GOLD Learning Speakers

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

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.