In February 2017, as a member of the `Women`s Voices` panel, I reviewed proposed updates to the pamphlet on Breech Births and Cephalic Version that the Royal College of Obstetricians and Gynaecologists is preparing. This is one of its impressive series of patient information leaflets available on the website, and covering all areas of pregnancy, birth and gynaecology.
I saw my role primarily as checking the pamphlet would be clear to patients and their partners / families, and that it provided most of the information they might need on the subject. As my historical research is often concerned with how information was conveyed by medical practitioners to women, it was particularly interesting to see the process at work in the present day!
The subject of breech birth, and particularly the relative advantages of vaginal birth versus caesarean delivery, continue to stimulate debate. In the UK, many hospitals opt for caesarean as the preferred, safest mode of planned delivery, although there are some centres - and some independent midwives - with particular experience in planned vaginal breech births (in suitable cases). The information leaflet by the Oxford Breech Clinic provides a very thorough overview of the criteria governing choices.
The situation today is in stark contrast to the assumption even a generation ago that the majority of breech births would be vaginal. (I was a breech baby, and my mother gave birth vaginally, on the recommendation of a team of experienced local GPs who attended all non-caesarean births at the nearby maternity home.) In part, the change has come about because caesareans have become far safer. However, in addition, as far fewer midwives and doctors regularly attend breech births, there are fewer opportunities for them to become skilled in vaginal breech delivery (although all are trained in managing the process in emergency, e.g. if a patient presents in advanced labour with a previously undiagnosed breech presentation).
Early printed midwifery / obstetric textbooks devoted substantial sections to managing breech presentations, and vaginal delivery was the only option that could save the life of both mother and child. One of the most accomplished practitioners and exponents was the German midwife, Justine Siegemund, who shows in the illustration below how the midwife should gently `catch` the breech.
Siegemund was a distinguished midwife in Brandenburg, looking to counter the rise of male obstetric surgeons in her manual for midwives, Die ChurBrandenburgische Hof-WeheMutter (The Brandenburg Court Midwife). She explained in detail the skills midwives should acquire, and the various manoeuvres they could employ in lengthy and difficult deliveries. In the case of frank breech births, she recommended that the midwife’s hands be ready to catch and support the presenting buttocks, without overly hastening the birth. It is noteworthy that the hands in the image are quite small, the arms slender; implicitly, Siegemund – who herself commissioned the illustrations for her volume – is portraying a potential advantage of the female practitioner. However, contemporary male midwife-surgeons also took care to commission portraits displaying their neat hands!