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Midwives are losing the skill to carry out breech births because so many women are having Caesareans, health experts have warned. Jean Robinson, a former General Medical Council (GMC) and Patient Association member, said better midwife training would give pregnant women more choices.
She said: "Women are losing the opportunity to have vaginal births and those that are being carried out are being carried out by obstetricians.
"In the days when a large proportion of our births were home births, midwives were able to deliver babies, twins, small babies and very large babies as well as breech babies."
A "breech baby" is a baby who is not positioned in the birth canal with his or her head down. Instead, the legs or buttocks appear first.
Ms Robinson said fewer and fewer midwives were being offered the chance to carry out such births and so were losing vital skills.
"They would not have the skills or the confidence to deliver them vaginally. More and more breeches now mean a routine Caesarean."
Ms Robinson, a current honorary officer for the Association for Improvements in Maternity Services (AIMS), raised her concerns in an article in the British Journal of Midwifery.
Complications
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Women are supposed to have a choice. At present only those who can afford a private midwife are likely to get a midwifery breech delivery |
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Jean Robinson |
She said: "Whether working at home or in the hospital, midwives are going to find themselves coping unexpectedly with a breech arrival.
"Transferring the woman before the birth or getting an experienced doctor quickly is not always an option.
"Some of the births in transit might have been better managed by delivery before transfer, but I suspect the midwives could not, or dare not, do it.
"Women are supposed to have a choice. At present only those who can afford a private midwife are likely to get a midwifery breech delivery."
She said women should be offered vaginal births wherever possible to avoid complications during surgery or in future pregnancies.
Independent midwife Mary Cronk agreed.
She said breech deliveries were not recommended but women should, where possible, be offered the chance to have vaginal breech births.
"I think many of us have lost the skills. And many who trained in the 80's and 90's never learnt the skill," she said.
Midwives who could carry out breech births were being inundated with calls from mothers anxious to avoid surgery, she added.
"In the last 48 hours I have had three calls from women with breech births and all the women told me that they had been told they would need a Caesarean."
'Unnecessary surgery'
She said midwives needed to be given better training and education to cope with breech births.
A spokeswoman for the Royal College of Midwives said they were aware of the need for health professionals to update their skills to avoid unnecessary surgery.
"Obstetricians and midwives need to update their skills to successfully manage vaginal breech birth once more," she said.
"The RCM has run practice based seminars for midwives on the management of breech vaginal births as part of our ongoing continuing professional development programme for midwives."
But she said that a Canadian study comparing the outcome of planned Caesarean section with planned vaginal birth for breech presentation at term suggested that planned Caesarean section was better for the baby than planned vaginal birth."
[Lancet]
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Last Revised at December 10, 2007 by Lusine Kazoyan, M.D.
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