With some of the recent published changes in the Alberta Midwifery competencies and standards of practice, and the increase in discourse around pregnant folks desiring more options for vaginal breech birth, this topic comes up pretty often during prenatal care.

I really love how Breech Without Borders (BWB) builds breech skill sets. I’ve taken a total of four upright, physiologic breech courses (and am currently enrolled in BWB). Breech Without Borders is incredibly comprehensive, and has completely changed the way I think about both breech and vertex (head down) birth.

So If I have the training, why don’t I promote myself as skilled and competent for vaginal breech?

While I have received training in and am pretty knowledgeable about vaginal breech birth in theory, I acknowledge and am openly transparent about the limits of my experience, having never attended a vaginal breech birth as a primary care provider or managed any breech specific complications.

Having attended births in various roles for over a decade, I’ve been smacked with a heavy dose of humility enough times to know the difference between theoretical knowledge and actual lived experience. You don’t know, what you don’t know. And often, you find out exactly what you don’t know, and what that deficit might mean, when it’s staring you straight in the face.

As midwives, we attend births knowing that supporting the physiologic birth process generally comes with good outcomes – However, we also train for all possibilities, because sometimes, birth needs help. We become skilled by developing nuance around when a situation does, or does not need our assistance. We develop competency AND humility while actively managing complications, being aware when our actions sometimes cause complications, when we are personally challenged by the difficulty of a situation, or when following the flowchart of neatly laid out manoeuvres doesn’t yield the ease we might expect.

I’ll be frank (pun-intended). Anyone who attends a vaginal breech birth where the baby literally falls out, who then identifies themselves in a community as being “skilled or competent” in breech birth, is erroneously taking credit for the fact that natural physiology works well most of the time. While the ability to hold presence at a birth is important, simply being physically present when a breech baby is born does not make someone a skilled, competent breech care provider. Providers have an obligation to transparently discuss their experience level, their beliefs, biases, the limitations of their abilities and whether they actually have experience in managing the common and rare complications that can be associated with breech birth so that families can make a truly informed decision.

Do pregnant people require breech competent providers in order to give birth to breech babies? Of course not. Birth happens without assistance everyday. Birth givers have the right to be respectfully attended by their caregivers and to make informed choices about where, how and with whom their babies are born – it’s the birth giver that makes the final decision around what matters most to them when preparing for a breech birth. For families, finding support for a vaginal breech birth may look like remaining in care with a supportive caregiver who may be skilled, but not competent, transferring care to a provider who can offer competency, but within a medicalized framework, or potentially leaving the system altogether.

We all have to start somewhere, and as we find new ways to support birthing people within a changing midwifery landscape, I hope the learning of new skills occurs in the best way possible.