At least it does now get a mention in Midwifery text books, which it never used to. I think the profession is more open to "alternatives" than it used to be.

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I think you have to see a breech born this way to really understand why it is so much better. I saw a video at a study day and thought "yes, that's why we have to do all those manuoveres when women are on their backs. It's because they don't have the assistance of gravity." It was a real moment for me.

I'll go and see if there are any clips on YouTube.

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Right, just been searching on Youtube, but couldn't find anything suitable to show you (there was a video of active management).

However, there are some really good photo's here.

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Those photos are amazing, thanks for sharing them Shoshana.

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They are brill Shoshana how much did that baby rotate?? haha it was doing the twist coming out.

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I think one of the issues it is that whatever people have experience in, will then be self-perpetuating...so, in the RCOG guidelines it gives the nod towards non-dorsal positions as an alternative, but then says that experience is in dorsal/lithotomy therefore....

I do see why practitioners who are not persuaded by upright positions (on basis of 'no evidence, no experience') are reluctant to go with that. The only solution is really to have more education/training - and including medics - on upright positions for breech, and to have them properly audited too. (You would never get a research trial past the ethics committee, given that CS is recommended for breech currently...unless perhaps you randomized women who positively wanted vaginal breech, and then you might have difficulty recruiting sufficient numbers to really compare the two approaches.)

I've only been second at breech labours, but not as a primary midwife. The way I was thought at Uni was definitely hands on, and even when I challenged this practice at uni by pointing out the 'other' was of doing, I was told that I was wrong. I feel the issue with breeches is that if it goes well, it just goes well and you don't really have to do anything at all, it's only when you have breeches who do funny things like presenting posteriorly or presenting with a cord prolapse that you suddenly realise how important it is to be really clued up on the mechanism, but that applies to any type of birth I think, breeches, straight up, posterior whatever.

There is one indie I know who has the woman labouring in a bum up in the air position to minimise the chances of cord prolapse, yes, this might feel like an uphill struggle but most breeches do progress faster than cephalics.

I think realising that it is important to make sure that you have the skills, regardless of whether you think you will ever need to use them. A fair proportion of breeches are undiagnosed anyway so i think it would be prudent to think that you will not come across one in your personal midwifery timeline.

I did 'The day at the Breech' Study day when I was a first year. Really good and well worth every penny of the cost involved. www.sharingtheskills.co.uk. Then a couple of months ago I privelliged to deliver a baby who was presenting bum first. Unfortuately it was in lithotomy as breech deliveries are treated as emergencies in the trust I'm placed at.

Everything that Jane Evans and Mary Cronk said came flooding back. The baby was born so far and it started to do the flick thing to try to flex its chin. But because gravity was pulling in the opposite direction the baby needed help to deliver its head. I could see how a woman in a prayer positions whould just drop her hips over the fetal skull and it would be born. Lithotomy just doesnt work for breeches!

I plan to do the 'Day at the Breech' study day again when Im at the end of my 3rd year. Yes its that good!

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I've always wanted to go on that study day, thanks for the link x

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Thanks for the link, CG.

Will go to one next year definately.

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