GOLD Learning Speakers
Rixa Freeze, PhD
- Speaker Type: 2020, Add-on 2020 Vaginal Breech Proficiency by Breech Without Borders
- Country: U.S.A.
Biography:
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.
CE Library Presentation(s) Available Online:
Physiological Breech Birth
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.
Presentations:
10 | Hours / CE Credits: 10
| Viewing Time: 8 Weeks
Session 1: Evidence on Term Breech Since the 2000 Term Breech Trial
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.
Presentations:
6 | Hours / CE Credits: 13
| Viewing Time: 8 Weeks
Session 2: Outcomes of community breech birth
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.
Presentations:
6 | Hours / CE Credits: 13
| Viewing Time: 8 Weeks
Session 3: Breech maneuvers from 1609 to the present
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.
Presentations:
6 | Hours / CE Credits: 13
| Viewing Time: 8 Weeks
Session 5: Classification, nomenclature, and the risks of different types of breech presentations
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.
Presentations:
6 | Hours / CE Credits: 13
| Viewing Time: 8 Weeks
Session 6: Breech simulations: Recognizing and correcting abnormal breech labor
This is the second of two sessions and follows the presentation of normal physiologic breech birth. The focus will be on recognizing abnormal breech labors and birth, understanding the mechanism that has failed, and mastery of the maneuvers required to restore the mechanism and assist the birth.
This session puts all the pieces together using obstetric simulations. Dr. Freeze’s simulation videos demonstrate all of the upright and supine manvuers, one by one, using both a doll & pelvis and an obstetrical simulator. Students will follow along with a doll & pelvis as they watch the videos.
Dr. Hayes’ simulations present clinical scenarios. The instructor will create an obstruction on the simulator. Each student will identify the type of obstruction and select an appropriate maneuver to resolve it and then perform the maneuver. By the conclusion every student will have identified one of each general category of obstruction and performed at least one of each type of maneuver correctly.
Presentations:
6 | Hours / CE Credits: 13
| Viewing Time: 8 Weeks
