My first birth in Barcelona as a actual midwife came with a lovely couple who’s baby was breech. I had met them months previously, when I was doing and elective placement with my group of home birth midwives. They chose to use the services of our group of midwives early in pregnancy as they wanted the choice to birth at home and the support offered to them by private midwives that was not available in the state system.
Their baby had been breech for a while and because of this they were going to be forced to abandon their plans of a home birth and go into hospital for delivery. In Spain it is illegal for a midwife to deliver breech at home. Although this is done in the UK, Spain, I was learning,is very behind, when it comes to normality in childbirth and evidence based practice in the world of obstetrics.http://www.withwoman.co.uk/contents/evidence/evidencemt1.html
A few weeks before our ladies due date, she came in to attempt to turn her baby in to the cephalic position as using moxabustion did not work for her.Turning breechs is usually done by doctors in hospital and it is an upsetting site to see. But everything is different with the midwives I work with. It was the most amazing thing I have seen. Maria, the primary midwife in my clinic and O the founder of the clinic, used the mexican rocking method to begin the turn. I have no idea how it worked, but just from rocking the mama with a cloth between them the baby turned to transverse! I watched this baby actually travel on its on, while its mother was being gently rocked from side to side. Then O and Maria used a gentle massage and baby turned, but it also turned back quickly. It was truly amazing and really gentle and loving, the lights were low and all voices hushed while O spoke to the baby, encouraging him to turn. It was really lovely and this could never be said about a medical attempt at turning. With this said, baby soon moved back in to breech position. I feel sometimes babies just need to come breech.http://www.aims.org.uk/Journal/Vol17No1/handsOff.htm
As the baby did not stay turned the parents decided to delivery baby at a private hospital with one of the few doctors in Barcelona who will deliver breech. Most opt for a caesarian straight away. This I believe is based on a breech trial conducted in 2000, I believe, which found that caesarians were safer than vaginal delivery of breech babies.http://www.ncbi.nlm.nih.gov/pubmed/11052579 This study was later challenged by many midwives and obstetricians and midwives and students were again trained and allowed to deliver breech babies. This re thinking of the safety of breech was largely championed by an amazing midwife called Mary Cronk, who not only continued to deliver breech at home but also trained midwives how to do this, so the skills need to do this would not be lost. http://www.aims.org.uk/Journal/Vol17No1/handsOff.htm It is now an integral part of midwifery education, to learn to deliver, breech in the UK, so the fact that we could not do this in Spain came as a great surprise to me.
Although our lady could not deliver with us, our plan was to have her stay home and dilate as long as possible before going in to hospital to deliver. This went well and our lady was able to stay home until she was 6cm dilated. The time at home was tranquil and warm, and she laboured in an amazing and unexpected way. At times we midwives do tend to brand ladies by the way we think they will labour, and in this case we were all dead wrong. This woman laboured in silence and with the strength of a goddess. She made it to 6cm quickly and we were off to hospital.
Labour wards in hospitals in Spain, to my shock and horror, are split into dilatation rooms and delivery rooms. The dilatation rooms are like those in the UK, where we also deliver. But in Spain, once a woman is fully dilated, she is inconvenienced and moved into a a space that shouts GOOD BYE NORMALITY and screams INTERVENTION! In this particular hospital, private and considered the best, the delivery room was a cold space with a narrow bed that had well polished metal 19th century stirrups attached to it. I nearly fainted when I first saw it. You must change to hospital greens when entering this room and there is no privacy for the mother. The nurses in charge, yes nurses, not midwives, are short tempered and lack the basic understanding of the needs of a woman in labour, which I feel are,
- to feel safe and secure
- privacy
- low lighting
- time and space
- and peace to just birth
None of this is on offer in the delivery rooms. The doctor was an older woman who was jovial and warm but appeared to have been trained in the 70’s and her delivery of the baby was deeply upsetting to me, as I was trained to use a hands off approach when delivering. The baby was twisted, turned and finally pulled from his mother and an episiotomy was and is considered standard for this procedure and for that matter,every vaginal birth in Spain. In the end, mother and baby were well and our lady was grateful to have been helped to deliver her baby. She did not mind being cut and was blissfully unaware of how gentle and tranquil it all could have been at home. I on the other hand was deeply disturbed by the experience and was left with a clear understanding of how fortunate women are in the UK and how fortunate I was to have trained there. I had had no idea of this previously and spent a lot of my time in my training complaining about how crap our service was, we gave to women. Hindsight is an amazing thing.
Oh, just in case you were wondering, I am very biased towards normality in childbirth. Below is further information about breech birth and two lovely videos I found on utube of breech birth, thank you so much to the ladies who shared these. There is also a video of a medica ECV breech turning and a using moxibustion.
http://www.youtube.com/watch?v=8vIRTpPOgVw
http://www.youtube.com/watch?v=jD5939e5PZ8&has_verified=1
http://www.youtube.com/watch?v=6AM6wDwTjmc
http://www.youtube.com/watch?v=6AM6wDwTjmc
http://www.breechbirth.ca/Welcome.html
http://midwifeinfo.com/articles/evidence-based-midwifery-practice
http://www.homebirth.org.uk/youcant.htm#19
http://www.aims.org.uk/Journal/Vol14No2/BirthingBabyBreechHome.htm
http://www.rcog.org.uk/files/rcog-corp/uploaded-files/GT20bManagement_ofBreechPresentation.pdf
http://www.partodenalgas.com/
The Barcelona Midwife 