Breech Birth ~ The Conundrum

I recently spoke with a rural woman, devastated by the news that her only local option for her first birth was a cesarean. She was healthy, her baby was healthy. The only difference? Her baby was bum down at 38 weeks.

She had already tried an ECV (where they attempt to turn the baby externally), but her little one stayed put. And that’s perfectly okay. Sometimes there’s a reason, unknown to us, why a baby chooses a certain position.

How Common is Breech?

Around 3–4% of babies are breech at term. Yet the only option most women are presented with is major abdominal surgery. It’s worth remembering that the risks of an unnecessary cesarean may actually outweigh the risks of a planned vaginal breech birth.

Before we get into the numbers, let’s talk about the providers themselves.

The Loss of Breech Skills

Obstetricians are increasingly de-skilling in breech birth. It is now treated as a medical emergency, and very few hospitals will ‘allow’ a planned breech birth. That means 4% of women automatically fall outside the skillset of the most highly trained obstetricians.

This issue also flows into twin births, where a breech baby is very common. Vaginal twin births are becoming more and more rare, not because women cannot birth in this way, but because providers aren’t confident or trained to support them.

Whether it’s due to hospital culture, liability concerns, or lack of opportunity, many obstetricians have turned away from breech birth altogether. It’s almost like a birth professional saying “ oh no, I dont do shoulder dystocia's". We can't! It's a core skill for our profession.

Midwives Rising in Breech Care

As obstetric skills fade, midwives, particularly homebirth midwives, are stepping up. Passionate about women’s choices, they are actively building knowledge and experience in breech birth, ensuring that women continue to have real options.

Let’s be clear though: a skilled and experienced provider is absolutely essential for a safe vaginal breech birth. 

Breaking Down the Stats

The biggest concern around breech birth is the risk of adverse outcomes for babies. Here’s what the numbers show per 1000 births:

• Cesarean birth: 0.5 babies with poor outcomes
  
  

• Normal vaginal (head-down) birth: 1 baby with poor outcomes
  
  

• Vaginal breech birth: 2 babies with poor outcomes
  
  

Yes, breech carries a slightly higher risk. Babies born breech are also more likely to need resuscitation at birth. However, studies show that by age two, outcomes are similar, with no long-term differences.

So, is the small increase in risk enough to warrant major abdominal surgery for every woman? For some, yes. But not all women will agree, and that choice should always remain theirs.

Considering Future Pregnancies

A first cesarean also increases risks in subsequent pregnancies, such as uterine rupture, placental complications, postpartum hemorrhage, and other health conditions.

If you compare the numbers, the risk of uterine rupture in a woman’s next pregnancy after cesarean may even surpass the mortality risk of a first-time vaginal breech birth. Cesareans are not automatically saving lives in the context of breech birth, they are simply shifting risks into future pregnancies.

Breech at Home

With hospitals largely closed to the option, breech birth at home is slowly becoming more common. While long-term research is still limited, we do know that outcomes are safest when women are supported by skilled providers who are trained, equipped, and confident.

Key factors for safety include:

• A midwife experienced in breech birth
  
  

• Neonatal resuscitation equipment available
  
  

• Clear transfer plans if needed
  
  

• Informed decision-making as the foundation of care
  
  

For many women, simply knowing this is an option is deeply empowering.

Finding a Breech Provider

If you’re searching for a provider, a great starting place is the Breech Without Borders online directory. You can also connect with your local homebirth midwives, who may guide you in the right direction.

The Bigger Picture

It is heartbreaking that women, especially in regional areas, are left feeling as though their bodies are broken or their babies are being ‘stubborn.’ This is simply not the case.

Midwives are keeping breech skills alive, teaching, learning, and sharing with each other, while holding space for women who want to birth their babies vaginally. My hope is that one day, the wider medical system will open its eyes and restore breech birth as a safe, supported option.

Until then, we keep the torch lit.

Hannah x

Oxytocin Highs and Lonely Lows ~ For Midwives

Working this way gives me so much joy each and every day. From having full control over my business and my clients, to enjoying relationship-based in-home care, there are so many benefits and joys to this model. But as my experience grows in this space, I also experience the very, very hard moments.

As a midwife, we truly love women. We want the best for them and want to give them every opportunity to achieve their dreams. With this love for women also comes a vulnerability to compromise yourself, your family, your boundaries and your self care.

The Cost of Being On Call

Some of this is uncontrollable. On call life, unavailability, longer labours, we really do put a lot on the line to be with women. And it’s absolutely worth it. The beautiful midnight births. The women who fall outside of mainstream guidelines and go on to have a beautiful undisturbed birth. It’s so special, and the relationship is so strong after such an event.

That said, there are many struggles that bring us back to earth. Sleep deprivation. Stress. The emotional load of walking with women through all that birth brings. These are stressors that only truly a private midwife can understand.

But, and it’s a big one, when I worked in the system, the moral distress and emotional overload of working against my values was far stronger than anything I’ve experienced in private practice. So I never undermine the beauty and gift it is to work in the community. Still, I think we need to bring more awareness to the harder moments, and how we can manage them.

Outside Pressures

There is a lot of responsibility when working this way. Not necessarily from the relationship between client and midwife, but from outside influences.

As a small-town private midwife, I go out of my way to collaborate with local public services to enhance the experience for women. But I’ve also learned that with this comes pressure and stress to comply — something the women choosing this model of care are often actively avoiding. So as we buffer and protect our clients from unnecessary stress, I always return to the woman.

Every decision, right or wrong — is hers. The difference we make as PPMs is that we offer women all options and choices, give them the evidence, and they make the decision for themselves and their babies.

Coping Strategies That Help

One word, mentor.

Nothing has helped me more than having an amazing, experienced PPM to guide me through these challenges. A community of like-minded midwives all over Australia has also been invaluable — learning how others do things and what I might do differently next time. It’s all give and take. Collaboration and building good relationships are important to me, but from each experience I grow, learn and adapt for the future. Hopefully, these are things I’ll laugh about one day in 20 years of practice.

Boundaries, Self Care and Regulation

As someone who loves being with women, providing options and solving problems, there is nothing harder than saying no. It’s truly one of the hardest things. And something I still really struggle with.

Because we’re so close with the women we support, it can feel deeply personal to say no or to uphold professional boundaries. But what I’m learning is this — if you step outside the boundaries you’ve set for your business, you are often the one who pays. You, your family, your health.

As devastating as it is, I’ve learnt that boundaries are non-negotiable.

It still hurts. Saying no. Not solving the problems women bring to me. But I know holding those boundaries is what keeps me available, healthy, and able to serve more women long term.

And even with boundaries in place, episodes of stress and overwhelm are still to be expected. This work will inevitably be stressful at times. The strength of the relationship-based model, and the emotional give and take, means that moments of discomfort feel like part of the passage.

My Strategy: Learn, Debrief, Regulate, Repeat

The trick? Self care. Community. Debrief. Strong support. Growth. Learning.

Just like above, the lessons need to be integrated. I’m well on my way. But you also need to cope in the moment. For me, this looks like self care and regular debriefs.

My husband — the amazing human that he is — gifted me a mini sauna for my 30th birthday, just before I launched my business. It was the most perfect present. Now, I jump in the sauna three times a week, decompress, and always book something just for me.

I eat well. I talk. I talk until I feel resolution — often with other PPMs, my close support network, and my husband.

Then I remind myself of my vision, my why, and I move forward. Easier said than done, but I assure you — this work is worth every challenge, every hard conversation, and every awkward interaction.

Women are worth it.

Thinking of Stepping Outside the System?

Thinking of offering women community-based care?

Like I said earlier, even my lowest moment in private practice doesn’t remotely compare to what I felt in the system. The highs and the vision far exceed my expectations, and I know that with strong community, balance, and real relationships, my vision for this space is absolutely worth it.

Want to chat more? I’m always available to connect with future midwives who want support stepping into this model of care.

Until next time

Hannah x

Ultrasounds in Pregnancy

Here at Soul Midwifery, we aren’t against the routine use of ultrasounds to give us insight into baby’s wellbeing in utero. Absolutely, this can be an overused and abused test, but I’m very mindful of both the benefits and the flaws within this system.

In general, most of my clients receive just the dating scan and the 20-week morphology scan. I think of these as pretty low-risk tests that come with the great benefit of knowing bub is doing well. It is always the woman’s choice, and I’m happy supporting women in the decisions they make around ultrasound testing.

The Dating Scan

The dating scan can be helpful, especially when a woman isn’t sure exactly when she became pregnant. Most women are excited to see baby moving about and appreciate the early reassurance this scan can provide. While not essential, it can help guide us later in pregnancy, particularly if we approach 42 weeks and are trying to determine when conception may have occurred.

(Conversation for another day, but women can ovulate and conceive at very different times to the "magical" due date calculated by apps or online calculators.)

Overall, the dating scan tends to be about early reassurance and gathering a bit more information.

The Morphology Scan

The “fun” scan, as many women call it. This scan usually takes around 40 minutes and is when the sonographer checks over every little part of your baby — fingers, toes, heart chambers, internal organs. Their job is to check that everything is there and appears to be functioning normally.

They also check that the placenta is far enough from the cervical os (the opening), assess the cord insertion site, and confirm the number of arteries and veins in the cord.

As a homebirth midwife, I do like women to have a morphology scan. When we’re planning a homebirth, it’s reassuring to know that everything appears normal for baby. If abnormalities are picked up, it can help guide us in choosing the safest place for birth. For example, if a heart condition or congenital abnormality is detected, hospital birth may provide quicker access to medical care. If the finding is minor or unlikely to cause issues in the early hours or days of life, then a homebirth may still be the safest and most appropriate option.

Navigating Abnormal Results

Another important factor to consider is this: if the scan tells us something isn’t 100 percent normal, what would you do about it?

I’ve recently reflected on the aftermath of ultrasounds when abnormal results come through. For many clients, it doesn’t change their care or birth plan but it causes a lot of stress. In other situations, both the woman and I have felt reassured by the information and made a plan we both feel good about.

It’s definitely been my experience that most abnormalities picked up on scans turn out to be nothing at all. Do I still encourage these two routine ultrasounds? Yes, I do. But my experience has deepened my understanding of this topic, and I now focus even more on encouraging women to make a fully informed decision about what steps they want to take.

A Third Trimester Scan ??

When I worked in the system, I was always cautious about recommending any ultrasounds beyond the dating and morphology scans without a clear medical need. I saw time and again how a third-trimester ultrasound could derail a woman’s birth, often without any true medical concern. Labels like “baby too small,” “baby too big,” or “fluid slightly low” were incredibly common, and I saw women left at the mercy of the report and the fear of their care provider.

Now, as a private practicing midwife, I’ve developed a new perspective. Women in my care have full autonomy to make the decisions that feel right for them. I trust that they are well-informed and value my input. When a scan shows something unexpected, we can have a balanced conversation about what that means for her and what steps she wants to take.

I no longer see this as a birth derailing moment, but instead as another option on the path. One where the woman is in control and decides how the results affect her, her birth, and her baby.

Routine third-trimester ultrasounds are not recommended in low-risk pregnancies. There is no strong research to support that they improve outcomes in these situations. Despite this, they are often recommended in mainstream care models for reasons such as higher BMI, previous large baby, age over 35, and so on.

42-Week Optional Ultrasound

One scan I do find value in beyond the standard two is a 42-week ultrasound, helpful if we haven’t yet had baby and you’re planning to continue with expectant management. There’s actually some good evidence that a scan at this stage may help us pick up any signs that baby’s wellbeing needs closer attention, like low fluid levels, changes in blood flow, or a placenta that may not be functioning as well as it was earlier on.

While most babies and placentas continue to do beautifully past 42 weeks, a scan around this time can help guide our decision-making. It’s a way to check in and get reassurance, or, if something unusual shows up, to have a meaningful conversation about what it means for your birth options.

At Soul Midwifery, we only recommend extra ultrasounds if there’s a genuine medical concern or if it's supported by solid evidence.

This post just touches on the edges of what ultrasounds you might be offered in pregnancy and what they can mean for your journey. I encourage you to talk through the risks and benefits of any ultrasound with your trusted care provider.

Until next time,

Hannah x

Can You Be Too Risky for a Home birth?

Mainstream maternity care often tells us that most women carry too many risks for a safe home birth. But the reality? Many women who are deemed high risk go on to have beautiful, straightforward home births. They actually seek it out as the alternative is a highly medicalised process..

And yes—some don’t. Some need additional care, and some transfer during labour. That’s okay! we’re not homebirth ride-or-die show!

As trained professionals, midwives know what’s normal and what’s not. That’s exactly why most women should be supported to experience a normal labour and birth if they want to. With the covering of having a trained professional to intervene if necessary. Should we control the narative and sift out most women from even having a choice? no, is my opinion on that.

VBAC after Multiple Cesareans

Take vaginal birth after cesarean (VBAC) as an example. I’ve heard many researchers ask,
“Why wouldn’t you let them try for a vaginal birth each time?”

Yes, VBAC after multiple cesareans carry additional risks. But vaginal births come with plenty of positives, including faster recovery, less blood loss, lower infection rates, and improved outcomes in future pregnancies. So why not support women to try for a vaginal birth with each pregnancy if they desire?

They deserve individualised, evidence-based care, not blanket restrictions in overstretched hospital systems. too often I hear women in this camp be completely denied the option of attempting a vaginal birth. It’s not even on the table, women are often given no support if this is what they want.

“High Risk” Is the New Buzzword

The term high risk is being applied so broadly now that it’s starting to lose meaning.

But here’s the truth:
You're not in danger just because you’ve been labelled.
You’re not unwell.
You’re not broken.
You’re not a ticking time bomb.

Just like ageing increases the odds of health issues, some pregnancies comes with additional risks—but that doesn't mean you should be treated as if something has already gone wrong.

Risk Doesn’t Always Mean Unsafe

A big part of private midwifery care is risk mitigation.
Often, risks can be significantly reduced—or even neutralised—through simple, holistic approaches like:

• Nutritional support

• Quality midwifery care

• Emotional wellbeing

• Ongoing monitoring

For Example: Gestational Diabetes

If your blood sugars remain in a normal range through diet and lifestyle, your baby isn’t exposed to excess glucose. The outcomes are just as good as any low-risk pregnancy.
You may still carry the label—but are you really high risk? Not in the ways that matter most.

Another Example: Over 42 Weeks

Is this statistically higher risk for baby outcomes? Yes.
Is it dangerous by default? No.

Your chance of a healthy baby is still over 99%.
And with the right support—like daily monitoring, home visits, and clear informed decision-making—many women safely birth after 42 weeks at home.

Risk Is Nuanced, Not a Checklist

The idea that age, weight, ethnicity, or a one-size-fits-all policy can determine access to homebirth is outdated.

Policies that exclude women based on blanket criteria aren't evidence-based.
They’re impersonal, inflexible—and women are the ones who suffer.

True midwifery care looks at you, your health, your baby, and your goals—not just your risk category.

In saying this - Not every midwife will take on every woman. And that’s okay.
Each midwife has a different scope of practice, different experiences, and different levels of comfort.

If a midwife says no—it doesn’t mean you aren’t meant to birth at home.
It just means she isn’t the right one to walk with you. Keep going. Explore other care providers, ask questions, and don’t give up.

When Homebirth Might Not Be Possible

Let’s play bad cop for a moment. Some situations do make homebirth questionable—and it's important to be honest about that too. These include things like:

• Preterm birth (before 37 weeks)

• Pre-eclampsia or eclampsia

• Placenta previa (where the placenta covers the cervix)

• Certain congenital anomalies

Birth is unpredictable. Being open to alternative pathways is a smart way of planning your birth, even if your ideal is at home.

You make the Call

No matter where you choose to birth—find a care provider who listens, supports, and informs you.
Someone who respects your body and your choices, and helps you navigate risk with evidence and being ‘with women’.

Because at the end of the day, that’s what every woman deserves.

Hannah x

Low Level Laser Therapy – My Newest Discovery

Hello everybody! If you’ve been around for more than two seconds, you know I’m a bit of a can-do person. It has its positives, it has its negatives. But when I find out about something new, there’s usually a whole lot of excitement, spreading of the word, and then whatever business venture comes next.

I recently found out about Low Level Laser Therapy (LLLT), and honestly—once I knew, I felt like I’d been living under a rock.

From Skeptic to Super Curious

Let me start by saying: I was skeptical. I consider myself a pretty holistic, low-intervention type when it comes to health, food, and healthcare. The word laser in general doesn’t sit well with me.

But as I opened my eyes and learnt more, I started to understand the real mechanisms of laser therapy. It’s actually a form of phototherapy—similar to red and infrared light therapy, which we already know has huge health benefits.

As I continued learning, I discovered it’s used to enhance the natural function of the body. The light penetrates your skin and acts directly on the mitochondria (the powerhouse of your cells). It helps reduce inflammation and energises your cells to get on with the jobs they’re meant to do.

It All Clicked…

Funnily enough, about three months ago I read a book all about mitochondrial health. It explained how it's key to your body functioning as it was designed—and how mitochondrial dysfunction is linked to up to 80% of all illness and disease. (Check out Good Energy by Dr. Casey Means if you're curious.)

Then at a conference late last year, I heard more about sunlight, mitochondrial health, and infrared light being used to aid healing. So, when I learnt the true mechanisms of LLLT, I quickly shifted from skepticism to genuine excitement. It all just clicked—it aligned with everything else I’ve been learning about light, health, and energy.

What Is LLLT, Really?

Aside from the light stimulating natural healing at the site of use, LLLT is also an energy source—it brings more energy into the body, supporting its healing potential from the inside out.

LLLT has actually been used since the 1960s (yep—decades!) and now has thousands of studies behind it, supporting its role in healing and recovery.

How LLLT Can Support Women in Pregnancy, Birth & Postpartum

🌿 Pregnancy

• Pelvic balancing to support optimal fetal positioning

• Relief from common discomforts like pelvic girdle pain or carpal tunnel

• Reducing inflammation and promoting tissue healing

🌀 Labour & Birth

• Can be used on acupuncture points to promote labour and birth

💫 Postpartum

• Speeds up wound healing after perineal trauma or cesarean birth

• Reduces inflammation and supports recovery from mastitis

• Aids in pelvic floor repair and nerve regeneration

• Offers relief from haemorrhoids

That’s it for now—watch this space. My excitement around this therapy is still evolving as I continue to learn and explore. In the meantime, maybe it’s something worth trying?

Hannah x

A Day in the Life ~ A Personal Piece

Well, it’s been 5 months since I launched my Soul Midwifery business—finally stepping away from the hospital space and living my dream of working privately. I can hardly believe it’s true, as I was desperate to work in this way for so long!

The Reality Behind the Dream

As you can expect, I was a little naïve to some of the harder parts of the job. It all just looked wonderful from afar. As I continue to navigate this space, some things I’ve found challenging at times are the relationships—establishing yourself amongst your community, other services and navigating your support people… and your not-so-support people. I’ve really learnt to ‘find my tribe’ and be true to myself.

For so long in my work life as a midwife, I’ve had to suppress and adapt to serve the policies and not the women, and as I’ve moved into this space, I’m still learning to be fully true to myself. Not allowing others to hold me hostage—and absolutely—it’s been about gathering a support team around me to cheer me on.

The Midwife Gap

Midwives in this space are hard to come by. Would you believe that it’s extremely difficult to find midwives eager to work in the homebirth space? Cue barrier #2. After years building relationships, I thought I had a big pool of fellow midwives to run this race with me. But as the time came and the commitment was needed, the stress kicked in.

So many midwives were too fearful to work independently or didn’t feel safe at a homebirth. Other midwives were fully supportive but weren’t in the life space to work with me. This felt huge in the first 3 months of practice. I couldn’t believe after all this time this could be the thing that holds me back.

But alas, with some reassurance, patience, and continuing to show up and be with community, the support came. And now I feel completely well supported by some beautiful and experienced midwives. Despite this space generally lacking for regional midwives, I know now that I have my people. And I hope more join—just for the simple fact that working in this way is truly life-giving. Women-centered, joy-oozing, and a physiological haven of what is homebirth midwifery.

Behind the Scenes of Private Practice

A few other learning curves include creating and automating life as a private practitioner, building contracts, invoicing, paying second midwives, etc. Starting out can be totally overwhelming. I was fortunate to have enrolled in Mel Jackson’s mentorship as well as joining The Midwives’ Midwife (Jaimee).

Although starting out isn’t the best time to be spending thousands on mentorship, I just knew I needed it. With limited local support at the time, having these discussions and catchups were ground-breaking for my startup. Despite feeling very small, sometimes judged, I’d then jump on these pages with other PPMs around Australia all with overwhelming support. Great discussions on normal birth, navigating difficult systems, and all of the above! I truly felt on fire after every session.

And now I feel a million times more confident with all things ‘business life’. With a template for everything, I felt confident I was on the right track.

Reflections: Is It What I Expected?

A day in the life ~ is it what I expected? Sometimes yes, and sometimes no. There are hard moments, isolated moments—but the moments with women, of truly individualised, evidence-based care, in the comfort of their home—is so satisfying.

It’s harder work personally, but a million times more rewarding professionally. I wouldn’t change it for the world. But I’ll also always be honest and upfront about the struggles.

Hannah x