EBB 111 – Positioning Breech Babies with Dr. Elliot Berlin

Rebecca Dekker:  Hi everyone, on today’s podcast, we’re going to talk with Dr. Elliot Berlin of the Informed Pregnancy podcast. All about chiropractic care during pregnancy and breech birth.

Rebecca Dekker:  Welcome to the Evidence Based Birth podcast. My name is Rebecca Dekker and I’m a nurse with my PhD and the founder of Evidence Based Birth. Join me each week as we work together to get evidence based information into the hands of families and professionals around the world. As a reminder, this information is not medical advice. See ebbirth.com/disclaimer for more details.

Rebecca Dekker:  Hey everyone, before we get started, I have an exciting announcement to make. We have had so many people email and message us, asking for a potential to order bulk copies of Babies Are Not Pizzas to hand out to their friends or the clients. And so I’m thrilled to announce that on January 20, we are going to open up pre-orders for bulk orders of Babies Are Not Pizzas. The bulk order period will last for one week only, from January 20 through January 27 and you’ll be order Babies Are Not Pizzas copies in sets of 10 for half off the list price. If you want to join in this pre-order make sure you go to evidencebasedbirth.com/book to get on the wait list for when the pre-order period opens.

Rebecca Dekker:  And now I am so excited to welcome our guest, Dr. Elliot Berlin, to the Evidence Based Birth podcast. Dr. Berlin is an award-winning prenatal chiropractor, child birth educator and labor support body worker. He is the company-founder of Berlin Wellness Group in Los Angeles, the podcaster at the Informed Pregnancy podcast and the executive producer of two documentaries about birth, Heads Up: The Disappearing Art of Breech Delivery, as well as Trial of Labor.

Rebecca Dekker:  Dr. Berlin also works with several hundred breech babies each year, most of whom, turn into the ideal pre-birth position once normal function is restored to the mother’s lower back and pelvis. Dr. Berlin is also a labor support doula, who attends births, providing laboring parents with body work, such as massage, reflexology, acupressure, counterpressure and chiropractic adjustments, to help keep the birthing person relaxed, comfortable and focused and in an ideal mind and body condition for smooth, uncomplicated labor and birth. And Dr. Berlin attends labor at hospitals, at homes and birthing centers. Welcome, Dr. Berlin, to the Evidence Based Birth podcast.

Elliot Berlin:  Thanks, Rebecca, Thanks so much for having me.

Rebecca Dekker:  Could you tell our audience a little bit about how you got into doing birth work, as a chiropractor?

Elliot Berlin:  Right, so that’s a good question. As a kid, when people said, “What do you want to do when you grow up?” Doula was definitely not on my horizon. But I was always interested in healthcare, from the time I was little. I was maybe seven or eight years old when I saw a CPR class happening and it just blew my mind when they explained what was happening. That I could use my body to help somebody else sort of have the heart and lungs when theirs were not necessarily working. And I think maybe a year or two later, I took a CPR class for myself and then first aid, then responding to emergencies and eventually, as a teenager, I was teaching for the American Red Cross.

Elliot Berlin:  By the time I was 17, I started training as an emergency medical technician, by 18 I was working in ambulances and emergency rooms and I was on my way to becoming some kind of medical doctor. But when I was 19, unfortunately, my father passed very young, partially from a medical mix up and it really kind of made me take a step back and look at healthcare differently. I still love the options for drugs and surgery, but I didn’t want that to be my primary work. I wanted to see if I could work with the body to be healthy in other ways. And I took a year to study lots of the different modalities and I just fell in love with the combination of massage therapy and chiropractic together.

Elliot Berlin:  Addressing both sides of the musculoskeletal equation and how when you improve those structures, the body is better able to take care of itself. And so I went to school for both and it was soon after that, during grad school I was married already. My wife is a perinatal psychologist and she was in psychology school and I was chiropractic and massage school. And then, towards the end, when we tried to have our first baby, it was a very difficult go. We had a long fertility struggle and it wasn’t till we stopped doing all the medical interventions, pretty much, they gave up on us and said we’d never have a baby. It was when we stopped doing all those interventions that we actually got pregnant, thankfully, gratefully.

Elliot Berlin:  Then and pretty much every two years after that, another kid popped out. It was like hard to turn it off. So when we moved to Los Angeles, we just started a mind body wellness practice that was sort of focused on general wellness. But also with an eye on boosting natural fertility. And I think it was in the first year, we had several pregnancies and every year after that, the number of pregnancies snowballed. And we found ourself knee deep in prenatal care and one thing led to another, just a lot of research and trying to help with questions that would come in about different types of birth options or the stories that would come back after people had their babies. Very frequently, the journey seemed to go different than the plan.

Elliot Berlin:  We started to get involved in more education and trying to help better prepare people for the options that they would have through child birth education and a blog, that eventually turned into the other media. Then, I got invited to my first birth, it was midway, it was a home birth, that had been going on for quite some time and the baby seemed to be stuck. She was sort of stalled at nine centimeters for nearly nine hours. And the midwife just sort of called and said, “Do you think you could use body work to loosen up this pelvis a little bit, so the baby can rotate into a better position.” I had no idea if I could do that, but I said, “I’m more than happy to give it a try.” Things went really well there and after a couple of hours of body work, where things were just loosening up more and more, the baby plunked into a better position.

Elliot Berlin:  It was a moment when it happened and then soon after that, she had the birth that she was looking for. So that was kind of my introduction to attending birth and I just also snowballed from there. Getting invited to other births where there were issues, whether it’s spams or back pain or babies that are rotated in a not ideal position or not coming down well. Eventually, to births where everything was going just fine and using body work to help relax the mind and body for smoother experience. Not always helpful to people, but for the people who it is helpful for, it seems to be very helpful.

Rebecca Dekker:  So that’s amazing, that you can attend births, both as a doula and a chiropractor. Do you know of any other chiropractors who do that kind of work? I’ve only heard of a couple, in my experience.

Elliot Berlin:  Right, so I’m Southern California, I’m in Los Angeles, there’s a school here and I’m an internship site for that school. So we’ve had several chiropractors come through my program and learn the combination of massage and reflexology and cranial work. That’s in addition to what’s normally done in chiropractic school and how to apply it to pregnancy, birth, post partum. So several of those chiropractors bring this kind of work in, they’ve become doulas as well and they bring this kind of work into their doula support too.

Rebecca Dekker:  I was wondering too, if we could back up just a little bit and for people who are listening, who might not be familiar with chiropractic care. I know that it’s often not part of the medical model in terms of, I know for example, in my pregnancy, I had a lot of back pain, a lot of pelvis pain. And my OB never once suggested that I see a chiropractor and I didn’t even really know what they did. Then, with my second birth, I had a midwife and that was one of the first things she told me to do and it helped immensely. And I was introduced to this whole wide world. So could you explain and just briefly, to our listeners, who aren’t familiar with that, benefits of chiropractic care during pregnancy and kind of what it does?

Elliot Berlin:  Sure, at its core, chiropractors look at joints throughout the body. Wherever two bones come together, they form a joint. There should be good motion around that joint, not too much motion, not too little motion. And if sometimes, because of various factors, the joint loses some of its mobility, it can start to create problems. Either loss of range of motion, or things become swollen, things become rigid, where you should have fluid movement. You sometimes have tight, rigid movement and so, what most chiropractors are doing, is looking through the body for where there are restricted dysfunctional joints and restoring motion between the bones, around the joint. There’s a lot of different ways to do that, there’s lots of different ways to find the restrictions, lots of different ways to release them.

Elliot Berlin:  But that’s what most chiropractors have in common. So if you go to different chiropractors, you might find different approaches to find and release those joints, but what they’re trying to do is improve skeletal function. Now, in addition to the actual structural issues, the spine in particular, is supposed to protect the nerves in the spinal cord and if it’s not functioning well, normally it doesn’t sometimes not protect them. But it can create trouble for them, it can create pressure on them. So you might feel pain, you might feel nerve pain, which is very intense or there could be other types of dysfunction. Those nerves don’t normally carry pain information, they carry information to and from the brain about what’s going on in the body.

Elliot Berlin:  So the bigger picture with chiropractic is if we can help alleviate issues in nerve communication, then we can help the body, which is the ultimate doctor. Find and correct problems on its own, in a way that it was having trouble doing before. In our case, we also incorporate soft tissue therapy to address muscles, tendons, and ligaments. When they’re unhappy, they usually become short, stiff, tight, and during pregnancy, they can commonly, also let’s say around the sciatic nerve, maybe from sleeping on your hips, if you’re not used to it, those muscles in your lower back, hips, and glutes get really stiff and tight and start to compress the outer bundle of the sciatic nerve. Creating a kind of pregnancy sciatica, that you just feel locally. It doesn’t go all the way down the leg.

Elliot Berlin:  That’s one of the most common things that comes into the office, but it’s easier to treat if we can release the muscle that’s compressing that nerve and restore motion to the joints around it. People usually get a lot of improvement from it and you don’t have to do it very often. It’s not like you have to come back three times a week, it lasts for a while. So generally speaking, some of the symptoms that come up during a pregnancy, whether it’s headaches or rib pain or lower back pain or sciatica or sacroiliac pain. Groin pain is pretty common, pubic symphysis pain. Sometimes it’s at the wrists or in the legs or at the feet. Those are the kind of things that are fairly easy for chiropractors to treat.

Elliot Berlin:  But in terms of positioning and readiness for birth. If the lower back, hips and pelvis are really stiff, tight and rigid, it makes it an environment that’s reasonably more difficult for a baby to move around in, to maybe settle into an ideal position, prior to birth or to kind of rotate and drop through the pelvis during birth. So part of our work in improving the musculoskeletal structures on the expectant mother, is to make an easier transition for both the laboring person and the baby during childbirth.

Rebecca Dekker:  And some chiropractors are especially trained or have special experience in that kind of prenatal and preparation for labor and birth care, correct?

Elliot Berlin:  Absolutely, so in chiropractic school, it’s covered, prenatal is covered. But in my experience, it’s not covered that well. It’s kind of how a massage approaches, massage schools often approach prenatal as a list of things not to do. But there’s so much more to prenatal massage that you can do. The same with chiropractic, it’s oftentimes a list of don’t do this, don’t do this, modifications maybe. But it’s not like how can we use these powerful tools for the pregnancy? It’s how can we not do harm during the pregnancy, which is important, but we can go a lot deeper than that.

Elliot Berlin:  So anybody who’s licensed chiropractor has some training and can work on pregnant people, but there is a lot of postgraduate training available, especially through the ICPA, the Internal Chiropractic Pediatric Association and I think that when you look at people who spend postgraduate time studying, furthering their education in this field, they’re going to be the people who attract pre and postnatal clientele and ultimately get a lot of experience, which counts for the most. The more experience you have, the more you learn, the more you can help somebody.

Rebecca Dekker:  So tell us a little bit about your own birth experiences, if you feel comfortable. I know you had multiple children and after a difficult journey with infertility, did the birth go smoothly or did you have problems with the healthcare system or how did that go?

Elliot Berlin:  Our first pregnancy, I come from a very medical background, emergency rooms and ambulances. And the holistic side of things really came to me somewhat during chiropractic school and massage, but I still was fairly medically minded when we were pregnant with our first. And so was my wife, her father also is actually, at the time, was a paramedic and we volunteered together for a community based ambulance organization. So we both came from a pretty medical background, we did the standard thing, go to a doctor at a hospital and the typical visits and they were fine. Our pregnancy was thankfully very healthy and our labor and delivery plan was to just go to the hospital and have a baby, whatever that meant.

Elliot Berlin:  My wife was not too keen on the idea of having a big needle next to her spinal cord and so she had this goal to not have an epidural, not necessarily for holistic reasons, but just not in love with that visual. And so we hired a doula, who was amazing. She was an incredible source of information and support during the pregnancy and once labor started it was pretty cool. We labored at home for a long time, it was a long first birth, it was somewhere around 42 hours and we did a lot of it at home, together. And we were at the hospital for about 13 hours and the original doctor, who came by, it was an HMO group. So it’s not like your doctor that you see all pregnancy long, is necessarily going to be there.

Elliot Berlin:  But they have multiple doctors on the floor and so the original doctor seemed pretty medically minded because labor had been going on for a while was pretty interested in interventions. Our doula realized that wasn’t a great match at the moment and asked if there was another doctor available. And the other doctor, who came in, seemed just more aligned with what we were trying to do. My wife was incredible and the doula was incredible and I was in awe and doing my best to be just somehow useful. And she plowed through it, she was able to do the unmedicated birth and it was just very, very surreal, the whole thing, incredible. The second baby, at the same hospital, came a lot faster.

Elliot Berlin:  So the whole labor was just over two hours and I think we were at the hospital for about 20 minutes before she came out. So there wasn’t a whole lot of time to do any kind of intervention. And then the third was a little bit longer, and at a different hospital, where they were much more keen on intervention and by that point we had become a lot more holistic. My wife and I were both, had done doula training, were attending births and just holistic from the point of view of don’t intervene if we don’t need to. And this particular doctor and hospital were just a different model. Intervene early and often to control things and it’s not that, that’s a good or a bad model, it just wasn’t a good fit for us at the time.

Elliot Berlin:  So by the time we had our fourth, we decided to have a home birth, and we found a midwife, who we loved and it was just a great chemistry and that birth was pretty short. About 19 minutes, start to finish, at home, a beautiful home water birth. I would say they were all pretty magical and we didn’t have any bad experiences, but we did go through kind of this progression in terms of almost like what you said, how your original doctor was one model and then your midwives were a different model.

Elliot Berlin:  And I think that one or the other model probably appeal to people, one appeals more than the other, to people. And maybe different model at different times, or for different births. But for us, I feel like we got pretty lucky in terms of nobody really forced anything on us and also, we were fortunate to have just pretty healthy pregnancies and births, without anything coming up that would put us in a position to have to make decisions about big interventions.

Rebecca Dekker:  That’s wonderful, so you had relatively smooth labors and births, can you talk a little bit about the struggles though, that some of your clients are facing, around perhaps maybe breech birth in particular and the lack of choices available there?

Elliot Berlin:  Sure, so I was a breech baby in the 1970s and I don’t think they really realized that I was breech till towards the very end. And they didn’t really seem to care that much, that was I breech. It was at that time, not an automatic given that you would have a caesarian birth. Today things are different, I think that since the term breech trial came out in 2001, which had a conclusion that breech babies have a better, statistically significant, small, but statistically significant better outcome when they’re born via caesarian then when they’re born vaginally. It just seems like the option to deliver a breech baby vaginally, disappeared around that time, in North America at least.

Elliot Berlin:  So even though subsequent studies kind of indicate that for some people, vaginal breech delivery could be a great option, it’s still not happening very much and I think because of that, it’s very hard find out anybody to get trained adequately on how to attend breech births. In California, midwives who are still doing breech births and still very supportive, a couple of years ago, it became removed from their scope of practice. So they’re not allowed to any more and the doctors generally don’t want to. So here in Los Angeles there’s still a few doctors and still a few hospitals that are supportive and you could get a vaginal breech birth if you wanted one. And if you meet their criteria for safety, but the numbers are dwindling fast and if you don’t have the insurance that covers that or for other reasons couldn’t see that particular provider, than you really have no options.

Elliot Berlin:  And it’s hard to watch that because sometimes if I see somebody, who’s let’s say, on their third baby and they have had two great vaginal births and would love to have another vaginal birth, she might be a great candidate for it, but she can’t find support for it. Sometimes I’ll see someone having their first baby and it’s a breech baby and I know she’s planning to have five or six kids and it’s part of the calculation is whether or not having the first baby via caesarian is going to affect the rest of her reproductive history, health or future. But it almost doesn’t matter because it’s hard to find support, so it’s been pretty challenging and I think the more that people become educated about their options, the more they want to have choices. But their choices are disappearing nonetheless.

Rebecca Dekker:  So do you get a lot of frantic phone calls from people who find out at the end of pregnancy that their baby is breech and they come to you for help with chiropractic care?

Elliot Berlin:  Yeah, practically every day and I think that chiropractic care can be helpful. There’s a lot of different causes I think, of breech babies. Some of them are structural, some of them could be functional and some are a combination of both and sometimes we never know. But if there’s let’s say a high up placenta with a short cord, I’m not sure that chiropractics is going to be helpful, if their placenta is right in the baby’s face, if the fluid’s really low, if you have a large baby deeply wedged into the pelvis, not head down, since week 20. There are some structural things that can work against us.

Elliot Berlin:  And what we do is, we don’t manually try to move the baby, we don’t try to turn the baby, we just try to make a more functional space around the baby. So if towards the middle of the pregnancy, somewhere around 50% of babies are not head yet, but then all of a sudden by 32 weeks, 90% of babies are head down. It seems that as they run out of space, they have to pick a position and they typically turn head down. If that’s not happening, there’s generally some sort of explanation as to why it’s not happening and to the extent that stiff, tight, rigid pelvis, lower body, plays a role. We can start to loosen that up and perhaps make it more inviting or make the body be able to better accommodate or facilitate the movement. External cephalic version

Elliot Berlin:  So that’s what we do and I would say that sometimes babies turn after our visits or between our visits. Doctors, who do the external cephalic version, where they manually try to move a baby. Several of them send their clients to us to try what we do first. Either in the hopes that it will work or in hopes that it will at least soften the playing field, so they have a better chance of success during the medical procedure. So that’s kind of what we do, I would say, I think in the opening, you might have said that most of the babies that we see turn. I would say many, many of them turn and some of them don’t turn.

Rebecca Dekker:  And when do you recommend that people start kind of figuring out what position their baby is in? Knowing that there’s so many restrictions around breech vaginal birth in North America. When should people start paying attention to the position of their baby?

Elliot Berlin:  I like to know at 32 weeks, according to statistics that I read recently, 32 weeks, about 90% of babies are head down. At birth, about 96% to 97% are head down. So at 32 weeks, you still got a really good of the baby turning, even if we don’t do anything. But time starts to really work against you then. So if you’re in that 10% that’s still not head down, it’s a great time to explore your options for things you can do to try help naturally encourage the baby to get head down, if you make it further into the pregnancy, there are going to be some choices, if you want to medically try to turn the baby.

Elliot Berlin:  How that’s done, when that’s done, if it’s done with or without drugs and what drugs are used. There’s a lot of information to accumulate in a short period of time. And then of course if the baby stays breech and you need to have breech delivery options, which options are available to you, in your area? Or I even see people traveling large distances to be able to get to a provider that can help them. That’s all stuff that takes time.

Elliot Berlin:  So I think 32 weeks is a time when, since the majority of babies are head down at that point, it’s a good time to know, is your baby head down or not? How big is your baby? What kind of fluid do you have? Is there any known variation in the shape of the uterus that might be contributing? Where’s the placenta? Just things to be aware of, are there people in your area that can help with holistic modalities, like chiropractic massage, acupuncture, moxibustion, homeopathic, hypnotherapy.There’s a lot of different things that be used to try to help encourage the baby to flip into the ideal position and to explore the options in case it doesn’t happen.

Rebecca Dekker:  And if it doesn’t happen, the baby remains breech, what is it like for your clients in that situation?

Elliot Berlin:  For some of them, they’re totally okay with it. Some clients don’t really even do the medical procedure, the external cephalic version to try to turn the baby because they are of the philosophy that if the baby’s breech, there’s a reason for it, and let’s not mess with it too much. Some of them don’t particularly care for the option to deliver babies are breech, vaginally and they’re okay. And even then, I think it’s great to study what happens during a caesarian and so it shouldn’t be so scary and intimidating.

Elliot Berlin:  And there are also choices to make during the caesarian birth, especially scheduled caesarian birth, that people are probably not that aware of until they get there. So, for that reason it’s also kind of nice to study ahead of time. For other patients, it’s a much bigger deal. People who are very opposed to medical pharmaceutical interventions, surgical intervention, people are sometimes just terrified of surgery. People who trust in their bodies and are good candidates, generally considered good candidates for vaginal birth, but can’t find a provider. It can be really devastating and traumatic.

Rebecca Dekker:  Yeah, we had somebody on the podcast who was in that situation, who they told her that there were no providers available to do a breech vaginal birth and turns out there was, the hospital staff didn’t know that there was somebody that could be called and was very traumatic for that person, that parent. Also, I’ve also seen, obviously it’s great if you have the benefit of the advance knowledge, of knowing that your baby’s breech, so that you can educate yourself about all of your options for either turning the baby or the type of delivery you have. But I also know there’s situations where there’s a surprise at the very end. Can you talk a little bit about if the baby’s coming out, if mom’s in labor and all of a sudden it’s discovered that the baby is breech?

Elliot Berlin:  Well, I think what generally happens is a state of panic. So in our film, there wasn’t exactly that scenario, but we interviewed a mom who found out towards the end. She was planning for a natural birth, found out towards the end that she was breech and she wasn’t given many options in terms of trying to turn the baby. They just scheduled a caesarian for 39 weeks. But before her 39 week caesarian date, she went into labor and she progressed really quickly, and so by the time she got to the hospital, the baby was pretty much coming down frank breech. So I’m pretty sure it was frank breech, butt first. And so-

Rebecca Dekker:  Which is the most ideal position for a breech baby, correct?

Elliot Berlin:  In terms of safety, yeah, if you’re going to deliver a breech baby, in terms of safety needs, coming down frank breech. The butt will block the cord from coming out first, to prevent one of the concerns of vaginal breech birth, which is umbilical cord prolapse, if the cord comes through first and then the baby comes through, then the cord can get compressed and then it could be a serious complication. But just like a head blocks the cord from coming through first, so does when the butt’s wedged in there, it does as well. But they just panicked, they haven’t seen vaginal breech birth before, the providers who were there.

Elliot Berlin:  They didn’t really know what to do and what they did is, they kicked her husband out and they knocked her out completely, so that labor would stop. And according to the op report, they pushed the baby back in and did a caesarian birth and she was very traumatized by that. And even with her second baby, which is when I met her. She was not breech, but she was very nervous about having a vaginal birth because she thought the same thing would happen to her again, that she’d totally lose control. She has no memory of her first birth. Her husband wasn’t allowed to be there, there were no pictures, she was knocked out completely.

Elliot Berlin:  And that’s the kind of panic that sometimes happens because younger providers don’t have any experience now, oftentimes with delivery on breech babies. I think it’s a problem, I think, especially in those scenarios, where things are going very well. We also, on our podcast, we have a story of someone who was breech and she was planning to, she tried everything, she did all the holistic things, we did chiropractic and acupuncture and massage and she did the external version, which also didn’t work. So she was set to meet one of the doctors here locally, who delivers breech babies vaginally, but her water also broke before they had that meeting.

Elliot Berlin:  And so she went into the hospital and her doctor was apologetic, he said, “I just, I don’t know, I don’t know how, I’m not comfortable. I don’t feel like I can do it for you safely.” So she had a caesarian birth, which went well and she recovered well. It was better than she thought it was going to be, in a rare repeat episode because nobody knows why her first baby was breech. So there’s no real identifying reason for it, but her second baby was also breech and she started really early, at 24 weeks, noticing it and trying to do things to help encourage a turn.

Elliot Berlin:  And that baby also wouldn’t turn, but in a very unusual case, she found a doctor who was comfortable doing a vaginal breech birth, after caesarian. So sometimes it’s hard to find VBAC all by itself, a plain old vaginal birth after caesarian, it’s typically hard to find a doctor to deliver a breech baby vaginally. In her case, she was able to find a doctor who delivered her breech baby vaginal birth after caesarian and she had a great experience.

Rebecca Dekker:  And I notice at your website informedpregnancy.com, if people click on watch, there is a section called Breech Stories, where there’s a collection of all of the breech birth stories on your podcast.

Elliot Berlin:  Yeah, absolutely, and there’s an easy way to get to that too, is breechpodcast.com. We get so many requests for information, since the film came out. We get so many requests for information, that we just took all our breech podcast stories and articles and stories that people submit about their own breech experiences and our film, Heads Up, and just put it all in one, easy to access place.

Rebecca Dekker:  Yeah, so tell us a little bit about your film. What inspired you to create a documentary about breech birth?

Elliot Berlin:  Well, it’s just what I kind of live through and witness every day, with people panicking towards the end of the pregnancy, not having information and not having options. I’m quite pro-choice when it comes to childbirth. I think that if somebody who doesn’t need a caesarian birth, but wants to have one, I think we should support that, in today’s day and age. She should be given all of the pros and cons of the different options available to her and we should support that. And I feel the same way about vaginal birth. I think that it’s not really a problem, anybody who wants to have a caesarian birth, really has access to it. But oftentimes people who want to have a vaginal birth, don’t and so we made Heads Up to sort of tell that story and to kind of put a more human side.

Elliot Berlin:  I think sometimes doctors don’t realize the toll it takes emotionally and psychology on somebody who really, really, really doesn’t want to have a caesarian birth. And finds out that they’re a pretty good candidate for vaginal birth and the only reason they can’t have one is because they can’t find a provider who will do it. And so I wanted to sort of give a little more insight to what that’s like sometimes for people, emotionally. Also, at the same time, to highlight that this could be an option for somebody. For somebody who doesn’t even know that it’s an option. We show a pretty close up frank breech birth towards the end of the film and sometimes when people watch that, their minds are blown. In fact, we sometimes get invited to grand rounds at a hospital and do a presentation for both obstetricians and residents.

Elliot Berlin:  And sometimes they’ll see it and it’s the first time they’ve seen a vaginal breech birth and they’re kind of blown away by it. How just normal, natural it can look, so I think any way you give birth, there’s always going to be some risk. There’s different risks involved with vaginal breech birth, than with head down vaginal birth or with caesarian breech birth. Our goal is to sort of help inform somebody about the different known pros and cons, risks and benefits to each option. Both for them and their baby and put them in a position where they can make an empowered choice, an informed choice and then support the choices that they make.

Rebecca Dekker:  And I think that goes really well with the title of your podcast, the Informed Pregnancy podcast. Although, as you mentioned, one of the big barriers to choice is not having providers who are trained in offering choices. So can you talk a little bit about since the documentary came out, have you seen any changes in a positive direction, in terms of providers getting training or relearning this lost skill of breech vaginal birth?

Elliot Berlin:  So here in Los Angeles, which is my immediate community, there are two positive changes. One is a doctor, who has always done vaginal breech birth, he’s always supported vaginal breech, he has some criteria that are important to him, that people need for safe vaginal breech birth. But he’s always done it and never publicized it, so after the film came out, several people said, “Oh, do you know this doctor does vaginal breech birth?” So I reached out to him and I showed in the film, we went out for dinner and talked a little bit and he agreed that it would be okay to tell people that he does it and that they can come and consult with him towards the end if they find themselves in that position.

Elliot Berlin:  And I’ve sent dozens and dozens of clients to him since then and they don’t always choose to go through with it, but at least they can have a consultation with somebody and have a choice. Oftentimes, they do go through with it and so that’s been a great resource here, locally. There was another doctor, who saw the film and he kind of got up to ask some questions and I thought that he was going to give me a hard time and be negative about the film and he wasn’t. It was towards the end of the film, we do show a side-by-side of I think, a pretty fair choice for a home vaginal breech birth and a caesarian birth with a person who did not have a breech baby, but did allow filming and the hospital also allowed filming, which is sometimes hard to get for caesarian birth and she’s happy.

Elliot Berlin:  She’s not angry, she didn’t want to have that vaginal birth, she wanted to have an out of hospital birth. She didn’t want to have that caesarian birth, she wanted to have an out of hospital. But it turned into a caesarian birth and she’s happy and that’s what he pointed out. He said, “Although sometimes I think residents and doctors feel threatened by that side-by-side and feel like it’s not a fair representation.” He got up and he said, “I’ve been to a lot of caesarian births and I feel like you picked a fair caesarian birth to put side-by-side with that vaginal birth because she’s excited and she’s happy to be having the baby and she’s smiling and she’s not screaming.”

Elliot Berlin:  He was touched by that, he was touched by the whole film and even though he’s younger, he had some experience with vaginal breech delivery from an older doctor. He’s one of those younger doctors, who when he was new, really sought out the experience from the older doctors, which is rare. I think today, most of the other doctors are not interested. And he became another source of vaginal breech birth, we actually have another vaginal breech after caesarian episode with him on the podcast, a totally different story. So those are two of the local positive things that came out. Another thing that I think that’s positive that came out, is more and more consumers, more and more pregnant people are aware that this could be a choice and so they’re more vocal with their doctors and providers.

Elliot Berlin:  And I see especially with the HMO, they’re sometimes demanding that the HMO pay for them to go out of the network because they’re not offering the service that they need and sometimes they’re successful, sometimes they’re not successful. But if an HMO doesn’t offer a service that you need, then there’s this gap exemption coverage, where they’re supposed to pay for you to go get it some place else. So sometimes they argue that this is not a necessary procedure, vaginal birth and sometimes they seem to be willing to accommodate. Ultimately, I think that if there’s going to be a change, that’s how it’s going to happen.

Elliot Berlin:  It’s that the consumers are going to demand change and then it will eventually take place. I think it also, the film, to a degree motivated some of the people, who do go around the country, teaching breech birth. Unfortunately, they kind of have to teach from video libraries and on simulators because there’s just not that much vaginal breech birth happening for young providers to witness. Although, the one guy who reemerged and said we could publicize that he does vaginal breech birth, he always asks the laboring person if they mind if extra people come into the room and witness it.

Elliot Berlin:  At his hospital, people really do seem to be interested, nurses and residents and doctors do seem to be interested in at least having some exposure to it. So the signs are not huge, the positive changes are not monumentous, they’re not big changes, but there are small changes. The problem is that as time goes on, it’s the older doctors and midwives in some states, that have the most experience, that start to retire and stop practicing and I think that’s happening at a faster rate than younger practitioners being trained. So the net shift is not amazing.

Rebecca Dekker:  Well, that’s why it’s even more important that you did the documentary though, to raise awareness to this issue before the option disappears completely. It really struck me when you talked about the doctor who originally didn’t want to publicize the fact that they did vaginal breech birth. I have seen that across the country, among the handful of clinicians I know, who attend breech vaginal births. Similarly, they want to draw attention to it because I think many of them feel like they’re trying to practice under the radar. Perhaps hospital administrators, other OBs are willing to kind of turn a blind eye, as long as it’s just one vaginal breech birth or there. But if they got a flood of people coming to them for vaginal breech births, they’re worried about the pushback from the hierarchy and the power hierarchy in the hospital.

Elliot Berlin:  Right and so I think that statistically, there’s around 3 or 4% of their clients are going to be breech at the very end and most of them are not going to request a vaginal breech birth anyway. Then they would only be doing them once in a very blue moon and they could fly under the radar. But there was a local hospital that the head of obstetrics invited us to do a presentation and we presented the film. There was another doctor who does go around the country, teaching breech, who did a presentation, showing a whole bunch of different videos of breech birth and explaining what to look for.

Elliot Berlin:  And there had been several doctors in that hospital, who had some experience with breech birth and they kind of agreed as a team, that they’re going to try to make this option available to the community and always have somebody on who’s comfortable with vaginal breech delivery. It only went on for a few weeks, it was like a few weeks later, they had two or three in a row and one of the hospital administrators caught wind of it because it kind of made a wave. They were all great births, but that administrator just didn’t like the optics of it and made it really impossible for them to continue attending vaginal breech birth. So I understand why people want to, providers want to kind of fly under the radar because they may lose the option altogether if they draw too much attention.

Rebecca Dekker:  Which is just crazy when you think about it, it’s like, “We’re giving people options.” “That’s terrible, stop that.”

Elliot Berlin:  I know, I mean that’s the crazy thing about VBAC was, it is a whole other genre, but it’s our other movie, is that VBAC is essentially the absence of a procedure and women who don’t have access to a VBAC are just begging for no intervention and a hospital that bans VBAC, is banning the absence of a procedure, it’s kind of mind boggling. In other words, they’re saying, “We’re forcing you to have this baby with intervention.” Which seems very unAmerican, just not the kind of thing that happens in a free country.

Rebecca Dekker:  So, Dr. Berlin, do you have any advice or suggestions for how people can educate themselves more about breech birth?

Elliot Berlin:  Well, I generally think for individuals who are going to have a baby or are currently pregnant, I think it’s good to find out at 32 weeks what’s going on with your baby. Not just what position the baby’s in, but is your baby measuring on the smaller, medium, or larger side? Is your placenta maybe on the front wall, anterior, where maybe it gets in the way a little bit more? Is your fluid, normal range for fluid is a big range, so is your fluid on the low, middle, or higher range of normal? Anything we can tell about the cord, just things that if your baby’s not head down, more intel, so you know what you have to work with. I think that in terms of options and choices for both things you can do to encourage your baby to get head down or things that you, options that are available to you if the baby doesn’t turn into a head down position.

Elliot Berlin:  Both in terms of vaginal birth and caesarian birth, we try to put together all of that at breechpodcast.com. I just think it’s important early on, to have these conversations with your provider because you don’t know if it’s going to be you until you get to the very end and then there’s not a lot of time to react to it. So in general, I think that when you’re finding your birth provider, if it’s a medical doctor or midwife, to really just ask these questions more towards the beginning, what if my baby is measuring large? What if my baby is in a breech presentation? What kind of options will I have available to me?

Rebecca Dekker:  Thank you so much for the advice. Dr. Berlin, do you have any questions you want to pick my brain about? Is there anything I can help you with today?

Elliot Berlin:  I mean, I have so many questions that I want to pick your brain about and I’m hoping that you’ll come onto our podcast, Informed Pregnancy, several times. But I know that your perch is evidence based birth and so I would just maybe turn it around for a second and say, from your research in terms of somebody who has a breech baby and their options to deliver from the evidence based side, what information could you offer?

Rebecca Dekker:  So we just a couple of resources at Evidence Based Birth about breech babies. We have not published an article about vaginal versus caesarian birth in that option. However, we do have an article about the use of external cephalic version for turning a baby. They have research evidence on that and you can find that at evidencebasedbirth.com/breech-version, V-E-R-S-I-O-N. We have in the article some statistics about how often breech babies are born and we pulled those from the birth certificates in the United States and have some tables and info about the success and failure rate and how often are versions successful in turning a baby and what’s the caesarian rate if you attempt version versus if you don’t.

Rebecca Dekker:  And then we have research on the effectiveness of versions and what increases your chance of the version being successful and turning the baby head down, as well as one of the risks. We talk about pain and timing and techniques that can increase the likelihood of success, as well as like a long bullet point list of things that can increase or decrease the chances of the version being successful. We even have a little section about VBAC and version because sometimes people who have a scar on their uterus from a prior caesarian and they’re hoping to have a vaginal birth with the second baby and then unfortunately, they find out the baby is positioned breech. Sometimes, at least in my community, but I’ve also heard this in other communities, their providers will refuse to do a version to manually turn the baby if there’s a scar in the uterus.

Rebecca Dekker:  So we talk a little bit about the available research on that, which there’s not much. But there are a couple of studies and there are also guidelines on that from ACOG. ACOG’s official stance is that people who have had previous caesareans are not any less likely to have a successful version, but they should be counseled that the risk of uterine rupture with version has not really been well studied. So yeah, there’s that article and then the other thing we do have, we do have a blog article about moxibustion for turning a breech baby. You can just Google the evidence on moxibustion, which is an acupuncture Chinese medicine technique. So those are the two resources we offer.

Elliot Berlin:  I mean, that’s incredible because I think that what happens is, when you have a provider that wants you to go a certain way, that would like for you to make a certain choice, the information is presented in a way that will influence you towards that choice. So even for VBAC, if somebody says the risk of uterine rupture is one half of 1%, to most people that sounds pretty low and like a risk they’re willing to take. But if you turn it around and say one in 200, which is the same thing, all of a sudden it sounds like a much bigger number. Like I know 200 people, if my odds of winning the lottery are one in 200, I would jump on that, take it right away.

Elliot Berlin:  So I think the way we process risk is pretty interesting, but the way we’re fed risk is more interesting. So I frequently hear people say, “I’m not going to do the external version because it’s so risky.” But I can’t wait to read through your articles on it because I like to just present to somebody, these are the actual risks and let you decide if that’s a risk you want to take. I think that risky and safe are somewhat subjective terms and so, that’s why I love your stuff in general. And with your permission, I’m going to link all that stuff to our breech podcast page.

Rebecca Dekker:  Oh definitely, and also the article is free to the public, all about the evidence on external cephalic version for a breech baby. But I will also send you a printer friendly PDF, that our members have access to. So that you can print that off and hand it out to your clients.

Elliot Berlin:  Awesome, thank you so much.

Rebecca Dekker:  So thank you, Dr. Berlin for coming on the podcast. I know people can follow you on your podcast, the Informed Pregnancy podcast, which is available on iTunes and everywhere else and your website, informedpregnancy.com. Is there anywhere else people can follow you on social media?

Elliot Berlin:  We have everything on Instagram, and it’s @doctorberlin, I’ll spell it out, D-O-C-T-O-R-B-E-R-L-I-N.

Rebecca Dekker:  All right, thank you so much, Dr. Berlin, for coming on the podcast.

Elliot Berlin:  Thank you.

Rebecca Dekker:  Thanks everyone for joining us on this episode of the Evidence Based Birth podcast. I hope you enjoyed listening to Dr. Berlin and hearing his thoughts about breech birth and chiropractic care. I know for me, it was really informative. Just a reminder that the opportunity to order bulk copies of Babies Are Not Pizzas will open January 20 and be open for one week only, through January 27. If you want to get on the wait list for those bulk book pre-orders, just go to evidencebasedbirth.com/book. Thanks everyone and I’ll see you next week, bye.

Rebecca Dekker:  Today’s podcast was brought to you by the PDF library inside the Evidence Based Birth professional membership. The free articles that we provide to the public at evidencebasedbirth.com and this free podcast, as well as other resources, are supported by our professional membership program. Everyone who joins our professional membership gets access to a library with all our printer friendly PDFs. Each signature article that we publish online, has been turned into a professionally designed, easy to print PDF, so that our members can print and share evidence based info with their clients, other parents or other professionals. To learn how you can become a member today, visit ebbirth.com/membership.