What Partners Should Know About Wrong-Way Births
21 Jul 2009
What’s one of the worst things a baby can do to a mother (and her partner) at the time of delivery? It decides to be born feet or bottom first, rather than head first. Wrong-way birth is called breech birth, and it can have major health consequences for the baby and for family, lasting a lifetime. So women and their partners should never, ever make a hasty or emotional decision on whether or not to have a Cesarean section.
The Society of Obstetricians and Gynecologists of Canada (SOGC) recently stated that doctors should no longer opt for cesarean section for breech birth. They claim there is no difference in the complication rate between a right-way and wrong-way delivery.
This decision is adding fuel to the fire for organizations who want women to have the personal right for vaginal delivery even for breech births. As one women complained after cesarean, "I didn’t have the experience to catch her." But with this option, women and their partners should remember the old adage, "Let the buyer beware" of the potential long-term consequences.
What are the possible hazards of vaginal birth? For several years vaginal delivery was considered too dangerous and cesarean section became the preferred choice of doctors. Medical schools have therefore not trained young doctors about the technique of breech delivery. In addition, many older doctors with this expertise have either died or retired.
If I were a woman I would not agree to fly with an inexperienced pilot. Nor would I want to have a wrong-way baby delivered by a doctor who lacked the expertise to perform a breech delivery.
To correct this shortage the SOGC says there will be a national training program to bring doctors up to scratch on breech deliveries. I wish the SOGC and patients luck for this is easier said than done. First, there are few doctors who can teach this technique. There are also few cases in university hospitals as only three to four percent of births are wrong-way births. It also takes many breech deliveries for doctors to become proficient. And how will they teach doctors already in practice?
But let’s assume this monumental task can be accomplished. There’s another major problem, lawyers. Litigation lawyers must be rubbing their hands in glee just waiting for those pregnancies that end in disaster. After all, it was in part because of law suits that vaginal breech deliveries were largely discontinued years ago.
What will lawyers (and willing patients) be looking for following a wrong-way delivery? They will be looking for a baby that is not perfect and has been injured in some way by vaginal birth. And asking why the doctor didn’t choose cesarean delivery.
The real tragedy is a baby who has been severely brain-damaged in childbirth. A baby whose feet and buttocks were delivered first without trouble, but the fetal head, larger than expected, became stuck in the bony birth canal causing a traumatic wrong-way delivery. All too often in the past this has caused brain injury and families have sued for millions of dollars.
One highly respected obstetrician said to me, "I have the expertise, but in view of possible litigation, I no longer do a vaginal delivery for breech birth". He knows that, if a complication occurs the organization sponsoring vaginal breech birth won’t be in court holding his hand. Or help him through the emotional strain of a court case that could last several years.
What’s the outcome? I have no crystal ball, but I believe this guideline issued by the SOGC, will have limited success with huge economic costs. And I think hell will freeze over before this policy is adopted in the U.S. where litigation has become a way of life.
Women and their partners who want the right to "catch" their baby should also be willing to sign a legal document that they also accept the possible complications. I realize that cesarean section poses a risk of infection and other surgical problems. But pound for pound, I’d get down on my knees and beg for a cesarean section after what I have personally observed over the years.
But, as always, these decisions must be between patient and doctor.
