Breech Part 2

Witch tales...

For my second post on this subject, I’d like to combine a few things. Firstly some breech birth accounts, mostly taken from my non-fiction title Women's Choices, Midwife Voices, secondly a bit of personal memoir that shares the vulnerability a practitioner feels when practicing outside of ‘the system’, and thirdly, how I equate this vulnerability as associated with the witch hunts of yesteryear, a favourite subject for me She Rites. I conclude with a short comment on the excellent book that also demonstrates how women today can never escape the label ‘witch’ in a patriarchal society - How to Kill a Witch: A Guide for the Patriarchy

The Stories

Breeches

Breech babies pitch up in around 4% of pregnancies, more often in twins, but my records show that 10% of the births I attended whilst independent were breech. This higher than average figure came about as once you are known to have the rare (these days) skills, you are sought out by the brave women wanting to birth their babies this way rather than accept the most offered solution in hospital of a planned caesarean section. I do not say brave because having a breech baby at home is especially high risk requiring courage, but brave in going against the grain, against medical advice, in challenging a system that does not inherently trust a woman’s body to birth without intervention. That’s what takes real guts, being able to sit in a doctor’s office and say,

“Thank you for your advice doctor, but I’m going to have my baby in the safety of my home with the midwife.” And to be able to say this just after you’ve been told that unless you have a caesarean section in hospital your baby is likely to die. My wonderful mentor, the woman who taught me how to help women birth their breech babies, Mary Cronk MBE, also taught me to encourage women to believe in the safety of their home to birth. Whilst we midwives can be seen as strong women, I always felt this was a myth. I was only as strong as my clients; if she was strong, then I could be strong for her. Sometimes it was just fortuitous that a client already booked with me happened to end up presenting at term as a breech. This was the best case scenario as there was already history between us either by virtue of previous babies or simply our developing relationship antenatally.

One of my regulars, Gail, (she had three babies at home with me as her midwife in the end) presented with breech for her second. In that case, given the option to consult with an obstetrician she elected for an ECV, (external cephalic version, the baby turned to the more common head presentation). When the baby flipped back around soon afterwards, she decided to go ahead with another home birth, and the obstetrician was supportive. As I regularly referred women to him, we had a good working relationship; I trusted his skills, and he trusted mine. My client had another gentle home birth.

A Birth Story - Planned Breech labour

Women were increasingly seeking me out as a practitioner who would support breech birth, as opposed to breech delivery or elective caesarean section for breech. Some arrived incidentally as I said, often the case with women expecting twins booking with me. My mentor Mary Cronk was an absolute legend regarding breech births. Once, with another client, Emma, I rang a labour ward of a local Trust just as a courtesy as she was in labour nearby; you hope not, but you may need them later - I wasn’t to know that in this case I would. I asked to speak to whoever was in charge that day.

“Hello, my name’s Lynn Walcott. I’m an independent midwife and I’m with a client in your area. I’m just ringing to say that she’s in labour and it’s a breech, first baby.” The sharp intake of breath on the other end was audible.

“Are you coming in for a section then? We’re not busy, I can have theatre ready in a jiffy.”

“That won’t be necessary, she’s planning to birth at home.” I paused to let the fact of the matter sink in, the decision was the woman’s where and how she chose to birth.

“Oh…” I could feel the co-ordinator’s fear through the phone line. I felt a little mean stringing her along like that. But I always enjoyed the punch line,

“I have Mary Cronk with me. I’ll only ring again when the baby is born or if we need to come in.” This time there was a long sigh, a relaxed, out breath,

“Oh, okay then. No worries with Mary there. Have a lovely baby…”. It was like a charm, dropping Mary’s name like that.

This time we did need to go in for a caesarean in the end. As was most common in a breech baby that couldn’t be born this way, the labour stopped, the woman’s body sending a strong message of, no - this isn’t going to work this way. At least she tried and knew that it wasn’t to be and wouldn’t always wonder if she would have been able to birth vaginally if she’d had a planned section. With a halted labour, there is no rush, and we lazily made our way to the labour ward after alerting them to our need to transfer in. I must tell of the poor, young, junior doctor sent to admit us in triage. He had no idea why we were there, all part of the training, he has to learn to ask the right questions and report back to the Registrar on duty. It was going so well, then when he asked what had brought us in as she obviously wasn’t labouring, I casually said,

“Emma’s membranes ruptured yesterday but she hasn’t gone in to labour… it’s a breech… so…”. I wasn’t able to finish before, bless him, he’d jumped up to press the emergency bell whilst uttering,

“Oh my God…” and starting to prep the woman verbally for an emergency section…. He clearly didn’t have a clue why we were all so serene with this scenario.

“Well, doctor, the baby hasn’t attempted to arrive for the last eighteen hours, so I doubt it’s about to make an appearance in the next few minutes.” I reassured, trying not to smirk.

A Birth Story - Unplanned breech labour

I am not afraid to admit, that I once had an undiagnosed breech - it can happen to anyone. Faye was to be a VBAC (Vaginal Birth After Caesarean) and had a slow beginning of labour, which was unusual for a VBAC in my experience. After a night and day with no apparent change, I offered a VE (vaginal examination), and there it was, a bottom – she palpated as head down, or so I thought. As Mary Cronk had taught me, a breech labour that doesn’t progress is safest born by LSCS. You just don’t mess around trying to push a breech through a pelvis; if it wants to be born that way, it will be. We transferred in… and actually, there is a bit more of that story to tell.

It was a hospital that I’d never needed to go in previously, despite having births in the area. So they were terrified of me, I think. Certainly, they felt it necessary to call out the SOM (Supervisor of Midwives) to attend when I arrived. What was rather funny, was that I was wearing a t-shirt a friend had brought back for me from a holiday in America - she’d been to Salem, the notorious town where there’d been a high incidence of witches burned. A picture of a witch on a broomstick was obviously too near the mark for the staff. So probably not the best introduction to their local IM. However, at least we were all in agreement that a LSCS was needed.

At first, they did not want me to be in theatre, but the SOM was at least supportive on that front, and I’m so glad I was present (and maybe, even the staff were?). The surgery was no problem, but the baby was not vigorous at birth. The paediatrician present was very inexperienced. I always feel sorry for junior doctors, at the beginning of their clinical training they are just thrown in at the deep end. The baby began to deteriorate, and whilst the staff midwife in theatre to receive the baby, support the mother, and watch me (my perception) implored the very young, looking doctor to get on with resuscitation, I stepped in to do just that. I couldn’t understand why the midwife herself hadn’t just gone ahead, but I suppose it showed the strength of the local hierarchy. This midwife then shouted at me,

“You’re not allowed to do anything!” She was horrified that I was ‘practising clinically’ when I didn’t have a contract - I was there only on sufferance and as a moral support for my clients. I just retorted that it was an emergency and got on with what needed doing. The doctor finally came to her senses and took over from me. The babe was fine, just needed a bit of help to get going. Afterwards in the staff room, to her credit, this midwife did apologise to me. Contract or no contract, in an emergency, I would have been negligent to have not acted.

A Birth Story – breech booked in labour

Being one of the few practitioners available for breech births, meant that it wasn’t unusual to be called when a woman was at term and at the end of her tether. Trying to get the NHS to agree to a natural breech birth was one thing, but for a home birth, nigh on impossible. Mostly it was a case of a hospital Trust just not having midwives with the skills for breech birth. However, they were always happy to pour resources into ensuring midwives were all competent for obstetric skills such as caring for women with epidurals, but breech birth was never a priority. I always tried to get to know the woman a bit before she laboured, which when they were often 36 weeks or beyond, meant a lot of home visits over a short time… if we were lucky. I’d regularly been called as a second midwife to attend a breech birth for a woman whom I did not know - just sensible precautions on the primary IM’s part. It wasn’t like in the NHS where most home births they insisted on two midwives in case there was an emergency, which virtually never happens with healthy women at term, by the way. But in a breech, it wasn’t so out of the ordinary to need to assist the newborn to get going, so another midwife to reassure the mother was normal practice.

I remember Tina extremely well, despite only meeting her for the first time, in labour, with her breech baby, a couple of days after our first conversation. After this one, conversation, she was obviously so relieved to find someone to support her, she’d relaxed enough to go into labour, on the day I’d planned to visit her for the first time. She was 38 weeks and had a birth pool already set up for her originally planned home birth. I have midwifed twins born in water, but never a breech, although plenty had used water for the labour.

It was Tina’s first baby, and she had a very straight forward labour and birth - typically quick as most breeches are. She chose to vacate the pool in the end. I always aimed to use these opportunities to train other midwives in breech, and I had another IM who was new in private practice. What was great about this situation, was that technically, I was too far away to provide regular care, so this other IM was able to provide the bulk of the postnatal care. Tina moved house before her next baby was due, and was closer to where I was now living, so booked with me for her second baby and the other IM she knew, was the back up this time. Primarily I always worked alone - having other practitioners involved only for specific situations.

This arrangement was to prove to be so important, when in the last couple of months of Tina’s second pregnancy, my personal circumstances meant that I needed to give up her care to the back-up midwife. She was the only client that I ever had to do this for. Tina was absolutely lovely about it - had a lovely home birth with the other IM, but my guilt remained. However, a couple of years later, I ‘bumped into’ Tina at a midwifery rally outside of the Houses of Parliament! I was there with hundreds on a bitterly cold winter’s day, to present a petition to government - and I even stood on a soap box with a megaphone and rallied the crowd - there’s a picture somewhere? But Tina was one of the many mothers there to support IM’s, and she was so pleased to see me and show off her toddler wrapped up in a sling close to her body. I was apologetic again for letting her down, but she was so generous and kind, that I was finally able to release the guilt. What a gift.

Memoir

Below, I now share a part of my (unpublished) memoir, which recounts the kind of thoughts and fears around taking on a woman in a perceived high-risk scenario - just the sort of birth that radical midwives become vulnerable over supporting. If all goes well, the baby born without incident, then fine. But, if you need to transfer in to an NHS hospital trust, then whatever the outcome, you may be pursued, seen as practicing unsafely - or more accurately, practising in a way that cannot be controlled. Daring to practice autonomously as a midwife, is enough for some ‘authorities’ to see you as a dangerous rebel and so the witch hunt is perpetuated. Radical and confident women have always been mistrusted, the patriarchy naming them ‘witch’ in times past, and today, much the same characters, midwives assisting women who seek sovereignty of their bodies through their choices in childbirth, are persecuted.

Just like all midwives, I had a life outside of my profession, in my case a family life that was a little more out of the ordinary. I share this story, as it also reveals the complexity of thought we have as midwives; whilst our families come first in our thoughts, often our work as midwives must come first in our actions. The midwife who attended my birth in 1962, a home birth, was the classic ‘spinster devoted to her vocation’ - Sister Brown was the community midwife in the small village where my family lived. Historically, circles of women who had had babies themselves, with a supportive extended family available for childcare, had been the birth keepers. I suspect that the modern era midwives like Sister Brown, had to make a choice - career or family - as society had changed so drastically, but not enough for equality in the workplace. The changes in the twentieth century in the midwifery profession, control being taken away from midwives, away from women continued, hard choices had to be made. I believe that midwives working today have enormously complicated lives trying to accommodate their calling - they don’t have to have a famous member of the family, as I do, for the politics of midwifery to impact their lives significantly - witch hunting pursues all.

(Preparing a granddaughter for what to expect in her future…)

A Birth Story - A Breech

I pull into the side of the road, a residential area in Hampstead on the hill, semi parked, the engine ticking over, so that I may concentrate on the phone-call in which I have been engaged for the last ten minutes. It’s early evening in winter, cold and crisp, the clarity here on the brow of the hill gives me a perfect view. The cityscape a twinkling wonderland of lights and activity. I am distracted from my conversation by the beauty of such an urban landscape, unusual for me a country girl and I am momentarily struck by the bizarreness of my situation.

I can see my destination, not far away now, a floodlit amphitheatre, awesome really, that I have always thought looks like an alien spacecraft has just landed in the city. The mighty Arsenal Emirates stadium, it’s like a scene from a futuristic film, not reality at all. But what is reality these days for me? I think of myself as an ordinary woman. I am an ordinary woman. I have a career and a family, a semi-detached three bedroomed home and Labrador. Right now, I’m in the middle of an urgent professional call, of such import that I will have to find a moment when I get to my destination to make a record of it in my diary. Only a complete account in full detail will suffice in these days of increasing litigation.

And yet, what is my destination tonight? A football ground in the middle of London along with almost 60,000 others. Arsenal are playing in the Champion’s League, and I have to get there two hours before kick-off so that I may park in the stadium itself. Every time I drive through the barriers of the adjacent roads waving my pass, I feel a mixture of pride and trepidation. I don’t belong here, but my son is playing tonight. Just like when he was ten years old, I will be there to watch and cheer him on, just a different location.

I say that I have a job, but it’s far more than that really, being a midwife. It’s a vocation and as I am working independently, outside of the NHS, it is all consuming. My role is complicated and exciting enough without being the mother of a top premiership football player, I muse. Tonight’s call concerns a woman I have not yet met, but whom is pregnant with her first child, due any day now, and it’s a breech; presenting bottom first, not head. Once upon a time this made no difference to midwives. They had the skills and the autonomy for such a situation and no such conversation would take place, it was all part of normal practice. But now, in 2008, I have the skills but autonomy is debatable. I must inform a Supervisor of Midwives (SOM) that I am caring for this woman and it is to her that I am speaking as I gaze towards the alien spacecraft. The world of obstetrics fears this scenario greatly, the breech presenting baby. Having made a hash of it so often, Hospital Trusts are at the mercy of lawyers continually as cases of negligence are pursued when parents are failed by the system.

For now though, I’m distracted by the evening’s entertainment, a world-wide spectacle of Champion’s league football. The game will be beamed live, throughout the world and people will marvel at the players, at my son, and I will watch as I always have, with utter pride and wonder that I gave birth to such a rare talent. For all that, I will watch as my mind goes over, again and again, the details of the conversation tonight with the SOM, the conversations with the mother involved; have I covered everything? Have I recorded everything in the notes? I have the skills, I have the experience, but there is always doubt. If the birth does not go perfectly with a positive outcome, then I will be pursued. Not by the parents, their trust and knowledge are unimpeachable, but the powers that be, the system of supervision, set up to support midwives and protect the public, which has been abused too many times by my registration body, the Nursing and Midwifery Council (NMC) in my opinion. I have attended enough cases myself to know how vulnerable we are as midwives serving women in these difficult situations.

Always, though, my fear holds another edge; I have a family in the limelight. We live our lives in a fishbowl forever scrutinised by the media. Thankfully, my son is ever the consummate professional. He really never puts a foot wrong. Posh has her ‘Golden Balls’, I have my ‘Mister Perfect’, and I am proud that the tabloids have never had any material to flash across their pages other than match reports. Proud that I haven’t had to endure a famous son who falls drunkenly out of night clubs or who abuses his position in any way. He really is the ultimate professional, it is not a case of things happening and being covered up.

But what if elements of his life were controversial, not boring, but news-worthy? This is a real fear that lurks. How the press would enjoy finding a flaw in Mister Perfect’s life; his mother, the renegade midwife pursued by her professional body. So I am so very careful to engage with the system, not only to protect my clients, but to protect myself and ultimately, my son. Therefore, I write copious notes - every conversation, every phone-call, every interaction, it is all logged in unmitigated detail.

But for now, here I am, on my way to a football match, alone in my car, as I’m on call and at any moment may have to attend this birth. My mobile is always on wherever I am. I have missed family weddings, school sports days, but only once, have been called when at the Arsenal stadium. I’ve learnt over the years to just carry on. Never put my life on hold, but always, my mobile is on and my equipment is in the boot of the car. That’s been my life for years, now. Midwifery first, then family. There is no other way to be ‘with woman’, the meaning of the word ‘midwife’. There will be many weddings and sports days, but each birth is unique and special and demands my full attention, and I gladly give it.

Lynn R S Genevieve 2020

Someone’s Mum (Unpublished memoir)

An excellent overview of breech presentations, care and options recently published by

Suzanne Yates

can be found here Can we turn breech babies?

How to Kill a Witch: A Guide for the Patriarchy

Claire Mitchell & Zoe Venditozzi (The Witches of Scotland)

In case you do not know, Mitchell and Venditozzi aka The Witches of Scotland are not (to my knowledge) ‘actual’ witches, but women who have successfully campaigned for pardons for those women and men who were prosecuted, found guilty of witchcraft and killed in the 1600s - some 4,000 were accused. The Witches of Scotland. Mitchell is a King’s Counsel (KC) Venditozzi a writer and they have combined their skills in this cleverly constructed book; it is a combination of nonfiction and fictional writing. With a legal mind’s eye on the details of historic cases, joined with a storyteller, the reader becomes immersed in the facts of the judgements and then through reading a speculative but accurate portrayal of the experiences, you are able to empathise and understand the impact on individuals and communities.

What is equally impressive is the inventiveness of the ‘living memorial’ these women have conceived which can ensure that this shameful episode of history is remembered by future generations; they commissioned a tartan, the design of which cleverly incorporates the dates of the Witchcraft Act 1563 to 1736 in Scotland within its thread count of colours through the numbers as single entries – inspired! Witches of Scotland.

There is one aspect of this book though that I would like to draw attention to – the title gives a clue. ‘… A Guide to the Patriarchy’ raises the issue of the killing of witches as a current situation. This is so serious that the United Nations has made a resolution against people being accused of witchcraft. The authors state that in 2025 ‘As with the Scottish experience, the accused are often (though not always) older, isolated women and consequences can range from banishments (such as the witch camps of Ghana set up for women who have been excluded from their community due to witchcraft accusations), to physical punishments, to – and we cannot believe we are writing this in the 21^st century – executions.’ (p 232). To read a bit more about this injustice, the UN Rapporteur on Violence Against Women and Girls, Reem Alsalem, is a good place to start https://www.theinternationalnetwork.org/events-2/reemsrevent. (I can’t help thinking how this fabulous dedicated and brave woman has been vilified by some in the name of ‘beliefs’ not facts, emulates exactly the witches experiences she raises – and that, coincidently, she has ‘salem’ in her name – the famous witch trials of America immortalised by Arthur Miller in The Crucible). This kind of misogyny is universal and How to Kill a Witch… reflects that despite many women believing that we have parity in the 21^st century, the patriarchy continues to erode the rights of women and this important book cites the shocking census that we have in this country to remind us - Femicide Census.

And now for something completely different… maybe… Here’s a little picture to whet your appetite for my next planned post… Lunatics Abroad…