Ep 24: Breech Birth Conference

Alex and Lacey attended a breech birth conference in April 2026 at Thomas Jefferson University. Join us this week to hear the nuggets of wisdom they learned while at that conference. 

In this episode, they discuss:

Clients using moxibustion which has lead to much faster labors

The impact of the Term Breech Trial which has been disproven, but still had a lasting impact on choice in labor. 

We are blessed to have the Breech Birth Team in Reading, PA and the DC Breech Birth Team. 

They break down the perinatal mortality risks of cephalic/head down (1/1000), breech (2/1000) and c-section (0.5/1000) deliveries of breech baby as well as the long term risks of cesarean--> the part of the conversation most doctors leave out. 

Those risks including: Uterine scarring, pelvic floor dysfunction, lymphatic drainage issues, pelvic organ prolapse, long-term pain, increased risks of placenta previa and accreta, and rupture among others.  

Transcript

SPEAKER_00 0:04

Welcome to Duelist Unhinged, the podcast where we tell the unfiltered truths and disrupt the accepted view of modern birth and parenting.

SPEAKER_03 0:12

We're your hosts, Alex Shaw and Lacey Morgan, here to cut through the noise, share the stories no one else will, and empower you with real talk that's equal parts honest, funny, and unapologetic. Let's get Unhinged.

SPEAKER_02 0:32

Hey, what's up? How's it going? How are you? Doing good. Uh, enjoying the life of uh new baby kitten ownership. Oh, he's just rolling like a like a little precious boy onto me.

SPEAKER_00 0:46

Hello. Yes, you are. Are you the most precious?

SPEAKER_03 0:49

It's like having a new baby. And I thought maybe it would um stop me from my baby craving. Yeah, because I well, I thought maybe like the responsibility and the lack of independence and you know, like having to think about him constantly all the time would put it off. Yeah, no, it made it worse. Yeah, oh I bet it made it so much worse.

SPEAKER_02 1:13

I bet.

SPEAKER_03 1:14

Uh so here we are. Here you are with the kitten and baby fever. Yep. Um things are going great. Things are right on track. Um okay, so uh I think we should open with uh birth story, and then we're gonna talk about the breach birth conference that we attended at um Jefferson in April, yeah.

SPEAKER_00 1:38

Yeah, it was great. So uh the one of the most recent births, this mom was a second time mom. Uh, did she pass her due date? No, she was early. She was early. But she had a few false alarms, and we were like, ignore, ignore, go to bed, go about your day.

SPEAKER_03 1:56

Which is what we tell everybody because that's what you should be doing when you're in early labor, is ignore, ignore, ignore until you cannot, and then distract, distract, distract. And then when they start to get air quotes intense, we need you to gaslight yourself and remind yourself that this is nowhere near intense and to shut that ish down. Yep. Except that with this mom, things got real intense, real quick.

SPEAKER_00 2:27

Real quick. She she wanted to go to the hospital. Um her water broke, her water broke, so she opted to go to the house. And you know, for those of you just joining in, you'll hear us say this a lot. Sometimes it can it can take a couple days for a labor pattern to establish when your water breaks first.

SPEAKER_03 2:46

Yep, you know, and most providers out of a place of uh fear and liability will tell you to come in right away. Come on in. Because the risk of infection increases at the 24-hour mark, which again is a round number, and you know, it's not that the risk of infection increases at 22 hours and you know, 13 minutes, right? It's an estimated amount, which means that it's bullshit. Yeah. Right? And so and also what I think is really important about that uh sort of data point, because again, it's a made-up data point, but what I think is really important to note is that the research did not isolate for women who did not have vaginal exams in labor, right? So that research is only for women who are in the hospital getting the standard protocol of care, which is every three to four hours getting a vaginal exam to see what's happening. And so providers who are risk averse, they're going to tell you to come in and then they're going to want to start to meddle with your labor uh immediately in order to get the baby out in or around the 24-hour mark. I was at Chester County one time and I just kind of like floated the idea of like, what happens if we get to 24 hours? And the nurse looked at me with this like, I don't even know why you're asking that question, face and she was like, We are monitoring for infection, and if we see any signs like fever or a baby's heart rate shifting, she's like, We'll give him mom antibiotics. It's not a big deal, we're not going to stop the clock at 24 hours. I loved that so much. Um but a lot of providers do want you to come into the hospital and at least start the process. Um but we counsel our clients that they do have options as long as they understand the risks. And and again, I think it's hard to understand the risks when no research has been done on what happens if we keep our fingers out of the body. Um anecdotally, home birth midwives do not have a 24-hour push mark, and they uh they don't have extremely high rates of maternal infection. Shocking. They're also not doing lots of vaginal exams during labor. Uh so um we let our clients know their options, their choices. She texted it at midnight, I think, and said, Um, I think my water just broke, I'm going to head into the hospital. And I said, Okay, you know, there are local providers and there are a handful of really great providers uh who tell their patients you can wait 24 hours and then come in if nothing is happening. And so that's what I said to her. Um, she opted to go in.

SPEAKER_00 5:49

Yep. So she gets there, she is laboring, and I think by five she started Pitocin. They recommended starting Pitocin. Uh, she elected to do that, and I was on the phone with her around five, I think, five or six. So they might have done it, but like uh right when they talked to me. Mm-hmm. Yep, they did. And um, and I was like, oh, okay, sounds like you already did it. So, um, and she was fine. I was like, okay, cool. Like, ignore, eat something. It's you know, 5 a.m. Eat a good breakfast, continue to hydrate by mouth. You're in a hospital. Just because it's your second baby doesn't necessarily mean that it'll go quick. We kind of all like we all assume it's going to go quick. Right, but that's not a guarantee.

SPEAKER_03 6:41

And if you need a reminder, go back to Emily's birth story.

SPEAKER_00 6:44

Yeah.

SPEAKER_03 6:45

Uh for second babies who don't come quick. Yeah. It's always a possibility.

SPEAKER_00 6:48

And so we counsel, you know, I counseled her um and her partner like, eat, distract, watch something fun. You know, she her plan was to go unmedicated, so again, distract, gaslight, all the things. And then we both got on the phone with them by like eight.

SPEAKER_01 7:06

Yeah.

SPEAKER_00 7:06

And I we both were like side texting each other, like, uh, things are getting things sound intense over there.

SPEAKER_03 7:15

Yeah, it was she went from being okay to really being in the throes of labor. And we were like, why do you want to get checked and just see where you are? Yeah. Both of us, I think, were expecting her to be like 10 centimeters, right? Like we were both like, if we were in the car together, we would have been looking at each other with huge eyes.

SPEAKER_00 7:38

I literally put my kids on the bus and started making my way to her, even not even knowing where she was, just based on her like behavior.

SPEAKER_03 7:47

Yep. And and what did they determine that she was three centimeters? And we both died.

SPEAKER_00 7:53

Died. We're like, what?

SPEAKER_03 7:55

Yeah. Like this does not sound like three centimeters. Uh-uh. And it did not, it did not at all. Uh, and we stayed on the phone with her, and within an hour or less, like I it was really changing. I think she got checked at three, and then like within 15 or 20 minutes, sounded like she was pushing, right?

SPEAKER_00 8:18

Yes, yes, and that's when it was like, oh no, I'm glad I'm going. Like, yeah.

SPEAKER_03 8:22

And you know, it's it's very interesting because moms who push on uh incomplete cervix, one that is not 10 centimeters dilated, uh, are often told to stop because it could cause swelling of the cervix, which then uh could elongate labor, it could create fetal distress, it could cause damage to your cervix, to push against a cervix that is uh not ready. Right, yeah, and injured. But then there is the alternative midwifery, and a lot of midwives believe that and follow that, but then there is this alternative belief that the body does not do things that it shouldn't be doing, right? Um, and so you know, some some midwives would say just trust your body, and that is what the nurse in the room said to her.

SPEAKER_00 9:16

Loved her so much, yeah, loved her so much, and she said that what did she they got eventually got in the shower. We're still on the phone with her. I'm in route, you know, we're all on the phone, and she was like, got in the shower, and the nurse goes, You can have a baby in the shower. I was like, You got a good one, girl. She's like, We've got lots of babies in the shower. It was so great. I was like, Oh my god, thank God, because many nurses around here are like, Oh god, please don't have a toilet baby or a shower baby, like get out of there.

SPEAKER_03 9:48

Yeah, really like don't want you to be where you are most comfortable uh to prevent the paperwork that they have to do.

SPEAKER_00 9:56

She said that the water was really what helped her relax. Yeah.

SPEAKER_03 10:01

Yeah. Um and within an so from the time that she was checked and she was three to the time that she had the baby was how long?

SPEAKER_00 10:14

An hour. It took me an hour to get there. And by the time like it was an hour.

SPEAKER_03 10:20

Yeah. Crazy fast.

SPEAKER_00 10:22

Three centimeters to ten and pushing.

SPEAKER_03 10:24

Yep.

SPEAKER_00 10:25

Crazy fast.

SPEAKER_03 10:26

And that can happen for second-time moms. Second time moms, but we are attributing it to something different.

SPEAKER_00 10:34

Yes, the mox uh. They were religious with the mox subbustion.

SPEAKER_03 10:38

Mm-hmm. So we've been teaching our families to do sacral fanning with moxabustion, a technique that we learned uh from an acupuncturist in the area who does uh training for birth workers. And we are really, you know, like having to pivot in the way that we are counseling our clients, coaching them. Yeah, well, we are thinking on the other side, right? Because my my inclination with this client was oh, pushing three centimeters. It's baby, not ready, it's gotta be baby's position. Right? And and maybe it was, and maybe baby just rotated through that position and dropped. And but I I think, and you know, I we always talk about like cervix our cervix is not a clock. And this is a true testament to that saying, right, exactly. And also, I think it's so important for people to know that your cervix can open and close just like your anus, right? You don't have a bowel movement and then walk a walk around with an a dilated anus all day. And likewise, it doesn't dilate before the bowel movement comes through it. Yeah, and the the No, it's really not supposed to. But the systems of our body are uh repeated, right? Like uh the sphincter in our stomach is similar to the sphincter of our cervix, is similar to the sphincter of our anus, right? We have flaps, we have sphincters, right? Urethra, yeah, right? And so people think that it goes one direction in labor and that's it. Yeah. Right? It's supposed to open and stay open, yeah. No, and that is not the case, it is reactive. Our cervix, I I always tell clients that you know, this a deer in the woods with a fawn halfway out will close her body around that baby to run away from a predator if she does not feel safe. Yeah. The same is true for humans. Same is true for humans. If you do not feel safe, your cervix will close. Right. And so that could be a provider that makes you feel ruffled, or it could be the drive to the hospital. It could be a cervical exam that you don't necessarily want. Right. And especially if you have this preconceived notion that they're uncomfortable, yeah. Right, or that they're bad, or or you don't like the provider, or you have sexual trauma, right? All of these things can lead to your cervix closing and giving inaccurate data. Yeah. Yeah. Uh, but also, you know, we have Friedman's curve, which kind of uh sought to predict the rate at which a cervix would dilate. Yeah, right, to give some kind of uh guidance on what to expect. Um but women are not data points, right? They're they're they rather they are a single data point on that curve and not the curve itself. And so to expect that you're three centimeters and that means it's going to be roughly seven to fourteen hours before you have your baby is just absurd.

SPEAKER_00 14:04

Yeah, yeah. I had a mom once, she went from three a first-time mom, she went from three to eight in twenty minutes. I timed, I was like, it's only been twenty minutes. I don't understand. She opted for an epidural. Baby time, baby did not like that epidural, but anyway, she still went from three to eight in twenty minutes for a first-time mom.

SPEAKER_01 14:26

Yeah, it's crazy.

SPEAKER_00 14:26

We don't typically see that, but it is crazy. The cervix is not a clock, it's not a clock, and that's why I struggle so much with cervical exams because it's like great, cool. You're so what? Yeah, you're three centimeters right now. It could change the drop of a dime in 20 minutes.

unknown 14:43

Right.

SPEAKER_00 14:44

Like it, especially if you allow your body to do what it's gonna do and you don't tinker with the perfect system. Good! And for this mom, uh, it will I mean she she owned her birth. She was like, I'm going when I want to go, and I'm starting Pitocin when I want to start Pitocin, and she's just laboring and just did it unmedicated, you know?

SPEAKER_03 15:06

Yep, yeah, and and she had a very traumatic first birth, and she was so happy, yeah. She was so happy and so quote unquote easy.

SPEAKER_00 15:18

And she got to cuddle, yeah. Like the things that she didn't get the first time, she got this time, and you could see it all over her face. She was just in heaven, yeah. In heaven, so beautiful. I know. I gotta see them.

SPEAKER_01 15:32

Yeah.

SPEAKER_03 15:33

Um, so you know, I I think that uh one, I would say that it's a a testament to her mindset. She worked hard through her pregnancy to release the fear from the last bird and really come to this one with the expectation that it would and could be different. Um and then I really think that the sacred fanning with Mox Sebastian is making a huge difference. We're seeing across the what has it been now that we've been using it um February three months. Yeah. In three months, I would say that the gross majority of our clients who have used it religiously have dilated very quickly. Yes. Have had very short labors, um, sort of skipped the early labor. Yeah. Like they go from like hey, I think I'm in labor to it's almost like the end of active into transitional labor pattern. Um so it could be jarring for some. I think it's important to maybe start mentioning that to people, um, that it can go very quickly. Uh but for the most part, I mean, I I think that it is it's doing something. It's gangbusters. It is. Um I we've had two moms that uh did not seem to respond to it. Um and my guess is that uh there was either a physiological or emotional uh component to those two births. Um but you know, I mean, and that that is a data point to hold on to too. I know I love keep I love keeping track. Yeah. It's fascinating. Yeah, it's really it's really been very interesting. Um okay, so today we had said that for our topic for today, we were going to talk about the breach birth conference that we attended. Yep, back in April. Uh I uh I was fangirling, so I'm a huge fan of uh Dr. Stu and Bliss and their podcast uh Birthing Instincts. Um now they were not there, uh super disappointed about that. But there were so many amazing people that I was just crushing on. I mean, first off, Nicole Cheney, uh who is a midwife in the area, and uh Dr. Dominic Camerano are providers that we really love, love, love at Reading. And Katrina love Katrina so much. Yeah. Um, but Nicole and Dr. Camerano were the head of the um, they were kind of like the Nicole primarily was the reason that this conference happened. Yeah, she did all of the legwork, all the organizing, um, really made it happen um so that people in the area could be educated. I was so happy to see that there were tons of residents at this training, not a lot of local OBs. Uh we had one family practitioner there, um, a lot of midwives from the region, um, and people who came even from Canada. Yeah, yeah. Uh, which I thought was really cool. Um, but I was most excited that Ricksa Fries was there. Um, there was Hermine Hayes Klein. Love her. So Rick's researcher. Yep. Uh Hermese Hayes um Hermese Hayes Klein. Hermeen Hayes-Klein, excuse me. Hermine Hayes-Klein is a lawyer who really focuses on maternal rights and justice.

SPEAKER_00 19:16

Uh everyone was sitting at the edge of their seats for that one.

SPEAKER_03 19:20

Oh my gosh, she was amazing. Uh Betty Ann Davis was there who has done so much for birth in uh the US. Um, and then Emilio Sheer of uh Shavira. Oh my gosh. I I don't know why, but I just love that guy so, so much. He is a maternal fetal medicine doctor in California. Um, you know, and maternal fetal medicine doctors are trained in what goes wrong, right? Like they're the specialists of the things that go wrong in obstetrics, but he has this view. I don't know how he got out of his training, still believing that birth generally works and that like it's pregnancy is a beautiful thing. Like the man just glows this like golden light off of him. Uh I think people should go find him on social media and and hear what he has to say because if anybody can give you confidence in like things usually work out, yeah, he's the guy.

SPEAKER_01 20:30

Yeah.

SPEAKER_03 20:30

Um, but then they had other people, right? Like they had moms who shared how breached birth options, you know, changed their lives.

SPEAKER_00 20:38

And and a lot of those moms came from other states to come here to Reading, you know, to Reading Hospital, um to have a vaginal breach birth. Right. You know, and they shared their story. It was uh it was amazing. Yep, it really was.

SPEAKER_03 20:55

Uh, you know, and so I think that for many people, uh, they believe that breach birth is dangerous and is automatically a cesarean. Right. And that came out of the breach birth, uh, the breach term trial. Yep. Uh, which was a research study that came out and said, hey, breach is way more dangerous than uh cesarean, right? And um way more dangerous than cephalic head-down babies, and so everyone should stop doing breach births. Within a year, another study came out that refuted that uh, but hospitals had already adopted policies to stop offering breach births, and then universities stopped offering training in breach deliveries. And so now Obstetrics uh does not address a need that exists in the population.

SPEAKER_00 21:56

Yeah, and right now in Pennsylvania at least in our area of Pennsylvania. There's one hospital that has a team of breach trained, vaginal breach trained providers.

SPEAKER_03 22:05

Yep. Uh I love the story that led to that. Dr. Camarano had a client transfer to his care because he was the only provider in the region who would offer a breach delivery. I believe she was a birth center client. Right? At the time it was called Birth Brynmar Birth Center. Now it's closed. Um but so she was a birth center client. Uh she wanted a vaginal delivery, transferred care to him. He said, Listen, I'm going away. Uh don't have your baby while I'm away. Yeah. And then she went into labor while he was away and ended up going to Bryn Mawr Hospital and having a cesarean delivery because he was away. And he came back and he was so upset that this woman had an unnecessary cesarean, was not offered a trial of labor because of inadequate training. Because he's the only one who will do it. And so he connected with the breach birth team in DC who they were at the conference. Conference. Yeah. Uh they actually came and talked about their program and the how they got it set up and all those things and and their outcomes, which are phenomenal.

SPEAKER_00 23:23

It was wonderful. Um lots of questions were getting asked to them. Yeah. Because there are lots of you know providers that want to implement a program to train. Right. You know, their residents.

SPEAKER_03 23:36

And so now Reading has a breach birth team team. Um, you know, and it is interesting to me because it's it's on the periphery, right? Like it's something that uh is under a microscope of scrutiny. If they have a negative outcome, then they have to defend their program all over again. Whereas negative outcomes for cephalic babies happen all the time. Negative outcomes for C-sections happen all the time. And no one is under the level of scrutiny that these guys are for offering a choice. And Hermese Hayne Hayes Klein uh listed she she did a presentation um and she put up a quote from a uh US Supreme Court case that really stood out to me. It was no right is held more sacred or is more carefully guarded by the common law than the right of every individual to the possession and control of his own person free from all restraint or interference of others.

SPEAKER_01 24:45

Mm-hmm.

SPEAKER_03 24:47

And what that means is you are entitled to the right to decide what happens to your body. Right? Uh she cited another uh quote every human being of adult years and sound mind has a right to determine what shall be done with his own body, and a surgeon who performs an operation without his patient's consent commits an assault for which he is liable in damages. So, news to me, I could have sued my doctor for damages uh taking me into the OR after I refused consent.

SPEAKER_00 25:29

She was phenomenal. There was n like everyone was on the edge of their seat listening to what she had to say.

SPEAKER_03 25:36

She is so intelligent and passionate. Oh my gosh, and so wide. And speaks so well. Oh, she's eloquent. Yeah. Mm-hmm. And you know, and she's snarky, which I like. I like too.

SPEAKER_00 25:50

I know she's got a little sass under there.

SPEAKER_03 25:53

Me too. But I think, you know, I bring up those two quotes because what she was speaking to is the fact that women should have the right and ability and appropriate counsel that they have options if their baby is breach. Yeah. What happens in the majority of the country is that somebody finds out that your baby is breached through palpation, that's laughable, or ultrasound, and they say, okay, well, we're going to schedule you for your C-section at 37, 38, 39 weeks, because they don't want you to go into labor and risk the baby coming before they have time to section you.

SPEAKER_02 26:39

Yeah.

SPEAKER_03 26:40

And so uh they schedule an early delivery, which creates risk for your baby, especially if your dating is off. Yep. Um, and they never tell you that you have choices to deliver your baby with someone else who has training to deliver a breach baby. Yeah. Nor do they tell you the risks of said options. Yeah. Right? And so I thought that we should talk about that. So there's not a a ton of data available. Uh, but two of the um the sources that were cited at the conference, uh, one came out of the Royal College of OBGYN, and the other, so like we have ACOG, the American College of Gynacology and Obstetrics. Royal College. Yeah, in England, that's that's what they have as the Royal College. Uh, and the other one came out of Canada. Yeah. And the the data is close enough in my mind that I feel like it is um, you know, it's comparable. Uh so they were talking about perinatal mortality risks, which is the risk of the baby dying dying. Yeah. Um during birth or after, right?

SPEAKER_00 28:03

Uh around the time of birth.

SPEAKER_03 28:06

Right. So yeah, I think it's like within two days or or something.

SPEAKER_00 28:10

Yeah, because then there's like early neonatal mortality with it, which is a death of a live-born infant within the first seven days of life.

SPEAKER_01 28:17

Right.

SPEAKER_00 28:17

So late fetal mortality, stillbirths that occur after 28 weeks of gestation. So perinatal mortality is just around the time. The time delivery, yeah.

SPEAKER_03 28:29

Yeah. Uh so in a planned vaginal birth of a cephalic, so that's a head-down baby, the risk of mortality to the baby is one in a thousand. So that's a 99.9% chance that everything's gonna go great. Sounds like what happens uh around 40, 41 weeks of pregnancy. Yep. Uh planned vaginal birth of breach babies. The risk doubles.

SPEAKER_00 29:01

Sounds super scary, Lacey. Why don't you elaborate?

SPEAKER_03 29:05

Yeah, so let's talk about absolute data here, which is that the risk is two out of a thousand, which means a 99.8% chance that everything will be fine. Uh, and then a cesarean delivery of a breech baby has a 0.5 out of a thousand risk of perinatal mortality for that baby. For that baby. And so statistically, that is the safest mode of delivery for that baby, for that one baby, and if that is your only baby or your last baby, maybe that's a good choice for you. And maybe maybe you want to have 12 more, and maybe that's still a good choice for you. But I think that uh giving patients complete information necessitates a further conversation. And so if you have a cesarean delivery, you create a uterine scar, right? And that uterine scar can adhere to organs in your body, can create, absolutely does, not can, absolutely creates weakness in your pelvic floor, right? Absolutely impacts your lymphatic drainage systems, which can lead to chronic health conditions down the line, uh, whether that is from fluid being trapped in your lower extremities or um elimination of toxins being reduced, right? Which then creates chronic inflammation in your body, uh, can lead to pelvic organ prolapse, can lead to long-term pain at the incision site, right? Um, can lead to shoulder pain. Yeah. Something that you would think has nothing to do with your uterus or your abdomen. They're cutting into the fascia, right, which is connected from our heels all the way up to our skull.

SPEAKER_00 31:16

It's like a Superman suit that lines your body. I love that. Of connective, that's what I say in spin class. I'm like, it's your fascia, it's the connective tissue that runs like a superman suit throughout your body. And when you cut into it, that affects the rest of your fascia.

SPEAKER_03 31:30

Right. Uh so shoulder pain is a very common complaint from women who have had C-sections. Okay, and that is just for the mom. Yeah. Right? Also, increased risk of a hysterectomy. Um and then we look at risks to future babies. Every pregnancy after a cesarean is at a risk of an increased risk of placenta previa, where the placenta is too close to the cervix that you could bleed to death during a labor, or uh placenta acreta, which is where the placenta grows through the endometrial lining of the uterus, uh, thus making it stick in your uterus after delivery and cause hemorrhaging. Uterine rupture? Also a risk during delivery, which again is very, very small, right? I think sometimes uh from a place of fear-mongering, right, people talk about uh, you know, the the risks in the future um of like that's a reason that OBs would say, like, oh, you should not V back. Yeah, right? The risk of uterine rupture is very, very small, and it's unlikely to happen, but it is greater than an unscarred uterus. Correct. Right. Um anyway, so uh it is in my experience the case that clients are our clients are told, or patients of physicians are told, you have a breech baby, you have to deliver via cesarean, uh, it's the safest option. The parts that are missing are for this baby only. And you have other options. And you have other options. There are choices. And because society has created this veil over the idea of breach births, moms blindly turn to, yep, that's what I'm going to do. No further information needed. Right? Yeah. Uh so during the the conference they shared a uh so cool. I'm gonna pop this on our social media. Uh the graphic discusses 8,500 elective C-sections for breach delivery from the years 2001 to 2005, and they said that 19 babies were saved at a cost of four avoidable maternal deaths, nine future fetal deaths due to the uterine scar and the risk that that creates, and 140 potentially life-threatening maternal complications in future pregnancies.

SPEAKER_00 34:28

Yeah, we're gonna post it.

SPEAKER_03 34:30

For me, that was that was huge, right? And and each woman has to uh come to the decision that feels good and right for her at the time, but I do think that it is so important that proper information, complete information is being provided so that women can make an informed decision and either consent with full information to a cesarean delivery, or decline with full information. Yep. Yep. Um so the data from Canada because I talked about it but didn't actually say what it was, um breach delivery of a cesarean, um, they came up with zero to 0.8 out of a thousand uh perinatal mortality, so babies dying, and then uh in planned breach, uh it was 0.8 to 1.7. Uh so again, like kind of the same risk at the lowest and highest threshold uh or double the risk. Uh so that you know could be interpreted in layman's terms as it's nearly as safe as a vaginal delivery.

SPEAKER_00 35:50

In the hands of a skilled provider.

SPEAKER_03 35:52

Yeah. Uh, you know, I I often hear uh people talk about ways to interpret data. Um, and you know, there's this concept of number to treat. How many people have to be treated in order to save one life? And so with vaginal with planned cesareans versus vaginal breach deliveries, you need to have 649 planned cesareans to save the potentially save the life of one baby. Now, if your one baby is the one baby whose life is saved, hallelujah, right? And I I totally understand and respect that, but uh for me that puts risk into uh kind of like a a way that I can really wrap myself around. It's like okay, so there are 649 unnecessary cesareans happening to prevent one negative outcome. Yeah. And what is the concern that people are really worried about? Death. Yeah, but from what? Like how is that different than yeah. You know, like uh babies die coming out vaginally, babies die coming out via cesarean. Right? And well, it's the fear that has been created.

SPEAKER_00 37:19

Yeah. Right? That it's unsafe.

SPEAKER_03 37:21

Right.

SPEAKER_00 37:22

But is it? I mean, clearly.

SPEAKER_03 37:25

It it is it is less safe, right? But for me, when I so I had a cesarean, right? And and uh I am living with the repercussions of that cesarean every day of my life, right? I have the lymphatic drainage issues, I have the weakened pelvic floor, I have the shoulder pain, right? I have scar tissue um pain, right? When I roll over in the middle of the night, there is a spot on my right side that is like being stabbed with a knife when it tugs. Yeah. Right. And if someone told me that my risk of losing my baby doubled from one per 1,000 to 2 per 1,000, there is no way that I personally would choose a cesarean a scheduled cesarean delivery of a breech baby. Uh, but you know, providers will say, like, oh, you know, the there's head entrapment is a huge risk. Um it's not a huge risk. It is a risk. Yeah. But it's not a huge risk. Huge risk.

SPEAKER_00 38:36

And there are maneuvers.

SPEAKER_03 38:38

Yeah. And in the hands of a skilled trained provider, the risk drops significantly.

SPEAKER_00 38:46

Which is why this conference is happening, because they want to train providers so that people have more options.

SPEAKER_03 38:52

Because if not, what is the purpose of the field of obstetrics at this point? Yeah. Right? A family doctor can catch your baby.

SPEAKER_02 39:02

Yeah.

SPEAKER_03 39:02

Right? And a maternal fetal medicine doctor can monitor you for all your high-risk conditions. What are OBs doing? Yeah. Right? If they if they don't have the skills to use forceps and vacuums and do vaginal breach deliveries, what are what purpose are they serving these days? Is my question. Yeah. Right? Like, why is there the specialty? And and as an OB, I have to imagine that providers must feel frustrated at the loss of skill.

SPEAKER_00 39:38

Yes, yes. It that was apparent at the conference. They were fr like providers were the providers that were there, they were frustrated. And it's like our hands are tied by hospital policy. By hospital policy. Like, it does that serve the people that actually need the care?

SPEAKER_03 39:58

Hermine Hayes Klein said um that A. Cog's 2016 Ethics Committee Statement on Maternal Refusal of Medically Recommended Treatment states this, right? The use of coercion is not only ethically impermissible, but also medically inadvisable because of the realities of prod prognostic uncertainty. That means you cannot predict what is going to happen and the limitations of medical knowledge, meaning we are still learning. Right? Say it again. Right. That's why they call it practicing medicine. Right. Uh, as such, it is never acceptable for uh obstetrician gynecologists to attempt to influence patients towards a clinical decision using coercion, meaning they shouldn't be studying. You understand what's going to happen, Lacey. You're going to have a dead baby. Coercion. Baby.

SPEAKER_00 41:02

Coercion. Clearly, some providers still need to learn how to um not coerce.

SPEAKER_03 41:09

They should read the 2016 ACOG committee statement. They should. Uh it says obstetrician gynecologists are discouraged in the strongest possible terms from using the use of duress, manipulation, coercion, physical force, or threats, including threats to involve the courts or child protective services can motivate women towards a specific clinical decision.

SPEAKER_00 41:33

You and I can both check, check, check, check, check all of that that we have seen.

SPEAKER_03 41:38

Yep. Yep. Time and time and time again. Mm-hmm. Right? Uh that's a damn shame. It goes on to say pregnancy is not an exception to the principle that a decisionally capable patient has the right to refuse treatment and uh even treatments needed to maintain life. Right? So that decision on my part to decline a cesarean at the risk of my baby's life was my right to decide. Yep. They say, therefore, a decisionally capable pregnant woman's decision to refuse recommended medical or surgical interventions should be respected.

SPEAKER_00 42:17

Yep. It reminds me of the the guy, uh, I totally forget his name. He was from um Was it Amir? Yeah, Amir. Uh shared a story at the breach be breach conference um about a baby who died.

SPEAKER_03 42:32

Because the mom was refusing his recommendations.

SPEAKER_00 42:35

Correct. And um he cared and this was what? I I believe this was at least ten years ago.

SPEAKER_03 42:42

Yeah, it was a long time ago.

SPEAKER_00 42:43

A long time. I got the feeling it was more than ten years ago. Um, but that baby died, and he carried that with him. And Because he felt like it was his fault, his responsibility that he couldn't get her to agree to whatever he was recommending.

SPEAKER_03 43:00

I actually I I found him in the hallway, and I went up to him and I said, He said a cesarean was the only thing that could be done. And I I caught him in the hallway and I said, You don't need to carry the burden of that baby's death.

SPEAKER_02 43:17

Yeah.

SPEAKER_03 43:17

I said, You did your job, you counseled that mother on her options, and the only option was not a cesarean. The other option was the possibility that she lost her baby, and that was the choice that she made, and it was her right to make that decision. You had no authority and no right to force or coerce her into delivering her baby via cesarean. I said, You did your job. Yes, he did. You did your job in the best way you could.

SPEAKER_00 43:51

Because imagine the damage that would have been done, yeah, like in your situation. Yeah, you had a you know, a C section that you did not consent to.

SPEAKER_03 44:00

to right how about the the the woman in Florida that hermine her mean yeah her mean I butcher her name all the time guys oh my god um that she represented yeah or is representing her right the mom because they pulled uh they pulled the court system into it and a judge gave the hospital authority to do a cesarean with so she had a court ordered cesarean against her consent which is absolutely not okay right like that is an atrocity that a judge would think that he had uh the power to decide that this woman had to have major abdominal surgery we're not talking about a few stitches from a cut no right we're talking about major abdominal surgery that impacts you for life for life yeah for life and I don't think I think uh I I don't think people don't know people don't know how it affects you right how it will affect the rest of your life well and he's lucky that they didn't cut that baby which you know is is a risk during a cesarean he's lucky that they didn't perforate her bladder or her bowels leaving her incontinent for the rest of her life right like he's lucky that that decision didn't result in more trauma than just the emotional and physical trauma of a a cesarean itself yeah it it's nutty to think that anyone has the authority to tell you what to do with your own body. Yeah I did appreciate that Amir then later talked about the fact that uh his hospital did try to pull something like that with a client uh with one of their patients and I can't remember the circumstances surrounding it but they had said that uh you know to like the legal department was determining whether or not they could get a court order to mandate you know something to happen to this woman and he was on the phone with them and he said who do you think is going to execute those orders yeah he's like it's not gonna be me yeah right so even with his own trauma feeling like he was the cause of that baby's death he still yeah he still would refuse to do something against a mother's wishes yeah and and that for that that man deserves a like a Nobel Peace Prize right like every woman should be so lucky to be cared for by a provider like that. I know I know it gives me chills me too there was a woman while we're on this topic there was a woman uh that presented a mother um I she was more than a mom I I cannot for the life of me remember I f she was in research or something we'll we'll I'll have to do some digging but she said some things that really stuck with me she said uh recounting one of her birth experiences uh no one touched my body without consent no one talked to me during a contraction no one turned on the lights without asking me this was the birth culture here she also said I'm a person with a brain not a patient with a body yeah and that is something that I think a lot of the medical field misses right it's like you're just a number room two yeah room two not Jessica right Jepressica my kids and I we have like the Gepressicas I don't know about that anyway continue we're like oh hey we're the Gepressicas continue yeah not Jessica who's going for an unmedicated birth and her partner's being a huge help and supporting her and she's got these doulas you know it's room two it's just room two and it's the vaginal delivery in room two or it's the shoulder dystocia in room two or it's the cesarean from room two and in part I understand that there is a need to separate yourself because if you are emotionally invested you live like a mirror with that baby in your heart for the rest of your life yeah right and and I live with some really beautiful births in my heart but I live with some really traumatic experiences from this work but I cannot emotionally separate myself to that from from the work that I do and do a good job. And so I sacrifice myself for the work that I do and I think so many providers put a wall up to protect themselves but in turn do not provide the same quality of care that leads to more positive birth outcomes that lead to happy healthy moms right we say a healthy baby healthy mom healthy baby right now but we we only mean a mom with good blood blood pressure and a mom who doesn't hemorrhage and like the bar is on the ground that that's what everyone wants like why are you stop saying that right that's that's the bar is on the ground. When we interview clients you know we often ask like what is important to you in your birth and I always say don't tell me healthy mom healthy baby right because that is the lowest barbit you can set yeah yeah right like what actually matters to you in your birth that's what I want to know because that's what we're going to work to yeah and that's what the space that we're going to protect.

SPEAKER_00 49:53

Something else that came up um someone said I don't know if it was the woman I was just referencing or someone else shared decision making changes the entire course of your life as a mother it's so true. What what resonates with that for you?

SPEAKER_03 50:09

Shared decision making even even how we talk to clients when we when we interview with them you know like the bars on the ground like that's duh that's a no-brainer like we are in that with them like we are part of your team we are part of this decision making and ultimately you mama bear are the one making those choices all we do and all providers should do is provide information and support you and that mindset takes the pressure off oh the providers would feel so much less fearful if they took the time and you know s it's a systemic problem right because the system does not allow the time I I have a acquaintance friend uh who's an OB who said she has seven minutes per patient right and that is absurd that's no time right you can't do your job in seven minutes and do it well yeah and so there is no counseling there is no education there is no relationship building and so when you screw up of course you get sued because just like I'm just the lady in room two you're just the person in the white coat who showed up today. Yeah right when you take that relationship away you increase the risk of um lawsuits for you know bad outcomes right um if providers were trained that their role is to educate and support the decision they would feel so much less pressure and I think that the dialogue between two adults would be so much more positive. Yeah right instead of what doctors you know are taught is that if somebody does not follow your recommendation you did not counsel them. You didn't do your job you didn't do your job and so doctors will lead with presumptive language where they presume you're going to comply or they dive right into coercive language to scare you into doing what they have been trained is the right or only way to deliver a baby. Yeah. Right? Uh I think in this mindset that um collaborative decision making changes the way you mother it empowers women yes and an empowered mom is more confident yes and she trusts her instincts and her gut to help her to make decisions for that child for the rest of their life.

SPEAKER_00 52:47

We just had this conversation I literally told one of our clients buckle up I said it in the nicest way buckle like buckle up buttercup like you are making this is your one of many decisions that you are making in your life you are changing in this very moment in time because you do have decisions to make and they are yours to make and and ultimately you're right like when she makes when that particular makes those decisions it sets her up as more confident. Yeah right like if if you allow someone else to make that decision for you and you go into motherhood you're like a flopping dead fish out of water.

SPEAKER_03 53:24

Yeah and that's not a that's not a way to enter motherhood own that shit right always always looking for someone else to to lead the decision always looking for someone else to make the decision always looking to deflect the responsibility that's crippling as a mother it is right to not feel like you know what your child needs that's crippling and and it is going to have a long-term impact on our society to have mothers who are not confident in making decisions for their children.

SPEAKER_00 53:58

Yeah yeah and I think we've uh I don't know how but uh who knows we've gone away from like our mother instinct yeah at least here in this culture and society where we're at in the world and so they don't trust their instincts and if we could only get back to doing that it would make life a lot easier you know like a resounding yes or like if it's not a resounding yes it's a no.

SPEAKER_03 54:24

Right right I don't know that it makes it easier I don't know either but I do think that it makes it better. Better I tell families all the time that uh parenthood is a series of Fing up. I love this right and hoping that that was the worst f up that you made that you're going to make in your parenting. Yeah right because all you can do is make the decision that feels right at the time Jocelyn was three years old sitting in the back seat of the car and she crosses her arms and bobs her head the way that three year olds do. Especially the ones who are like our sassy right and she says how could you be so stupid to have me in the hospital because she had just watched her sister be born at home. Oh my god I mean not just right like I I had three babies in under four uh so maybe it was after Brenna uh but you know how could you be so stupid to have me in the hospital I know you're like God that hurt oh my ouch like I said baby I did the best that I could with the information that I had at the time I didn't know better and as soon as I did I did better.

SPEAKER_00 55:41

Yeah right and not I don't know I feel like we all we mull over it and we hold it and we like beat ourselves up over it. Let it go.

SPEAKER_03 55:51

Yeah you made the choice and and you can't unbeat undo it. And so what does it serve yes like feel the feelings have the moment of regret say you know if I'm ever presented with that in the future I'm going to do something different and then let it go. Yeah let it go it does not serve you to beat yourself up especially as a new mom like no and it holds you in that place right it holds you in that place instead of allowing you the opportunity to use it like fertilizer to grow. Yeah this was so good I there were so many nuggets in it yeah I hope that it was helpful um if you have questions uh we are all ears for your questions yes uh we're starting to get questions from people which is super exciting so fun uh so reach out to us on Instagram if you want to chat more about this um share and uh follow our our show so that we can continue to do what we're doing. Yes love it peace out all right see you next week thanks for getting unhinged with us today we hope this conversation challenged you validated you or made you laugh out loud birth and parenting aren't meant to be perfect or polished and neither are we if you love this episode share it with someone who needs real and raw truths.

SPEAKER_00 57:13

Leave us a review and make sure you're subscribed so you don't miss what we're unraveling next. We're Alex Shaw and Lacey Morgan reminding you that your voice matters your experience is valid and you're allowed to do this your own way.

SPEAKER_03 57:25

Until next time stay unhinged