GOLD Learning Speakers

Breech births occur infrequently, yet their safe support requires skill, patience and discernment from the health professionals who attend them, whether planned or unplanned. In addition, recent research has prompted practice changes toward more physiological approaches. This presentation will discuss how research around how professionals learn complex breech skills, and modern technology, can help midwives and doctors to learn skills to assist breech births. We will cover the importance of respecting the mechanism of breech labour when it is working, and restoring it when it is not. We will discuss how to determine the level of the pelvis at which head entrapment has occurred – and how to teach others to resolve it. And we will discuss successful models of breech care with the potential to lead a revolution in the direction of choice, confidence and continuity.

A majority of physiological breech births unfold according to a recognisable pattern of movements as the fetus spirals through the maternal pelvis. Protecting and supporting this optimal process is the basis of physiological breech birth practice. Understanding how and why these movements occur, and how to recognise when a deviation has occurred, is key to determining how and when to intervene in a potentially dangerous situation. This presentation will help you become thoroughly familiar with the optimal process, and explain why understanding the normal mechanisms can facilitate resolution when head entrapment occurs.

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.

This presentation will introduce you to the work being done to determine if it is feasible to deliver a randomized controlled trial of OptiBreech Care, which is a programme of care based on physiological breech birth research and practice. You will be introduced to the background for this work and the results to date. A significant portion of the presentation will focus on our qualitative work with women and midwives participating in the study, as part of our implementation process evaluation. Our combined quantitative and qualitative data indicate that breech birth active sites have implemented services through a dedicated clinic and/or a proficient intrapartum support service, organized and provided primarily by a Breech Specialist Midwife. While we identified challenges, this model has achieved >90% fidelity to the intervention’s goal of ensuring trained, proficient attendance at vaginal breech births, and it is highly acceptable to women.

This presentation considers physiological breech research published within the last two years, and its implications for how we teach and practice vaginal breech birth safety skills.