This new set of homebirth photos shows us that breech babies can be homebirthed too if the necessary precautions are taken.

I believe no further commentary is needed as the pictures talk for themselves.

When lying on your back, the uterus and vagina are pointing slightly over the horizon. When pushing stray, you are actually forcing the baby’s head against a muscle wall formed by the tissue joining your anus and vagina: that is the perineum. If pressure becomes excessive then a severe tear might occur. In order to control the tearing direction -and not to avoid it-, medicine invented episiotomy, which basically is cutting the tissue so that it’ll continue to tear sideways and not towards the anus. In this position you’re also forcing the baby’s head to go upwards, and thus fighting gravity which again is putting pressure on your perineum.

If you’re facing a natural home birth, you should fellow what your body inspires you during labor. This of course will change from a woman to another, but there are common grounds. When labor starts you will probably be inclined to some walking: excellent as it helps gravity do its job and the uterus collar to dilate. Same goes for the “slow dancing” position, bending and resting on your partners arms while standing and waiting; this is perfect for first stage and second stage contractions.

Once in deep labor, I feel that what was once called “African position” as African women would usually hang from a robust tree branch with one hand while almost kneeling for birth, and now more widely known as “squat position”, is your best, more natural, intuitive and physiological choice. The squat position will allow for fast and efficient labor, reducing stress and pain on your body and your baby’s, allowing you to actively intervene in your birth as you’re able to catch your baby yourself and your chest is just nearby to welcome your newcomer. From this position it’s easy to kneel forward and rest after the effort without losing any of the positive aspects of this position. Usually as well, the birth tends to end with the mum on one knee while the other leg still in squat position.

Depending on the situation, I find that ideally the partner is supporting the mum; the squat position allows intimacy and direct communication, as often eye contact in these cases can be more of a difficulty. Accordingly, the midwife can stay discreet out of eye range but still make sure that everything is going fine, and come back to concrete presence when needed. The fact that the midwife is also in this case below the horizon and the parent’s eye line gives back to the mother her pro-activeness and the midwife her original role: assistant. Physiologically speaking, the squat position relieves all barriers for the baby, levering down the efforts of the mother and easing the way out, as nothing obstructs directly anymore.

Now, what about water births? As I stated above, what works for you is best for you, so if you’re facing a physiological birth and you want it to be in water, please go for it with the assistance of your carer. If I have to be honest, I’m not personally very fond of them. Water pressure reduces the gravity force and the mum is back to a closer gynecological position type; I don’t find this ideal and in a natural environment, you wouldn’t probably give birth in water as it would be too cool. There have been some incidents in water births, as birth baths need to be very specific in order to drain bacteria, blood and organic rejections, need to keep water temperature stable, etc… Anyway of water birth still seems to me safer and more respectful than a hospital one.

In any case my advice would be to do what feels right for you.

I’m proposing today a set of pictures taken during a homebirth. In order to protect the mother and family’s privacy, I’ve made sure that there was no way to identify neither of them, and as a result it may not be that easy to guess that this is happening in a home environment .

I want to draw your attention on to one particular fact: although the mum is giving birth laying on her back, a position that in my opinion is unnatural and unadapted to labor, you’ll see that there is barely any blood. That is because in a physiological birth there is no need for episiotomy -a horror close to torture and hardly ever needed (only when pathology is involved and at that stage, yes I believe you should be delivering in hospital. If a mum to be has  been followed properly during her pregnancy, it’s usually easy to tell if she’s facing a  physiological or risky birth)-; most of the blood you can see in a birth comes from the mother after the episiotomy has been done. Of course, there is some blood coming from the placenta and other parts anyway, but nothing comparable.

The laying down on back position puts a huge amount of stress on the perineum, and it’s important in these cases for the midwife to help support the pressure with one hand to avoid heavy tears. This is done by applying gentle pressure with the palm and fingers between the vagina and the perineum area, allowing for extra resistance and support (as you can see in picture 2).

Other positions let gravity do its job reducing pain and tear risk. 

But the reality is that even in this position, homebirths actually have a much smaller tear ratio than hospital births, and this is one of these testimonies: