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For women pregnant with a breech (bottom-first) baby—that’s about 1 in 25 pregnancies—delivery typically means one thing: a cesarean section. That’s because these days, most obstetricians don’t allow moms to vaginally deliver babies who aren’t headfirst. “A lot of residents maybe have seen one or participated in one, but it’s not standard curriculum in med schools,” says Dr. Katie Rustici, an obstetrician/gynecologist at Stapleton OB-GYN. “It’s a training issue for sure.” As a result, she says, “C-sections are what attending physicians are comfortable with, and then it snowballs into the next generation of trainees, who often never get exposure to what was once a standard skill.”
But Englewood’s Dr. Michael Hall says C-sections aren’t always necessary. Hall says he is one of the few Colorado obstetricians who routinely offer women vaginal breech deliveries if the pregnancies meet certain criteria—if the baby’s not too big, if labor is normal. The approach is more hands-off than you might expect, he says. “You have to know to leave the baby alone and let Mom birth her baby,” he says.
Vaginal breech deliveries were common until the 1980s and ’90s. However, a 2000 study in the Lancet medical journal that found fewer complications among breech babies delivered via C-section led to a decrease in the practice. Despite subsequent research showing otherwise and the current opinion of the American Congress of Obstetricians and Gynecologists that a planned vaginal breech delivery of a singleton “may be reasonable,” most doctors continue to recommend C-sections. “Because of the [study in] 2000 as well as the medical legal climate, fear of being sued, and the lack of qualified obstetricians at present to teach it, the art of vaginal breech delivery is being lost,” Hall says.
Hall admits there are risks to breech delivery—including brain and nerve injuries and hypoxia (oxygen deprivation)—and specific maneuvers are necessary. However, what drives him is the idea that women should be able to consider their options. “I’m not here to talk anybody into doing anything,” he says. “I’m here to take people who want choices.”
Dozens of women seek Hall out for his expertise each year; one of them, Shaunna Bishop, delivered her third child, a son, with Hall’s help. “It was a lot easier than I thought it would be for a breech delivery,” she says. “I feel really great about it. We need to listen to our bodies more as women and trust ourselves. To have a doctor who supports that is so important.”