Breech birth is changing. For nearly a decade, birth care providers have not offered families the option of vaginal birth, and nearly all of the breech babies in Canada and the US have been born by Caesarean section. The mother's birthing history, family circumstances, and family beliefs about birthing are rarely taken into account. If women ask, they are usually told that vaginal breech birth is too dangerous - despite the fact that the risk level is nearly identical to caesarean section with conventional management and could be much safer with protocols that permit a mother-led birthing.
We believe that the birthing family has the right to decide which mode of birth is appropriate for their breech baby. We believe that informed consent means that families have the right to know that vaginal birth is not only possible, but considered completely normal internationally. We believe that families have the right to know that Caesarean surgery has significant risks equal to that of vaginal breech birth, and should be undertaken with full awareness and acceptance of these risks.
In June 2009, the Society of Obstetricians and Gynecologists of Canada issued new guidelines that encourage care providers to offer vaginal breech birth to women. This policy change is an important first step in the re-normalization of vaginal breech birth in Canada and the return of choice to women and their families. The guidelines specifically state that the birth mode choice belongs to the woman, and that even if the doctor is not comfortable with her choice she "must not be abandoned but given the best possible in-hospital care." read the guidelines here
However, a guideline change alone does not solve the problem - guidelines are only guidelines, and care providers are expected to make case-by-case recommendations to their clients. This "case-by-case" judgement call, for many care providers, will continue to feature a strongly worded push towards surgical birth for breech. The guideline change will not of its own accord cause doctors and midwives to make changes in their informed choice discussions that would permit women to exercise their right to choose.
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