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The Elephant in the Room: Why It is Time to Recognize We are Winning on the Homebirth and Breech Issues Internationally

Sociologists have theorized since the 1950s that professions establish their domain by staking out a jurisdiction around a body of knowledge and monopolizing it.  It has long been demonstrated that the medical profession subordinates other groups by controlling any overlapping scopes of knowledge and practice.

Because obstetricians are offering only cesareans for breeches, their deskilling in vaginal breech birth has introduced some questions about the suitability and validity of their claim to jurisdiction over it.  While the medical profession continues to maintain that breech is high risk, recent literature exposing the fact that using the physiological position may eliminate the need for forceps, in fact, takes breech outside of the realm that requires instruments and an obstetrician in the room. Unfortunately, it has been demonstrated that having unwilling obstetricians in the room increases fear and unnecessary intervention.

The presentation will describe how the midwives and mothers in Ottawa reclaimed vaginal breech birth and the midwives' professional domain over it in hospital; although an ongoing battle, it has become an important step in establishing midwives as the experts in normal birth. If we can protect vaginal breech birth it becomes a microcosm of how to protect women from unnecessary intervention in other areas.

The Australian and new Frankfurt data will be presented demonstrating normal physiological management. Videos of the upright position will be shown but this will be less a technical description of the how to do breech and more the "why" and "how" to bring back breech in your community.

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