Twins and Breeches?

I am occasionally asked if I would attend twin or breech births.  Let me begin by saying that I have attended such births, but never as the primary midwife.  Out of six births, the outcome in each was fine, but at one, the mother had problems with bleeding afterward.

That said, I do not feel that I currently have the experience or skill level needed to attend breeches or twins at home.  Could I, in the event of an emergency or a surprise?  Yes, and I think I have enough knowledge that I could do it without causing harm.  But I would not intentionally plan to midwife a woman having twins or a breech baby.  Twins and breeches carry a somewhat higher level of risk than your average head-down delivery.  The provider MUST have knowledge of what can go wrong and know exactly how to assist in each situation to provide the safest birth possible.

I would like to go in search of training and experience with breech deliveries.  This will likely require travel and expense, but I believe that it would be a valuable skill to have in my practice.  I do not agree that cesarean birth is the best and safest option for all breech babies.  For some breeches, yes, but not all.  I would have a selective policy for breech birth in my practice, and I would still do everything possible to encourage babies into a head-down position before labor.  The parents must also be fully informed of the risk and complications that could occur.  It is not something to be treated lightly or glossed over.

While I completely disagree with the current obstetrical policy of planned cesarean at term for all twins, I am not sure that home birth is a wiser or safer option.  Even when the babies are full-term and in an optimal position, there is plenty that can go wrong for both babies and mother in a twin birth.  Problems can require quick and sometimes invasive action to correct, which may carry further risk of harm.  Better to find a doctor who supports natural twin birth in the hospital, even if it means traveling to find one.   At this time, I do not plan to attend twin births at home.

Here is a brief list of some of the risks and complications of twins and breeches:

Twins:  placental abruption before the second baby is born, turning of the second baby to an unfavorable position for vaginal birth, hemorrhage, obstructed birth due to position of babies

Breeches:  cord entanglement, cord prolapse leading to asphyxia, cord compression leading to asphyxia, arms stuck over or behind the head, entrapment of the head in a partially dilated cervix, extension of the head