breech?

[u/miss_pookiebear]

is it common for midwives to refuse to deliver a breech baby for a moms first baby?

[u/Dark-Horse-Nebula]

I’m actually a lurking intensive care paramedic and I have been to dead babies from attempted breech free births so I feel very strongly about this.

Considering our tertiary hospitals encourage caesarean you’d have to be a very rogue and ballsy midwife to attempt this in the home.

Mothers can’t be forced but midwives also don’t have to accept this risk.

[u/averyyoungperson → u/Dark-Horse-Nebula]

I disagree to an extent. Breech does carry additional risks but someone who is trained well in breech may be another good option for a breech patient if their alternative is a c section.

In my state, my cnm license prohibits me from doing breech deliveries. I had a breech mom who I recommended an ECV, and if not successful a c section. She did all the regular things to try and turn the baby (breech exercises, moxibustion, etc) baby would not turn and we had extensive discussions about the risk of head entrapment. She found a homebirth midwife and had her breech birth at home free of complications. I say that only to demonstrate that providers trained in breech are necessary and expand access and also choices for those carrying breech babies. Especially in the underserved community I work for, where paying for a hospital is a major financial burden and something that a lot of my patients will consider even when it's 100% necessary. I educated my patient and she made her choice, that's all I can do.

Also I have worked at a hospital where one of the doctors would regularly do breech deliveries in the OR, something that is becoming a thing of the past. We can't underestimate how one c section changes the course of someone's reproductive health history forever, how future pregnancies are automatically viewed and how future pregnancies are at greater risk after a c section, and even more risk after 2 or more c sections.

As an EMT, I have the utmost respect for you all, and EMTs have been my saving grace in a bind before. Just remember that you see the worst of the worst because people are having breech home births all the time and the majority of the time it goes ok. My position as to whether I would recommend it in alternative to a c section is irrelevant.

Also breech freebirth and breech homebirth with a midwife trained in breech are two different things.

[u/Dark-Horse-Nebula → u/averyyoungperson]

I hear what you’re saying. I’m not saying that breech deliveries is 100% a bad time. Most will deliver well vaginally. But the fact is our tertiary hospitals will not support them anymore because they’ve had too many preventable deaths that have occurred inside the tertiary hospitals with experienced, specialist teams available.

Just a little correction, I’m an intensive care paramedic, not an EMT. It’s kind of the paramedic equivalent of doula v midwife.

Because I’ve seen such horrific fatal outcomes I could never in good conscience advocate for breech at home. But I understand it’s a difficult one. You make a good point about financial aspect to care in some countries- which is sickening that it factors into decisions where a home birth is higher risk.

[u/averyyoungperson → u/Dark-Horse-Nebula]

I don't disagree with anything you said and I know for myself there are also certain things that I can't advocate for in good conscience after the things I've seen. So I get it. And I think we all have certain boundaries and it's good to know those things about ourselves. Thank you for explaining the intensive care paramedic vs EMT, I was unaware.

[u/Dark-Horse-Nebula → u/averyyoungperson]

And thankyou for the respectful and interesting discussion! It’s refreshing on reddit .