Well, it is obvious to this listmother that the one thing that can engage us
as much as discussions about breastfeeding, is discussions about childbirth.
Trouble is, Lactnet is about breastfeeding.  While the discussion is
fascinating, it is straying, not just into off topic areas, but also into
the kind of exchanges one doesn't want in one's virtual, or actual, living
room.  There is no need at this point to send public reprimands to
individuals on the list, but I can envision the necessity in the near future
if the discussion doesn't get back on topic.

Before we go back to our real topic, though, I am going to pull rank as a
listmother and tell you all that I didn't get to read any LN today until
after 10 pm local time, because I was at the annual meeting of the local
chapter of my professional association (Norwegian Association of Midwives).
We enjoyed a presentation by a colleague who reported on the Breech Birth
Project at our hospital.  Its aim is to increase our proportion of vaginal
breeches.  It started in 1999 when the rate was about 20%.  Over the 5 years
(and yes, the Hannah study is known - and critically questioned - in Norway)
for which data analysis is complete, the average was 30%, and it is rising.
During the same period, the number of breech babies with Apgar scores under
7 at five minutes has declined, to about one per cent, regardless of how
they were born.  Transfers to NICU have been for reasons unrelated to mode
of delivery - mainly prematurity, as breech presentation is more prevalent
the shorter the gestation.  
We have clear, very cautious guidelines for which women can safely go into
labor with a breech baby, and they are working.  And we are doing fewer
emergency CS for breech, and fewer CS for breech overall.  The most exciting
thing I heard tonight was that in 2004, our epidural rate for vaginal
breeches was about 50%.  Still three times what the epidural rate is for
vertex presentation, but half what it was when I began my training and
learned that laboring with a fetus presenting by the breech and without an
epidural was tantamount to asking for a dead baby.  Even episiotomy is now
considered on a case-by-case basis.
Our numbers for breeches include second twins. 
Last week we had three normal breech births, including one surprise one in a
primip, who gave birth two hours after admission for ruptured membranes
without labor.  Since we don't do internals on women who are admitted for
that diagnosis until they are thought to be in labor, by the time anyone
checked she was nearly completely dilated and the breech was on the pelvic
floor.  Only thing left to do was get the warm towels ready to catch the
baby!
I include this in my post because some of you may not know that there is
still a country in the world where it is safe to say out loud, at meetings
of the ob/gyn association and the midwives' association, that we are
convinced of the importance of continuing to teach practitioners the skills
needed to attend vaginal breech births - and of the safety of so doing,
given good selection and good skills.  We really want to show this off, so
when you plan your trip to Lactopia, aka Norway, be sure to include a tour
of one of the tertiary level labor wards like mine, so you can hear the
staff tell about keeping the skills of normal breech birth alive.

Rachel Myr
One very proud midwife tonight, in Kristiansand, Norway

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