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Wednesday
Jun172009

Canadian Birth Culture Begins Presenting Itself Differently

 

Today’s Vancouver Sun reports that Canadian doctors are being told to stop automatically scheduling cesareans for breech babies.

In a major shift in medical practice and another assault on Canada’s rising cesarean section rate, Canada’s delivery doctors are being told to stop automatically scheduling C-sections for breech babies and attempt a normal delivery instead — something significant numbers of obstetricians aren’t trained to do.

New guidelines issued Wednesday by the Society of Obstetricians and Gynaecologists of Canada say women carrying babies in the breech, or bottom-first, position should be given the right to choose to attempt a traditional delivery when possible.

The society says that women in Canada want the choice, and that some women with breech babies are delivering at home “because they knew if they went to hospital A, B or C it would not be offered,” says Dr. Andre Lalonde, executive vice-president of the obstetricians’ group and an adjunct professor of obstetrics and gynecology at McGill University and the University of Ottawa.

Lalonde says the group is working aggressively to ensure future specialists are trained in breech vaginal deliveries and is organizing courses across Canada for practising doctors to refresh their training.

Read more

 

This mainstream media coverage will no doubt excite the Coalition for Breech Birth, a grassroots Canadian coaltion advocating for change within the Canadian and US birthing communities. The CBB’s position on breech birth is that breech presentation is part of the normal spectrum of birthing positions and that families deserve to have complete information, free of “objection handling” or scare tactics to sway their decisions.

 

Oh, Canada. Please help us down here.

 

 

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Reader Comments (8)

This makes me want to make out with Canada (even more).

June 17, 2009 | Unregistered CommenterSonja

*starts packing bags* ;)

June 17, 2009 | Unregistered CommenterTara

Happy to read that some sense is being gotten about breech births. I'm rather irritated, though, that they still disclaim that women with suspected CPD (bogus and unpredictable), and suspected macrosomia (bogus and unpredictable) should have a c-section. :eyeroll:

June 17, 2009 | Unregistered CommenterEmily Jones

This is AWESOME!

June 17, 2009 | Unregistered CommenterNursing Birth

Thanks for the link hon!
I too am dismayed by the "size restrictions" - I think this falls into the realm of informed consent for the mama ie "risks may be higher if your baby is actually really big but we have no reliable way to tell you if your babe is really big". I've never heard of a late 3rd-trim u/s EVER measuring a baby *smaller* than s/he actually is.
Another important thing to note is that there is nothing in the guidelines, or at least in the advance briefing I had with the SOGC about the contents of the guidelines, that restricts breech delivery to OBs. Some of the news coverage I read yesterday implies that the guideliines state the woman needs to be attended by an OB who can go immediately to c/s, but their actual point is that they're recommending that breech birth happen in the hospital where a c/s is more or less immediately available, not that we must be attended by an OB. Hospitals, of course, will probably try to interpret it that way and limit MWs from catching breeches so we as women really need to speak up about what we need.
AND speaking of which.... positive as this is, we need to keep perspective on the fact that a guideline change is a guideline change. And getting this implemented in a practical way that is actually going to benefit women and babies is going to require some noise from women. We still need to insist that this HAPPEN because you know there is going to be a fair bit of resisitance from many OBs. We need to keep educating the women around us so that every family facing this situation is aware that the options are there and demand a referral if their own OB isn't willing to consider a vaginal birth.

Oh, Canada. Please help us down here."

yes, please!

June 18, 2009 | Unregistered Commenterpampered_mom

It would be nice if Canadian hospitals actually follow these recommendations. My midwives in Alberta still pass off breech births to doctors as part of their contractual agreement with the province in order to remain funded. Unfortunately this sort of recommendation is a bit like a cardiologist telling an overweight patient that exercise and diet is really what they need. It's revolutionary if the patient follows the advice. Sadly, like in the US, doctors get paid more to preform a C-section, so while we may see more doctors allow women to try a breech labour, my gut tells we're about to hear more stories of women who's doctors "saved" their breech babies life by performing a section last minute. It will be interesting to see how long it takes for us Canadians to follow these recommendations, hopefully I'll be surprised.

July 24, 2009 | Unregistered CommenterErron

Hi Erron,

It's only been one month since the news came out. Change will be a long time coming. It's a start, though.

I think the consensus is that doctors don't actually get paid more for a c-section than for attending a vaginal birth, but if you can line up five cesareans instead of waiting for five births to unfold normally and without induction or augmentation, you're using your time more efficiently and therefore being better compensated in the long run.

Thank for your comments.

July 24, 2009 | Registered CommenterJill
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