Dangerous? or Just Variations of Normal? Twin & Breech Births Have Existed Forever.Dec 28, 2022
January is all about Variations of Normal:
I feel like what I’m about to say should be coming out of the mouth of someone much older and more experienced than me, but I’ve seen the birth world change over the course of my career. I wish I could say it’s gotten better, but from where I sit, they’ve only apathologized normal variations of birth.
I’ve been a birth worker for a little over a decade, attending my first doula training in 2010, and just a few years later, Midwives lost their legal ability to attend breech and twin births at home.
I had no idea how lucky I’d be to be the staff prenatal massage therapist at the Sanctuary Birth & Family Wellness Center before those laws changed.
I was able to see twin mothers and breech births attended by midwives on a somewhat regular basis.
I remember a twin mom coming in for her weekly prenatal visits in the home stretch of her pregnancy, and thinking (though I never said it out loud), “wow, she looks magnificent.” She carried her babies to 40 weeks and birthed her 7 pound & 8 pound babies in the comfort and safety of her own home.
During another phase of my birth keeper journey, I was a student in the Advanced Heart and Hands Midwifery Intensives. I met a lot of amazing women, some of whom were long-time lay midwives seeking licensure for the first time in their careers. I’ll never forget at our graduation dinner, one of the elder lay midwives brought a photo album of all the breech home births she’s ever attended. I remember marveling at each page of photos showing beautiful healthy babies, some of whom had swelling on whatever was their presenting part (usually a buttock), and other photos of sweet little dangling feet, in the case of footling breech births. She had documented over 200 breech births in her career, and I once again feel lucky to have sat by her side and listened to her recount each of these beautiful stories.
I’m not saying home birth is the right choice for everyone. I don’t think there’s any right choice, however, I do believe it should be a valid option for those who want that type of care. It was the only option for much of human history and we are all descendants of home births that went well.
By contrast, almost all twin births now are planned C-sections. Most new OB’s don’t receive training in variations of normal, like twins or breech, and are instead primarily trained as surgeons.
C-sections may be the right choice in some circumstances, but as Dr. Sara Buckley talks about in great detail in her book “Gentle Birth, Gentle Mothering,” there are a whole cascade of hormones designed to promote mother-baby bonding and breastfeeding that get derailed during a surgical birth.”
Not to mention we have a horrible track record for repeating C-sections in subsequent births even when the predominant reason for the primary C-section is no longer the case, like having a head-down baby after having a breech baby during your first birth.
There is always a cost that comes with interfering with the complex and magical design of the birthing process. I think we’d better have an extremely good reason for interfering, or else risk the inherent benefits birth holds for the mother-baby dyad.
Twin and breech births have existed since the beginning of time.
I deeply wish that it could be normalized, and the option to birth in your place of comfort be supported, wherever that might be and with whichever care provider you so choose.
The less we see this unfolding normally, the less faith we have in this body’s ability to birth twins or breech babies.
The less care providers are trained in school, or get to practice hands-on care for these variations of normal, the more likely they’ll be to intervene or rush to a surgical birth.
There’s a lot to consider in how our culture treats these circumstances, and I’d like to use my voice to encourage you to find options that truly resonate with what you most desire for your pregnancy and birth.
If you find out your baby is breech, you’ll most likely be finding out at the very end of your pregnancy which can add to the stress of figuring out your options.
Here are a few things to consider:
1) You can try to turn the baby:
Spinning Babies techniques
2) Switch last minute to a licensed care provider that will support you:
Dr. Stu & Blyss Young
Dr. Bente Kaiser & Sara Howard
3) You can find a traditional midwife or Birth Keeper who's not beholden to the state governing agencies and will center you and your baby as the primary focus of their care (rather than their licensure regulations).
Reach out to Freebirth Society for a list of Birth Keepers in your area and listen to the Free Birth podcast for inspiring stories of women birthing their breech babies at home.
If you find out you're pregnant with twins, your licensed midwife will not be allowed to provide care for you.
Many care providers who support a “trial of labor” for vaginal twin birth require conditions that make birth riskier by creating environments not conducive to relaxation or a sense of safety. Some examples would be constant fetal monitoring, birthing in a surgical room, and having NICU staff on standby in the room, which is multiple people for each baby.
Oftentimes these providers have so little experience with normal vaginal twin birth their own discomfort interferes with their ability to trust the often long and unpredictable nature of birth.
If you’re expecting twins, you’re options are:
1) Try and find an OB who will give you a *FAIR* chance at a vaginal delivery
2) Hire one of the two OB/ Midwife Teams for a home twin birth
3) Find a traditional Birth Keeper who is experienced, untied to a governing body, and deeply trusting of the birth process to come and support you at home
Quotes from the Obstetrics industry: “Once a C-section, always a C-section”“The only C-section you’ll regret is the one you didn’t do.”
You can see how these sayings reveal our values as a culture.
I say culture, because that’s the only thing they’re based on. They’re certainly not evidence based.
The WHO says C-section rates should account for no more than 10% of all births, and yet we hover at well over 30% in the U.S. with certain cities, certain hospitals and certain care providers yielding a C-section rate way above the 30% mark.
So if it’s not based on evidence, what is it based on? Perhaps convenience, perhaps a sense of control, perhaps less liability for the doctors providing these surgeries.
We often talk about C-sections as if they’re simply another equally safe way to birth our babies (and rarely, but sometimes they are the safest choice).
However, we aren’t always told of the risks of C-section which include:
- Missing out on the fetal catecholamine surge that prepares the lungs for air breathing, and the maternal surge of oxytocin that provides a neuroprotective effect for the fetal brain when a C-section is done before the spontaneous onset of labor (source Dr. Sarah Buckley)
- The use of epidurals during most C-sections reduce endorphin levels which Dr. Sarah Buckley says the "reward-pleasure center" of the brain is not activated in the same way. This may affect maternal infant bonding in the long or short term (however, immediate skin-to-skin contact will help by releasing oxytocin, endorphins and prolactin).
- Scar tissue adhesions that may bind to surrounding structures during the healing process such as the bladder or rectum and potentially contribute to secondary infertility, pelvic pain, pain with intercourse, more severe menstrual cycles and decreased range of motion. C-section scar massage is highly recommended to support your healing post C-section and to prepare your body for any potential future pregnancies.
We all have different feelings about birth experiences, and they are all valid. My hope is that women are supported in realizing their dream births with accurate information and patient, competent care.
I personally had an unnecessary C-section and actually healed quite well, both physically and emotionally with the right support in postpartum. I’m 27 weeks pregnant with my second baby as I write this post, and am planning a home birth with a traditional midwife. I hope to share a successful HBAC story with you when this baby comes earthside.
I’d love to hear in the comments what your thoughts are on your own C-section, and whether you’d pursue a VBAC with any subsequent pregnancies.
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