Facebook group called Coalition for Breech Birth. You might get a lot of good recommendations from there as well.
[20:43] As a woman who's expecting a baby, it also is a reminder that you can't assume that everything is going to be fine. There's no guarantee with any pregnancy that you're going to walk out of it with a thriving baby, and a baby with no abnormalities. Part of, I think, accepting the risks of a vaginal breech birth, which aren't much different than the risks of a head down birth, just slightly higher in some areas, is just coming to terms with the fact that we have to accept risk. We have to accept that we can't control, we can't guarantee outcomes, we can't expect perfection. But that's a really good attitude to take for any birth, really not just a breech birth.
[22:06] What does it look like to have a breech birth? Labors really don't differ significantly. Labors vary widely, from one birth to another, one woman to another, but there's nothing that we can point to and say a breech labor is going to be, for example, a lot faster or a lot slower. There can be a big amount of variation, just like with the cephalic birth. Some are going to be really straightforward, really textbook. Some are going to have stops and starts and plateaus, just like a cephalic birth might.
[23:16] What are the differences in a breech birth? The pushing urge might feel different because when you have a head down baby you have this great big round hard thing coming out, and it stimulates all sorts of nerves in your vagina and your rectum, which stimulates that really strong fetal ejection reflex. Typically, we tell people, you might not feel that same crazy strong urge to push in the same way. And if you do feel it, it might be really, really late. Like once the baby's butt is actually starting to come out. Because it's softer, the tissues of the butt or the legs, it's not this hard round thing. You might have a slightly different feeling of an urge to push or a delayed urge to push. You just kind of follow your body's cues.
Once the baby starts to come out, once the rump of the baby is emerging and it's out past the head, that's the point of no return. From there, forget everything you've ever learned about cephalic birth. Breech birth is completely different at this point. One really big difference is the more of the baby that is out when a baby's breached, the less that the, the top of the uterus, which is called the fundus, is actually making really good contact with the baby's head and pushing the rest of it down.
Once the baby's halfway out, just push the rest out. It's going to be all on you. It's going to be your pelvic floor, your vaginal muscles, your abdominal muscles. It's going to be your vagina power. That's what we like to say. That gets the rest of the baby out.
[27:06] What is a provider doing during a breech birth? During expulsion, the provider's main job is to be very observant and to carefully watch all the steps that's happening. Babies do really predictable things. When they come out breech, they come out a certain way, they rotate a little bit a certain way. So you can kind of predict in advance what you should be seeing next. A provider might ask you to try changing positions, to try pushing harder, and sometimes just moving the maternal pelvis in different ways can open it up. They can also do something called fundal pressure.
[29:09] A good average is to expect that 70% of vaginal breech births, if they're in an upright position, will just fall out with no intervention needed. Around 30% might need some intervention. Most of that's pretty minor.
[30:07] Do you recommend or not recommend an epidural for vaginal breech births? We would really recommend trying to avoid an epidural, but we wouldn't go so far as to say you shouldn't ever, because for some people, there's just a certain level of willingness to feel certain sensations. We know that epidurals are associated with worse outcomes in a vaginal breech birth. We also know that supine positioning is associated with worse outcomes than with being upright, for both mother and baby. This doesn't mean that you can't use epidurals, but it means that you should really have a good true walking epidural if you're going to have one, that allows you to change positions, to be able to stand or be on hands and knees, and to move around a little bit under your own power.
[34:36] What are the risks or complications with having a breech baby? It's important to realize that there's at least five areas to talk about in terms of risk.
1. Short term risk to the baby
2. Short term risk to the mother
3. Long term to the baby once it grows up and becomes a child and an adolescent
4. Long term risks to the mother beyond the first few weeks after the birth
5. Future pregnancies and future children
[46:40] Rixa talks about risks and statistics of having a breech birth.
[51:26] Where to find Rixa:
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