The Value of Simulations for Teaching Normal Breech

Simulating normal breech birth with a doll and a pelvis is important for me when I teach breech.  It reinforces the importance of the midwifery model of care and the value of knowing normal.  In fact, from the feedback I have received from several midwives who have had surprise breeches, what kept them calm was knowing what they were looking at was “normal”, but also naming when help was needed.  There is a valuable tipping point and to know that we have to be able to recognize it.  For a few of these midwives, there was absolutely nothing to do because they were going down the mental checklist and things were aligning and progressing.  All of the touchstones of normal allowed them to be at peace.  

Our nervous systems are calm when we have practiced certain types of knowing and that includes hands-off and naming when you see the baby unfold and rotate.  The person who is helping the doll through the pelvis is actively learning how the doll navigates the pelvis as well.  This practice of imitating what we would usually see allows us a glimpse on the inside. Although pregnant bodies and babies descending breech have variations in relationship, we see patterns of descent that can help us think on a deeper level about what is happening inside as well as outside.  And as we begin to see these patterns from both someone naming normal from the outside and someone pushing a baby through the pelvis on the inside, we can also begin to see how we could approach complications by knowing where in the pelvis there might be an issue.  

Assymetrical Rumping 

Rotation to Sacral Anterior

Cleavage

Head is in Flexion (see the chin, bulging in the perineum or anus, and no shadow where we expect a Chin)

How does that baby spiral?  First the bum, then the body with the shoulders, arms, and head.  We can follow each diameter of the body through the inlet, mid-pelvis, and outlet.  

Jane Evans, in her article from MIDIRS noted breech cardinal movements that she and Mary Cronk had discussed at length (see the Story of Mary Cronk’s kitchen drawer here).  They tracked not only the normal rotations but also how the baby was able to participate in its own descent in these rotations.  I wanted to give credit to these UK midwives for such valuable contributions.  

In any case, let’s not just celebrate normal, upright breech with a quick slideshow, but with quality time and pacing.  Let’s do some “normal” simulations so we can learn it inside and out.  But also, let’s not forget the midwifery model of care in that as we must also practice holding the space for the person birthing and for the baby.  Knowing normal recognizes how we train our nervous systems to be in relationship with another and valuing consent in that process. 

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