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Breech Birth
At last, a book on breech birth for parents, obstetricians, midwives and all who come into contact with women carrying breech babies. This book addresses the whole experience of breech from causes to turning techniques to the options for birth. It engages in the controversial debate on caesarean versus vaginal breech birth and provides a powerful critique of recent evidence which has led to an increase in caesarean section. The book encourages parents to make an informed choice about the birth they want. For professionals, this book is an essential resource on breech. It deepens knowledge and encourages a critical examination of their own approach to breech births, improving the quality of care they are able to offer to parents of breech babies.
224 pages, Paperback
First published September 1, 2003
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November 29, 2008Breech Birth is a comprehensive examination of everything and anything surrounding breech babies. Four weeks before her baby was born, Waites discovered her baby was breech and embarked on a desperate search for information. From pregnancy advice books to medical textbooks, she was only able to find scattered, limited information—nothing extensive enough to answer her many questions. She was able to find a consultant (senior) obstetrician to attend her vaginal breech birth. This journey spurred her to write a comprehensive, exhaustive book about breech birth.
Exhaustive is a very fitting term in both of its connotations: this book is thorough and meticulous and examines every aspect of breech presentations and birth. It is also so thorough that it may leave the reader a bit exhausted herself! In fact, a consultant OB commented about her chapter on the evidence for vaginal versus cesarean section for breech: “This section is exhaustive and exhausting.” However, do not be intimidated by the depth of information in this book. Each chapter is organized with a concise summary and slightly longer conclusion summarizing all of the main points of the chapter. Breech Birth also includes some photographs of active breech births, although not as many as "Breech Birth Woman-Wise" by Maggie Banks.
Besides researching the medical and midwifery literature on breech birth, Waites interviewed nine midwives and obstetricians who have extensive experience with vaginal breech births. The perspectives of these attendants—sometimes agreeing with each other, at other times diverging on certain points—are fascinating and an invaluable resource as vaginal breech birth is fast becoming an endangered species.
Waites does not argue for one overall solution to breech birth. She has a strong interest in examining all of the evidence for breech birth, from opinion and anecdote to clinical experience and research studies. She notes that with breech birth, opinion is often presented as fact. Her books strives to delineate what, if any, uncontested facts can be asserted about breech birth (the only universal one, she argues, is that cesarean section more dangerous for the mother than vaginal birth). Even today, uncertainty is the rule with breech birth. She writes:
"there are few certainties when it comes to weighing up the options for breech birth. Even with the Canadian multicentre international breech trial, published in 2000, paraded by some as delivering 'the answer' to the breech conundrum (the answer apparently being to routinely offer caesarean section for breech, there is sufficient criticism of the study (see Chapter 8) to leave many feeling that the answer still eludes us. Overall the body of research we have often produces mutually conflicting data, and conclusions often state that studies of sufficient size and good enough design have not yet been carried out. The active, spontaneous approach to vaginal breech birth, described in more detail in Chapter 10 and espoused by some as the only safe way to conduct a vaginal breech birth is yet to be properly evaluated. Uncertainty should therefore be the uncomfortable though realistic norm in cases of breech."
I will not attempt to summarize each chapter in this review—there is simply far too much information to cover—so instead I will list the chapters. This gives a good overview of the topics covered in Breech Birth.
Part I: The what, why, and how does it feel? of breech
Chapter 1: What is a breech baby?
Chapter 2: Why are babies breech?
Chapter 3: The wrong way up? The emotional impact of breech
Part II: Turning Breech Babies
Chapter 4: An introduction to turning breech babies
Chapter 5: External cephalic version (ECV)
Chapter 6: Factors influencing the success of external cephalic version (ECV)
Chapter 7: Self-help and alternative therapies for turning breech babies
Part III: The evidence on vaginal and caesarean breech birth
Chapter 8: Vaginal versus caesarean breech birth: the evidence
Chapter 9: Selection criteria for vaginal breech birth
Chapter 10: The management of vaginal breech birth
Chapter 11: Emergency caesarean section after a trial of labour: not the worst of both worlds?
Part IV: Making a decision about the birth and negotiating for what you want
Chapter 12: Making your decision about the birth
Chapter 13: Negotiating for the birth you want
Of all the chapters, I found Chapter 10 the most interesting. She covers various approaches to vaginal breech birth, from medically managed breech deliveries to hands-off vaginal breech births. She covers topics such as epidurals, breech extraction and assisted vaginal delivery, forceps, various breech maneuvers, Pitocin induction/augmentation, episiotomy, cord prolapse and/or compression, head entrapment, and fetal monitoring. She describes two different techniques for natural, spontaneous breech birth: "hands-off" (à la Maggie Banks, Mary Cronk, and several of her OB interviewees) and “hands-on” breech birth (à la Ina May Gaskin and the other Farm midwives). She discusses justifications for various positions during labor; her interviewees and many other practitioners have found that upright standing or kneeling positions are so much easier than births where the mothers have their legs up in the air. From the summary of this chapter:
"The management of a vaginal breech birth is immensely controversial and particularly striking for the coexistence of starkly opposing views. Some argue that epidurals and forceps are essential to promoting safe vaginal delivery while others argue that this is actively harmful. The little evidence we have seems to suggest that less interventionist approaches permitting more spontaneous breech births are associated with better outcomes."
I would definitely recommend Breech Birth as the must-have, compared to the other books on breech birth I have read. I suggest that all midwives, physicians, doulas, and childbirth educators have a copy of Breech Birth on hand. Because it is published in the UK, it is not easy to obtain at a last minute notice—which is precisely when a woman, close to her due date, is trying to figure out what to do about a baby suddenly presenting, or refusing to turn from, breech. The book is written for a wide audience, from physicians, midwives, and medical students to childbirth educators and parents of breech babies. It is thorough in its research but still accessible to a lay audience without being overly simplistic.
Exhaustive is a very fitting term in both of its connotations: this book is thorough and meticulous and examines every aspect of breech presentations and birth. It is also so thorough that it may leave the reader a bit exhausted herself! In fact, a consultant OB commented about her chapter on the evidence for vaginal versus cesarean section for breech: “This section is exhaustive and exhausting.” However, do not be intimidated by the depth of information in this book. Each chapter is organized with a concise summary and slightly longer conclusion summarizing all of the main points of the chapter. Breech Birth also includes some photographs of active breech births, although not as many as "Breech Birth Woman-Wise" by Maggie Banks.
Besides researching the medical and midwifery literature on breech birth, Waites interviewed nine midwives and obstetricians who have extensive experience with vaginal breech births. The perspectives of these attendants—sometimes agreeing with each other, at other times diverging on certain points—are fascinating and an invaluable resource as vaginal breech birth is fast becoming an endangered species.
Waites does not argue for one overall solution to breech birth. She has a strong interest in examining all of the evidence for breech birth, from opinion and anecdote to clinical experience and research studies. She notes that with breech birth, opinion is often presented as fact. Her books strives to delineate what, if any, uncontested facts can be asserted about breech birth (the only universal one, she argues, is that cesarean section more dangerous for the mother than vaginal birth). Even today, uncertainty is the rule with breech birth. She writes:
"there are few certainties when it comes to weighing up the options for breech birth. Even with the Canadian multicentre international breech trial, published in 2000, paraded by some as delivering 'the answer' to the breech conundrum (the answer apparently being to routinely offer caesarean section for breech, there is sufficient criticism of the study (see Chapter 8) to leave many feeling that the answer still eludes us. Overall the body of research we have often produces mutually conflicting data, and conclusions often state that studies of sufficient size and good enough design have not yet been carried out. The active, spontaneous approach to vaginal breech birth, described in more detail in Chapter 10 and espoused by some as the only safe way to conduct a vaginal breech birth is yet to be properly evaluated. Uncertainty should therefore be the uncomfortable though realistic norm in cases of breech."
I will not attempt to summarize each chapter in this review—there is simply far too much information to cover—so instead I will list the chapters. This gives a good overview of the topics covered in Breech Birth.
Part I: The what, why, and how does it feel? of breech
Chapter 1: What is a breech baby?
Chapter 2: Why are babies breech?
Chapter 3: The wrong way up? The emotional impact of breech
Part II: Turning Breech Babies
Chapter 4: An introduction to turning breech babies
Chapter 5: External cephalic version (ECV)
Chapter 6: Factors influencing the success of external cephalic version (ECV)
Chapter 7: Self-help and alternative therapies for turning breech babies
Part III: The evidence on vaginal and caesarean breech birth
Chapter 8: Vaginal versus caesarean breech birth: the evidence
Chapter 9: Selection criteria for vaginal breech birth
Chapter 10: The management of vaginal breech birth
Chapter 11: Emergency caesarean section after a trial of labour: not the worst of both worlds?
Part IV: Making a decision about the birth and negotiating for what you want
Chapter 12: Making your decision about the birth
Chapter 13: Negotiating for the birth you want
Of all the chapters, I found Chapter 10 the most interesting. She covers various approaches to vaginal breech birth, from medically managed breech deliveries to hands-off vaginal breech births. She covers topics such as epidurals, breech extraction and assisted vaginal delivery, forceps, various breech maneuvers, Pitocin induction/augmentation, episiotomy, cord prolapse and/or compression, head entrapment, and fetal monitoring. She describes two different techniques for natural, spontaneous breech birth: "hands-off" (à la Maggie Banks, Mary Cronk, and several of her OB interviewees) and “hands-on” breech birth (à la Ina May Gaskin and the other Farm midwives). She discusses justifications for various positions during labor; her interviewees and many other practitioners have found that upright standing or kneeling positions are so much easier than births where the mothers have their legs up in the air. From the summary of this chapter:
"The management of a vaginal breech birth is immensely controversial and particularly striking for the coexistence of starkly opposing views. Some argue that epidurals and forceps are essential to promoting safe vaginal delivery while others argue that this is actively harmful. The little evidence we have seems to suggest that less interventionist approaches permitting more spontaneous breech births are associated with better outcomes."
I would definitely recommend Breech Birth as the must-have, compared to the other books on breech birth I have read. I suggest that all midwives, physicians, doulas, and childbirth educators have a copy of Breech Birth on hand. Because it is published in the UK, it is not easy to obtain at a last minute notice—which is precisely when a woman, close to her due date, is trying to figure out what to do about a baby suddenly presenting, or refusing to turn from, breech. The book is written for a wide audience, from physicians, midwives, and medical students to childbirth educators and parents of breech babies. It is thorough in its research but still accessible to a lay audience without being overly simplistic.
March 22, 2017
This is one of the very very few books devoted entirely to breech birth specifically vaginal breech birth. In regards to why babies are breech, techniques to attempt to turn babies in breech position, and making the decision to attempt a vaginal breech birth or have a cesarean, it is still very useful. And, although the book is very scholarly, it would still be of use to the lay reader.
Unfortunately, it was published in 2003 when Dr. Frank Louwen and Dr. Anke Reitter had just begun conducting their breech birth trials in Frankfurt, Germany. Their findings resulted in the creation of a new breech maneuver -- Frank's Nudge or the Louwen Manuever -- and shifted the position for the most favorable outcome to hands and knees accompanied by completely "hands off" management from lithotomy/supine used with forceps. So, the entire section on the management of breech births is outdated, and the reader would do well to bear this in mind.
As this book was written by a citizen of the United Kingdom, the experience cited is mainly within the National Health Service (NHS), but some research from the United States, Canada, Israel, and mainland Europe. Several of the most important players in the world of vaginal breech birth -- midwives Jane Evans, Mary Cronk, and Ina May Gaskin, Dr. Wendy Savage, Dr. Michel Odent, and Dr. Yehudi Gordon -- are cited or namedropped. Readers interested in further information may also want to research the work of Dr. Frank Louwen, Dr. Anke Reitter, Dr. Stuart Fischbein, midwife Betty-Anne Daviss, and Dr. Savas M. Menticoglou.
Unfortunately, it was published in 2003 when Dr. Frank Louwen and Dr. Anke Reitter had just begun conducting their breech birth trials in Frankfurt, Germany. Their findings resulted in the creation of a new breech maneuver -- Frank's Nudge or the Louwen Manuever -- and shifted the position for the most favorable outcome to hands and knees accompanied by completely "hands off" management from lithotomy/supine used with forceps. So, the entire section on the management of breech births is outdated, and the reader would do well to bear this in mind.
As this book was written by a citizen of the United Kingdom, the experience cited is mainly within the National Health Service (NHS), but some research from the United States, Canada, Israel, and mainland Europe. Several of the most important players in the world of vaginal breech birth -- midwives Jane Evans, Mary Cronk, and Ina May Gaskin, Dr. Wendy Savage, Dr. Michel Odent, and Dr. Yehudi Gordon -- are cited or namedropped. Readers interested in further information may also want to research the work of Dr. Frank Louwen, Dr. Anke Reitter, Dr. Stuart Fischbein, midwife Betty-Anne Daviss, and Dr. Savas M. Menticoglou.
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