Wednesday, March 18, 2009

Breech Birth in Canada

Despite recent research clearly indicating that vaginal breech birth and caesarean section are equal in both safety and risk, obstetricians persist in not informing families that vaginal birth is an option, and nearly all of the breech babies in Canada and the US are 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. Families are rarely given the impression that Caesarean birth is dangerous, despite the fact that the risk level is identical.

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 early 2009, the Society of Obstetricians and Gynecologists of Canada will issue 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 American College of Obstetricians and Gynecologists published a similar change in July of 2006.

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.
The real change must come from women. Know your rights. Know the evidence. Don't be "polite." Demand an unbiased informed choice discussion. If your care provider is not comfortable or qualified to "catch" a breech - or not willing to have this discussion - make it clear that you expect a referral to someone who will. It is your right to choose how your baby comes into the world, and the evidence is on your side.
Add your voice. We need you.