There was talk some time ago about it being arranged at uni. Prehaps if you were to talk to your tutors and I were to remind my tutor!

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Yes, that's a good point! It's the way things are in Consultant Led units.

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Canu Gess - thanks for sharing about the study day you attended. I've heard really good reports about this, but never attended. - Perhaps that's one to look out for!

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Hi All

I get a bit uppity about breech birth. I did my disseration on The Midwife's Role in relation to Breech Presentation blah blah blah. I spent over 2000 words of my precious word allowance critiquing the Hannah Trial which had just been published.
The Hannah Trial did not show that CS was a safer mode of delivery. The data were analysed by "intention to treat" not "mode of delivery". Women were randomised into plan for CS and plan for trial of vaginal breech delivery. No women were "allowed" to birth thier breech presenting babies physiologically ( more of this later). In the planned vaginal breech about half the babies (sorry can't remember exact numbers now) were born by CS. No surprise there and reasonable as all were primips so breech amy or may not descend in a hospital setting with woman flat on back. What most don't realsie is that in the planned CS, I think about 9% had vaginal breech deliveries because they fell out too fast to be cut out! So this leaves us comapring outcomes between two groups of mixed CS/vaginal delivery with different proportions in each. It says nothing about how the outcomes relate to the mode of delivery.
Earlier and later studies have found no difference at 6 months between breech babies born by CS, vaginal breech and cepahlic babies, though APGARS are lower for vaginal breech born babies.
Perhaps another thread on APGAR scores as a predictor of neonatal wellbeing - Moderators???

Back to physiological breech birth. Cannot recommend too strongly each of you tries to attend a Sharing The Skills - A Day at the Breech Workshop. Check their website for details. You will learn the mechanisms of breech birth, what positions mothers adopt and why and how to support a woman who plans to birth her breech baby herself.

Most women kneel upright (Christian prayer position) during their labour and ealry second stage. After the baby has rumped and descended as far as the chin being visible, if women drop their heads down, bum in air (more like a Muslim praying position) this helps the baby to flex its chin down onto it's chest and pivot around the pubic bone all nice and tidy.

My only personal expereince of supporting a woman with a breech birth was at an NHS midwifery led unit when I was an NHS midwife. It was the most breathtaking and amazing expereince to watch this baby manipulate herself out of her mother and be born in such good order that rather than clamp and cut the cord ready for resus, I simply passed baby through legs to her mother just as i might have done for a cepahlic baby.

Others are right - we have lost the Art of supporting breech birth as midwives. But our rules tell us we must be ready to cope in an emergency. In an emergency ie the baby is coming to quickly to be born by CS, remember nature wants this child to be born. Learn how to do no harm. Learn what normal breech birth should look like. Be ready to facilitate it. Transfer for help if your feasibly can. Not all babies are uncomplicated.

In sisterhood
Liz IM

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Liz
"Peace on Earth begins with Birth."
www.saveindependentmidwifery.org

Thanks Liz. That's a brilliant post!

It's good to have you on the site.

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Wow, just wow

Thanks for that liz!

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great post x

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Don't get me wrong...my criticisms of the Hannah TBT are legion, but is there anything intrisically wrong with analysis by intention to treat?

When we look at Home Birth, it would skew results massively if we only looked at outcomes for those who actually gave birth at home and excluded those who ended up transferring.

When we look at attempted VBAC, it would skew results massively is we only looked at outcomes for those who were successful and ignored those who ended up having in-labour CS.

Similarly, if you look at "planned vaginal breech delivery" you have to include those that end up having an in-labour caesarean section, because otherwise your figures make no sense. Of course, you might also want to include sub-group analysis for those that were successful and for those that were not. But bad outcomes for in-labour breech CS might be attributable to attempted vaginal breech, might they not?

Sorry I do not understand your post, the statistics are actual numbers that have given birth in x, y or z situation, otherwise they would be made up statistics, which would do nobody any favours would it?
It is still classified as c/section following prev c/section but instead of stating attempted VBAC it would instead be categorised by the clinical grading of c/section.

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Any I feel we have gone a littlehere in a breech thread TBH, start a c/section thread x

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