Written By: Faheema Z. Mohammed (The Doula Coach)

A breech presentation occurs when the baby is positioned with its buttocks or feet towards the cervix instead of the head. This occurs in about 3-4% full-term pregnancies. Historically, breech babies were often delivered vaginally, but over the years, the practice has shifted towards caesareans due to perceived risks and lack of training in vaginal breech delivery techniques. As a doula in the Middle East, I have encountered an increasingly large number of clients who are forced into believing that their breeched babies can only be delivered via a caesarean. While caesareans are sometimes necessary and lifesaving, they should not be the default option for breech presentations. In this article, I will explore why breech deliveries are not only viable but often preferable.

The Benefits of a Breech Natural Delivery

  1. Lower Risk of Complications for present and future pregnancies

Natural delivery, when managed correctly, can be safer for both mother and baby. Caesareans, while lifesaving in emergencies, come with their own set of risks, including infection, longer recovery times, and potential complications in future pregnancies. In addition, once a mother has a caesarean, it becomes a complicated process for her to have a VBAC, worse a VBA2C in countries where caesareans are considered the order of the day for any mom who had a caesarean in her first pregnancy.

I recently met with a client, who had a caesarean in her first birth due to Breech presentation. She was then made to believe that she needed another caesarean in her second pregnancy although her baby was in optimal position and both she and her baby were doing well. Now that she is educated about childbirth, she would like to try for a VBA2C, but unfortunately she is now being told by her doctors  that VBA2C is not possible.

"The evidence suggests that vaginal breech birth, when managed correctly, can be as safe as caesarean for the baby, with fewer risks for the mother. It's time we re-skill our birth professionals and support women in making informed choices." - Dr. Sarah Buckley.

  1. Empowerment and Control

Natural delivery allows mothers to be active participants in the birthing process. It empowers them to make informed decisions and feel in control of their bodies. This sense of empowerment can lead to a more positive birth experience and better postpartum mental health.

I once had a client who was almost full term when her water broke. At the ER she was fully dilated, and the baby’s legs were already in the birth canal. The doctor on call refused to let the mother give birth to her baby naturally even though she and baby were both healthy. When I asked the doctor why an emergency cesarean, she responded, “The baby’s head would get stuck!” This mother was about to give birth to her baby but never got the chance to deliver. She was off to the operating theatre in less than five minutes!

In contrast, I had a mom who recently scheduled a caesarean due to Breech presentation. On the day of the scheduled operation, she called me at 4am to announce her water had broken and she was having contractions. She was elated! I supported them at the hospital for six hours, where she was allowed to labor as her caesarean was booked for 12pm. Her labor progressed well, and I believed she was in transition when they took her into theatre, but the doctor never checked her dilation after the mother’s initial vaginal check at the ER, which was 3cm at 4:30am. Mom and dad were extremely happy because they knew their baby was ready to come into the world. On the flip side, I was a bit sad, because I knew this mom was almost there, but she did not have the support. She had accepted having the caesarean because no one will deliver a Breech baby!

So How Can We Support Advocating for Change When It Comes to Breech Vaginal Deliveries?

As doulas and childbirth educators, we are advocates for natural childbirth, therefore, we must work to change the narrative around Breech deliveries. This involves encouraging healthcare providers to receive training in vaginal breech delivery techniques. This may seem a daunting task, but changing the perspective of one doctor or hospital to practice Breech deliveries can attract the attention of other hospitals and doctors to consider implementing similar practices. It is also important to ensure that mothers are fully informed about their options, depending on their locality as well as the risks and benefits of both caesareans and breech deliveries. Mothers who choose to have Breech deliveries should have a strong supportive network which should include supportive doctors, midwives and doulas.

To recap, caesareans for breech babies should not be the default option. Natural delivery methods, when supported and managed correctly, can be a safe and empowering choice for mothers. By advocating for more natural approaches, we as doulas can assist mothers in making informed decisions, which can permit them to have the birth experience they desire. Let's work together to support and promote natural childbirth for Breech babies in the Middle East and beyond.