Variations are appreciated and expected when encountering competing research findings. Women will always labor outside of research expectations, despite best practices and the predictions of labor models.

In the midst of enthusiasm and medical society endorsements for the data of Jun Zhang et al, the Friedman data do remain scientifically viable and legal for triage evaluation purposes. Admitting a patient at 4 cm is very unlikely to expose a triage midwife to an EMTALA violation, or even a civil claim for negligence, as long as a proper screening or labor evaluation is performed and documented.

In American criminal law, Double Jeopardy protects a defendant from being punished twice for the same offense.1 In civil law, which governs malpractice in healthccare, defendant midwives can be punished twice for the same offense. Although the criminal version of Double Jeopardy does not apply in civil cases, the term is defined as “a risk or disadvantage incurred from two sources”

EMTALA is the Federal Statute, enacted in 1986, that eliminated the historic, common-law precept of “no duty to treat”

Experienced support and availability for competent breech birth providers is a sticking point in many hospital review processes. Clearly, those who support breech delivery must convene a dedicated team who are willing to be available at all times. For medical-legal purposes, availability means that there are experienced OB’s, midwives, neonatal nurse-practitioners, neonatologists, and labor and delivery RN’s who are trained and experienced in vaginal breech delivery.

Advertising for clients to bring claims following vaginal breech birth (VBB) mishaps is easy to find, just check billboards, phone directories, TV, and online articles. Although distasteful, directing some attention to these advertisements is important for your practice. Breech deliveries are regaining support and acceptance in the obstetrical/midwifery community.