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Breech Birth Online Course(s) & Continuing Education

Access the latest clinical skills and research for Breech Birth for PREGNANCY, LABOUR & CHILDBIRTH professional training. These Breech Birth online courses provide practice-changing skills and valuable perspectives from leading global experts. This Breech Birth education has been accredited for a variety of CEUs / CERPs and can be accessed on-demand, at your own pace.

Hours / Credits: (details)
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Shawn is a midwife who has worked in all midwifery settings, in the US and the UK: home, freestanding and alongside birth centres, and hospital labour wards. In response to local women’s demands for more choice and continuity in breech services, Shawn worked with her multi-disciplinary colleagues to develop the Heads Up Clinic, which was shortlisted for a Royal College of Midwives Excellence in Maternity Care Award in 2013, and where she worked as a Breech Specialist Midwife until January 2014. She has published numerous professional articles about breech practice and service organisation, and blogs at breechbirth.org.uk. Shawn’s on-going PhD research concerns the development of competence and expertise among professionals in upright vaginal breech birth. She currently works clinically on the labour ward at the Norfolk & Norwich Hospital.

Abstract:

This presentation will present an algorithm to assist with decision-making around complicated breech births where the mother is birthing in an upright position, e.g. kneeling, standing, hands/knees. The algorithm is based on video analysis research. It includes recommended timings to determine if the birth requires assistance and suggests maneuvers to help in various situations. The algorithm will be explained alongside explanations of the maneuvers.

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Presentations: 5  |  Hours / CE Credits: 5  |  Viewing Time: 4 Weeks
Hours / Credits: 1 (details)
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USA Barbara Harper, RN, Midwife, CBE, BHET, KCC

Barbara Harper is an internationally recognized expert on waterbirth and gentle birth. She is the Executive Director of Waterbirth International, founded in 1988, with one goal in mind – to ensure that waterbirth is an “available option” for all women. During the past four decades Barbara has influenced and educated hundreds of thousands of professionals and parents through her writing and publishing, and her work as a pediatric nurse, midwife, midwifery instructor, doula trainer, and Blissborn Birth Hypnosis instructor and trainer. Her vast experience helped her develop unique seminars and workshops which she teaches within hospitals, nursing schools, midwifery and medical schools and through her online Gentle Birth World Institute. Lamaze International recognized her in 2002 for contributions in promoting normal birth on an international level. She has published articles in many journals including a new work for the Journal of Perinatal Education (July 2021) on protecting waterbirth, even during a global pandemic. Her bestselling book and DVD, ‘Gentle Birth Choices,’ has been translated into 9 languages, including a 2016 Mandarin Chinese edition. Barbara has dedicated her life to changing the way we welcome babies into the world. She is the mother of three adult children, two of whom were born at home in water, and grandmother of a college senior and a three-year-old. She lives in Boca Raton, Florida. Her website is www.waterbirth.org

USA Barbara Harper, RN, Midwife, CBE, BHET, KCC
Abstract:

Waterbirth, often called the Gentlest of Gentle Births, has taught us many things during the past thirty years. The use of water during the birth process for a beech position of baby was at first considered risky. But, experience in facilitating breech births in water is growing throughout the world. One of the things we clearly see babies do is unfold more easily in the water. Breech babies, when born on land, and water born vertex babies transition in very similar ways. This course will review the cardinal rules when attending a breech birth – hand off, hands and knees, patience, leave the cord intact – and discuss the variabilities of how the water changes the perspective when attending a breech birth. Special emphasis will also be given on the fetal primitive neurologic reflexes and how they are expressed in a breech birth.

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Presentations: 18  |  Hours / CE Credits: 17.25  |  Viewing Time: 8 Weeks
Hours / Credits: 1 (details)
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Canada Andrew Kotaska, MD FRCS(C)

Dr. Kotaska is an Obstetrician & Gynecologist in Yellowknife, Northwest Territories, where he lives with his wife and two boys. He received his medical degree from U.B.C. in 1992 and worked as a GP-surgeon in northern British Columbia before returning to complete a residency in Obstetrics and Gynecology in 2006. He has academic appointments with the Universities of British Columbia, Manitoba, and Toronto. He is regularly active in midwifery and obstetrical education. Dr. Kotaska’s academic interests centre on preserving physiological birth while avoiding unnecessary obstetrical intervention; the overestimation of risk in obstetrics; and the ethics of informed consent and refusal. His latest research interests focus on safe vaginal breech birth, the effect of epidural analgesia on labour, spontaneous two-step delivery, and the shortcomings of guidelines. < br>

Canada Andrew Kotaska, MD FRCS(C)
Abstract:

It is no secret that vaginal breech birth can be dangerous; but can it be safe? Published in 2000, the Term Breech Trial suggested that cesarean section is markedly safer for all term breech fetuses in all clinical settings. It has led to a dramatic decrease in rates of vaginal breech birth and a reduction in the obstetrical skill set needed to attend them. Increased maternal morbidity and maternal deaths from unnecessary cesareans are now being observed. Unfortunately the Term Breech Trial protocol did not include adequate measures in the selection, intrapartum management and delivery technique to ensure safety. Larger trials with stricter safety measures have demonstrated that with a cautious protocol, breech birth can be conducted safely in appropriately supported obstetrical units. What are the important selection criteria, intrapartum management measures, and delivery techniques needed to ensure safety with vaginal breech birth? Dr. Kotaska will outline the safety deficits of the Term Breech Trial and contrast them to the practice of obstetrical units that have successfully demonstrated safe breech birth. Together with participants he will explore our understanding of the physiology of breech birth, identify key components that can compromise safety, and outline clinical measures to avoid or rectify them.

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Midwifery Bridge CEUs
Presentations: 5  |  Hours / CE Credits: 5  |  Viewing Time: 4 Weeks
Hours / Credits: 1 (details)
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USA Gail Tully, BS, CPM, CD(DONA)

Gail Tully, is a certified professional midwife (CPM) who began her midwifery studies preparing for a breech baby's homebirth in 1983. Expecting to photograph, Gail found herself already receiving the baby as the midwife entered and declined to take over. Gail is the founder of www.SpinningBabies.com which is a top resource for pregnant women with breech positioned babies and world renown approach to physiological birthing. Retired from primary care, she enjoys being called out to an occasional breech birth. Gail Tully is the author of The Belly Mapping Workbook (2005), Resolving Shoulder Dystocia video (2011), Daily Essentials video, Spinning Babies Parent Class video (both 2014), Spinning Babies Quick Reference (2015), and Breech Birth; Quick Guide (2016).

USA Gail Tully, BS, CPM, CD(DONA)
Abstract:

Identify what you see at the perineum to know what is going on in the pelvis with the breech birth. Breech obstructions; Here’s what you see when it is time to act.

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Midwifery Bridge CEUs
Presentations: 5  |  Hours / CE Credits: 5  |  Viewing Time: 4 Weeks
Hours / Credits: 1 (details)
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Dr. Rixa Freeze has a PhD in American Studies from the University of Iowa. Her doctoral studies focused on the history of healthcare and medicine with specialization in pregnancy, childbirth, and maternity care. Her dissertation examined why women in North America choose unassisted home births. She worked as a visiting assistant professor for 9 years at Wabash college. She has published two articles about home birth: “Staying Home to Give Birth: Why Women in the United States Choose Home Birth” (JMWH 2009) and “Attitudes Towards Home Birth in the USA” (Expert Review of Obstetrics & Gynecology 2010). She recently published the article “Breech birth at home: Outcomes of 60 breech and 109 cephalic planned home and birth center births” with BMC Pregnancy & Childbirth. In 2019 she published an article about outcomes of breech at home, birth centers, and hospitals (Midwifery Today) and a book chapter “Freebirth in the United States” in the 2020 book Canary in the Coal Mine. She is the founder and president of Breech Without Borders, a 501(c)3 nonprofit dedicated to breech training, education, and advocacy.

Abstract:

This lecture documents a physiological approach to vaginal breech birth: upright birth with mother and baby actively participating in the process. This biodynamic method combines gravity, maternal movement, and a baby assisting in its own birth to create optimal conditions for a successful vaginal breech birth. A discussion of the key principles of physiologic birth; resent studies documenting how upright breech birth leads to shorter labors, fewer birth injuries, fewer maternal injuries, and fewer maneuvers compared to supine breech birth; and 10 steps of physiological birth. I will demonstrate how what we see on the outside tells us what’s happening on the inside.

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Presentations: 10  |  Hours / CE Credits: 10  |  Viewing Time: 8 Weeks
Presentations: 10  |  Hours / CE Credits: 10  |  Viewing Time: 8 Weeks
Hours / Credits: 1 (details)
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Dr. Rixa Freeze has a PhD in American Studies from the University of Iowa. Her doctoral studies focused on the history of healthcare and medicine with specialization in pregnancy, childbirth, and maternity care. Her dissertation examined why women in North America choose unassisted home births. She worked as a visiting assistant professor for 9 years at Wabash college. She has published two articles about home birth: “Staying Home to Give Birth: Why Women in the United States Choose Home Birth” (JMWH 2009) and “Attitudes Towards Home Birth in the USA” (Expert Review of Obstetrics & Gynecology 2010). She recently published the article “Breech birth at home: Outcomes of 60 breech and 109 cephalic planned home and birth center births” with BMC Pregnancy & Childbirth. In 2019 she published an article about outcomes of breech at home, birth centers, and hospitals (Midwifery Today) and a book chapter “Freebirth in the United States” in the 2020 book Canary in the Coal Mine. She is the founder and president of Breech Without Borders, a 501(c)3 nonprofit dedicated to breech training, education, and advocacy.

Abstract:

This presentation explores emerging evidence on term breech birth. Studies on both short-and long-term maternal outcomes tend to favor planned vaginal birth over planned cesarean section. Because of the long-term benefits of vaginal birth to both mother and baby, I argue that providers and clinics should prioritize vaginal breech training, implement policies to support breech providers, and offer access to vaginal breech birth or referrals to breech specialty centers. Unlike a policy of universal cesarean, this proposed approach also supports maternal autonomy and protects health providers from violating women’s legal and ethical rights to informed consent and refusal.

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Presentations: 6  |  Hours / CE Credits: 13  |  Viewing Time: 8 Weeks
Hours / Credits: 1 (details)
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Dr. Rixa Freeze has a PhD in American Studies from the University of Iowa. Her doctoral studies focused on the history of healthcare and medicine with specialization in pregnancy, childbirth, and maternity care. Her dissertation examined why women in North America choose unassisted home births. She worked as a visiting assistant professor for 9 years at Wabash college. She has published two articles about home birth: “Staying Home to Give Birth: Why Women in the United States Choose Home Birth” (JMWH 2009) and “Attitudes Towards Home Birth in the USA” (Expert Review of Obstetrics & Gynecology 2010). She recently published the article “Breech birth at home: Outcomes of 60 breech and 109 cephalic planned home and birth center births” with BMC Pregnancy & Childbirth. In 2019 she published an article about outcomes of breech at home, birth centers, and hospitals (Midwifery Today) and a book chapter “Freebirth in the United States” in the 2020 book Canary in the Coal Mine. She is the founder and president of Breech Without Borders, a 501(c)3 nonprofit dedicated to breech training, education, and advocacy.

Abstract:

This lecture presents the existing literature on outcomes of breech birth at home and in birth centers. I give suggestions for data collection for out-of-hospital births so that we can, in the future, add more evidence to the very small number of studies examining outcomes of breech births at home or in birth centers.

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Presentations: 6  |  Hours / CE Credits: 13  |  Viewing Time: 8 Weeks
Hours / Credits: 3 (details)
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Dr. Rixa Freeze has a PhD in American Studies from the University of Iowa. Her doctoral studies focused on the history of healthcare and medicine with specialization in pregnancy, childbirth, and maternity care. Her dissertation examined why women in North America choose unassisted home births. She worked as a visiting assistant professor for 9 years at Wabash college. She has published two articles about home birth: “Staying Home to Give Birth: Why Women in the United States Choose Home Birth” (JMWH 2009) and “Attitudes Towards Home Birth in the USA” (Expert Review of Obstetrics & Gynecology 2010). She recently published the article “Breech birth at home: Outcomes of 60 breech and 109 cephalic planned home and birth center births” with BMC Pregnancy & Childbirth. In 2019 she published an article about outcomes of breech at home, birth centers, and hospitals (Midwifery Today) and a book chapter “Freebirth in the United States” in the 2020 book Canary in the Coal Mine. She is the founder and president of Breech Without Borders, a 501(c)3 nonprofit dedicated to breech training, education, and advocacy.

Abstract:

For more than four centuries, midwives and physicians have documented maneuvers to assist breech births. This lecture reviews all named obstetric breech maneuvers, which vary by technique and popularity, but all involve a supine mother with an immobile pelvis and a baby emerging against gravity. The lecture documents a new approach to vaginal breech birth: upright birth with mother and baby actively participating in the process. This biodynamic approach combines gravity, maternal movement, and a baby assisting in its own birth to create optimal conditions for a successful vaginal breech birth. I discuss recent studies documenting how upright breech birth leads to shorter labors, fewer birth injuries, fewer maternal injuries, and fewer maneuvers compared to supine breech birth. Because upright breech birth has easily recognizable mechanisms, which I will cover briefly in the lecture, providers can confidently know when the progress is unfolding normally ("Respect the mechanism") and when assistance is needed ("Restore the mechanism"). The lecture, I introduce and demonstrate maneuvers have been developed specifically for upright breech birth when the birth deviates from normal.

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Presentations: 6  |  Hours / CE Credits: 13  |  Viewing Time: 8 Weeks
Hours / Credits: 2.75 (details)
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Dr. Hayes is an OBGYN with an academic background and a passion for science and its proper application to clinical medicine. He has worked for Médecins Sans Frontières and has attended births in high- and low-resource settings and in both home and hospital. Physiologic breech birth and supporting the training of breech birth attendants are particular interests of his. Before joining Breech Without Borders in 2019, he had a home birth practice in Asheville, NC at Harvest Moon Women's Health. Dr. Hayes pursued training in vaginal breech birth during both medical school and his residency in Obstetrics and Gynecology, at a time when instruction in vaginal breech birth was no longer routinely included in the training of obstetricians in the United States. He has performed an estimated 140 vaginal breech births using traditional obstetric maneuvers in dorsal lithotomy positions. In 2016 he hosted a training session on physiologic vaginal breech birth taught by Dr. Shawn Walker, PhD. Since that time he has been fortunate to attend many more vaginal breech births with a 100% vaginal breech birth rate and no significant complications or instrument interventions.

Abstract:

This session is the first of two that are intended to present a practical framework for the practitioner to approach attending physiological vaginal breech birth. In this session I focus on understanding the mechanisms of vaginal breech birth, i.e., the movements of the baby through the pelvis from rumping to birth, and on what those movements look like to the attendant.

Part I. Normal breech birth:
Vaginal breech birth, unlike vaginal cephalic birth, has the advantage that all of the cardinal movements of the passage of the trunk, head, and upper extremities of the baby through the pelvis can be determined by directly visualizing the movements of the exposed portion of the baby from rumping through birth. The bulk of this presentation will focus on videos of actual breech births, most of which I attended, and relating what is seen to the movements unfolding as the trunk, shoulders, upper extremities, and head navigate their way through the pelvis. I will describe signs that the baby is assisting in its own birth, which both reinforce the traditional assessments of fetal well-being and reassure the attendant that the mechanism is intact and proceeding normally. There will be extensive focus on the timing of the events once rumping begins. The actual passage through the pelvis is normally completed within 7 minutes. Primiparous moms may take two to three minutes longer, and are more likely to require resuscitation; however, the evidence suggests that there is no difference in outcomes between multiparas and primiparas beyond 1 minute Apgars.

Part II. Selection criteria:
I review the various selection criteria for appropriate candidates for a vaginal breech birth and summarizing the evidence for those criteria. Many commonly accepted criteria have little to any support in the obstetric and midwifery literature, so the emphasis will be on those that have reasonable support in at least a portion of the literature. Part III. Abnormal breech birth:
This lecture will review the mechanisms of normal birth with an emphasis and where and what causes those mechanisms to fail. The points of obstruction will be presented obstructions will be shown in videos of actual births. This portion will conclude with the students reviewing breech birth videos, detecting the abnormality seen, and explaining the obstruction causing it. I present a decision tree for deciding when and how to intervene.

Part IV. Maneuvers (Optional)
I review the main supine and upright maneuvers for resolving obstructed breech births

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Presentations: 6  |  Hours / CE Credits: 13  |  Viewing Time: 8 Weeks
Hours / Credits: 1.5 (details)
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Dr. Rixa Freeze has a PhD in American Studies from the University of Iowa. Her doctoral studies focused on the history of healthcare and medicine with specialization in pregnancy, childbirth, and maternity care. Her dissertation examined why women in North America choose unassisted home births. She worked as a visiting assistant professor for 9 years at Wabash college. She has published two articles about home birth: “Staying Home to Give Birth: Why Women in the United States Choose Home Birth” (JMWH 2009) and “Attitudes Towards Home Birth in the USA” (Expert Review of Obstetrics & Gynecology 2010). She recently published the article “Breech birth at home: Outcomes of 60 breech and 109 cephalic planned home and birth center births” with BMC Pregnancy & Childbirth. In 2019 she published an article about outcomes of breech at home, birth centers, and hospitals (Midwifery Today) and a book chapter “Freebirth in the United States” in the 2020 book Canary in the Coal Mine. She is the founder and president of Breech Without Borders, a 501(c)3 nonprofit dedicated to breech training, education, and advocacy.

Abstract:

This presentation first reviews the different nomenclature systems for breech presentations and shows how they are often overlapping, contradictory, and unclear. Borrowing from Susanne Albrechtsen's work, we propose a universal nomenclature system that recognizes at least 7 types of breech presentations based on hip and knee flexion or extension. If we can adopt a clear, internationally recognized terminology, then we can better understand the risks of the various types of breech presentations.
Topics such as outcomes of vaginal footling breech, the distinction between a true “standing” footling and a “dropped foot” breech, risks of umbilical cord prolapse depending on the type of breech presentation, differences in birth mechanics between frank and nonfrank presentations, and differences in in-labor cesarean rates depending on the type of breech presentation.

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Presentations: 6  |  Hours / CE Credits: 13  |  Viewing Time: 8 Weeks
This presentation is currently available through a bundled series of lectures.