In my experience breech babies are worth following even more closely
than run-of-the-mill hospital-born babies.  Whether born vaginally or
by CS they are rarely simply allowed to slip out of their own accord
and breech presentation is listed as a risk factor for 'KISS
syndrome', a traumatic disorder of the cervical spine described by a
German osteopath and not recognized by most  medical practitioners.
(It is a bit like what I was taught to call torticollis).  I would
almost expect there to be less of this effect in breech babies born by
CS than vaginally, because the manipulations they go through in a
vaginal breech birth in hospital are not exactly a walk in the park
either.  As far as KISS syndrome goes, I don't care what it's called
as long as it gets better with CST and the baby can start feeding
normally.

Vertex babies born by CS will often have difficulty gaping wide,
especially if separated from mother when they should be unfolidng and
relaxing and taking in their new surroundings.  Linda Smith explained
this for a group of my colleagues so graphically, when she reminded us
of how they are lifted out of the womb: the operator delivers the head
by placing fingers under both sides of the baby's lower jaw and
pulling, and often they need to use so much traction to guide the head
through the incision that it's no wonder the baby doesn't gape for
days.  I've only seen one case where the baby never was able to gape
at all.  Even when very distressed to the point of screaming, she had
an almost clenched jaw and was unable to feed.  Sadly, the
pediatricians were not at all concerned, calling it 'within the range
of normal', despite our repeated requests for a PT and an ENT
evaluation, and breastfeeding never got started.  The parents were not
receptive to trying CST, especially since the pedis were so
unconcerned.

Still, it's worth keeping in mind that mothers and babies are
immensely resilient and resourceful, and breastfeeding can succeed
even without expert help, in circumstances where all the cards are
stacked against it.  Plenty of breech babies and CS babies do just
fine with no intervention, if the environment is truly breastfeeding
friendly, ensuring early contact, with knowledgeable staff following
best practice guidelines.  And mother and babies without any
identifiable risk factors may end up shipwrecked at the start of their
breastfeeding voyage if the care is bad enough - and it often is that
bad.  Watch and wait, but act swiftly to correct the situation at
first sign of something amiss, is the only viable advice for anyone
working with breastfeeding, I think.  If it ain't broke, don't fix it,
but know what the signs of trouble are and ACT on them without delay.

Rachel Myr
Kristiansand, Norway

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