Friday November 04, 2016

Into the Breech: This midwife says breech births are safe and natural. Now she just has to convince doctors.

Breech births 0:53

Listen 26:29

Normal, natural...and breech birth. 

In medicine today, those words aren't often spoken in the same sentence. 

But Ottawa midwife Betty-Anne Daviss believes that should change.

"The thing that we have to keep in mind is that there will always be women who want a normal, natural childbirth." says Daviss, who has attended around 150 vaginal breech births. 

A registered midwife for more than 30 years, Daviss is a rare breed in health care. 

Leanne Moussa

Leanne Moussa with Isa Russell Qureshi. delivered by Betty-Anne Daviss in complete breech at 42 weeks.

Delivering a breech is a dying skill in Canada. Very few midwives or doctors attempt it. Most obstetricians in Canada stopped doing natural breech births years ago. There's worry about possible complications and subsequent legal action.

Ottawa mom Leanne Moussa had her breech baby delivered by Daviss, but says she encountered negative reactions to her decision from other health-care providers.

"Many of the conversations that I had leading up to my choice to have a vaginal breech delivery hinted at me,  as a birthing mother, making an irresponsible choice for the health of my baby. And that is simply not supported by the data," Moussa says.

Moussa belongs to Mothers of Change – a non-profit group that advocates for fewer unnecessary C-Sections. 

Betty-Anne Daviss

Midwife Betty-Anne Daviss examines Erin Vanasse – and her ten-day old son Pax (Brian Goldman)

Breech, which make up 4 per cent of total births, means the baby comes out bottom first. A breech birth is difficult because the bottom doesn't widen the birth canal as much as head-first delivery. It takes more skill and experience to get the head out without injuring the baby and to do it quickly enough for the baby to start breathing on its own.  

Daviss believes that breech births are not only safe, but preferable to Caesarian sections. There's some evidence the medical community is coming around to her way of thinking. The Society of Obstetricians and Gynecologists of Canada has published guidelines recommending doctors no longer do C-sections routinely when a baby is breech. That's a revision on its previous stand.

In Guatemala the way you do any birth, whether it's breech or head down, is you throw a rope over a beam in the roof of your cornstalk house, and you squat down. If you have trouble, you just take another position; it's usually you fall over on your hands and knees. So that's the way you do every birth that becomes problematic. If the baby's not coming out, you take another position. - Betty-Anne Davis

Daviss' route to midwifery is unusual. It began in Guatemala in the 1970s  After a major earthquake, she went into remote, mountainous communities to help. She attended a number of births and studied local birthing knowledge and practices. 

She began her practice in Ottawa in the early 1980s, before midwifery was an officially recognized profession in the province. 

Adding to the evidence that the thinking around vaginal breech births is changing is the fact that Daviss is allowed to deliver breech babies at Hopital Montfort, in suburban Ottawa. She works alongside Dr. Daniel Moreau. Moreau has  attended more than 100  planned breech births. 

Daviss knows the road to bring breech births back into the mainstream is an uphill climb. She has to overcome decades of defaulting to C-sections for breeches. 

"There's major fear around vaginal birth. And trying to undo it is really difficult when you've got an entire cohort of physicians who have not been trained to do it. And more have been trained to fear it."