Tag Archives: Training

Visca les natges! Barcelona breech training

(See the Catalan version of this article below …)

This week (21-22 March 2017), the Breech Birth Network was in the beautiful city of Barcelona, at the invitation of the obstetricians and midwives of Hospital Sant Pau. Our team expanded for the occasion! Midwife Maria Segura translated all of our teaching slides into Catalan. And Cardiff-based midwife Carmen Rubio ensured everyone had an opportunity to receive hands-on help when practising manoeuvres to assist women birthing in upright positions.

I love studying and teaching physiological breech birth most because when a health professional learns how breech works, they learn how all birth works. Despite its apparent applicability for only a small proportion of the total population, skill in the art of facilitating breech birth resonates throughout a professional’s entire birth practice, their collaborative work with colleagues and within institutions.

Our experience in Barcelona made this clear. Hospital Sant Pau is in a period of transition, trying to increase the rates of normal birth. Breech birth is a part of that, but midwives are also working to establish the first midwifery-led birth centre in Catalunya. The hospital has recently established a new guideline enabling obstetricians to support physiological breech birth, including women who choose to birth without an epidural. To enable women to have a choice of pain relief for physiological birth without epidural, the hospital team are considering offering nitrous oxide (Entonox) for the first time. And for some of those attending this week’s training, our videos were their first exposure to women birthing in a kneeling position. One obstetrician suggested they could prepare for the change in breech practice by facilitating kneeling positions for cephalic births!

Dr Arianna Bonato, one of the external OB-GYNs attending the training, told me she feels that a breech birth is the most beautiful birth to see, because the physiology is so visible. I agree! This visibility makes possible learning about physiological birth in general within the microcosm of breech.

The way that a neurologically intact baby assists his own birth, the intuitive movements of a mother who feels safe and uninhibited, and the consequences of interventions in the mother-baby dance, to facilitate or disrupt, are all much more exposed. As Carmen Rubio reminded me, breech births demand calm wisdom in the birthing space like no other.

“Give it a wiggle” / “Donar una sacsejada” !

I have no doubt Hospital Sant Pau’s open-minded and forward-thinking approach will attract many more women to birth in this hospital, and that their midwifery unit will also thrive when it is opened. A blessing for the women of Barcelona. I look forward to staying in touch and learning from their experience of implementing these new practices!

Thank you to Consultant Obstetrician Ma Carmen Medina Mallen, and Maria Segura, for their work in organising the Breech Birth Network training this week. Hospital Sant Pau will be auditing their outcomes for term breech presentation over the next year, as part of our international evaluation of Physiological Breech Birth training.

— Shawn

Elevate & Rotate from Shawn Walker on Vimeo.


Many thanks to midwives Carmen Rubio and Maria Segura for the translation of this blog into Catalan!

Aquesta setmana (21-22 de Març 2017), la Xarxa pel Part de Natges va estar a la bonica Ciutat de Barcelona, com a invitació dels ginecòlegs i llevadores de l’Hospital de Sant Pau. El nostre equip va créixer per l’ocasió! La llevadora Maria Segura va traduir totes les diapositives de la sessió al català i la llevadora Carmen Rubio, amb seu a Cardiff, va garantir que tothom pogués tenir l’oportunitat de rebre ajuda en la pràctica de les maniobres per assistir les dones que vulguin donar a llum en posicions verticals.

Hospital Sant Pau

M’agrada estudiar i ensenyar el part de natges de manera fisiològica, sobretot, perquè quan els professionals aprenen el funcionament d’aquest, també ho fan sobre els fonaments de donar a llum. Encara que la seva aparent aplicació sigui per una petita proporció de la població, l’habilitat en l’art de facilitar els naixements de natges ressona a través de tota la pràctica professional, així com a la feina de col·laboració entre companys i al conjunt de les seves institucions.

La nostra experiència a Barcelona ho va deixar ben clar. L’Hospital està a un període de transició, intentant incrementar les xifres del part natural. El part de natges forma part d’això, però les llevadores, a més, estan treballant en la línia de crear la primera casa de naixements pública a Catalunya. L’Hospital ha establert recentment un nou protocol que permet als obstetres reconsiderar el part de natges de forma fisiològica, incloent-hi la voluntat de les dones que vulguin donar a llum sense epidural. A més, l’equip de l’Hospital està en vies d’introduir l’Òxid Nitrós (Entonox) per primera vegada, com un altre recurs d’analgèsia per les usuàries de part. Per alguns dels participants a la formació, va ser la seva primera vegada en veure, a través dels vídeos, a dones donant a llum en posició vertical. Una de les ginecòlogues va suggerir que es podrien preparar pel canvi en la pràctica de l’atenció al part facilitant més activament la posició vertical als naixements dels nadons que es troben en presentació cefàlica.

La Dr. Arianna B. una de les obstetres/ginecòlogues que va atendre la formació, em va dir que sentia que el naixement de natges és molt bonic d’observar, perquè en ell es pot veure clarament la fisiologia del part. I estic d’acord! Aquesta claredat és la que ha permès aprendre del part fisiològic en general des del microcosmos de les natges.

La forma en què un nadó neurològicament sa assisteix el seu propi naixement, els moviments que intuïtivament fa la mare quan se sent segura i desinhibida, i quines són les conseqüències de facilitar o interrompre la dansa entre mare i fill són molt clarament exposades. Com la Carmen Rubio em va recordar, el part de natges demana com cap altre, la saviesa calmada de l’espai en el qual es dóna a llum.

No tinc cap dubte que la ment oberta i de pensament avançat de l’Hospital de Sant Pau atraurà moltes més dones a aquest Hospital i que la seva Casa de Naixements serà també popular quan l’obrin. Una benedicció per les dones de Barcelona. Estic desitjant estar en contacte i aprendre de l’experiència en la implementació d’aquestes noves pràctiques.

Moltes gràcies als membres de l’equip obstètric, la Ma Carmen Medina Mallen i a Maria Segura, pel seu esforç organitzant la formació de la Xarxa pel Part de Natges. L’Hospital de Sant Pau auditarà durant l’any vinent els resultats dels parts en presentació de natges com a part de la nostra avaluació internacional respecte la formació del Naixement Fisiològic de Natges.

— Shawn, Carmen & Maria

Training in Norwich: 14 January 2017

Simulations in Christchurch, NZ, October 2017

Simulations in Christchurch, NZ, October 2017 – photo by Tina Hewitt

To kick off the new year, Breech Birth Network are providing a study day in Norwich on 14 January 2017. If you’ve been wanting to encourage your obstetric colleagues or trainees to attend training, this will hit the spot. Our teaching team includes Dr Anke Reitter, FRCOG, Shawn Walker, RM, Victoria Cochrane, RM, and Mr Eamonn Breslin, MRCOG. Send your colleagues the link to our Eventbrite booking page, with a personal invitation! Or download a poster for your work environment.

Eventbrite - Physiological breech birth study day - Norwich

This study day for obstetricians, midwives, paramedics and students will provide an engaging and interactive update on professional skills to facilitate physiological breech births, planned or unexpected. The study day would be especially useful for clinical skills teachers who want to include physiological breech methods in professional skills updates or student lessons, due to access to resources after the workshop. The focus is on collaborative, multi-professional working to improve the safety of vaginal breech birth using the skills of all maternity care professionals.

studying breech in Salford, 2016

studying breech in Salford, 2016

Training will include:

* A research update given by leading researchers in the field, including Dr Anke Reitter, FRCOG, IBCLC of Frankfurt

* Thorough theoretical and hands-on explanations of how breech babies journey through the maternal pelvis in a completely spontaneous birth (the breech mechanisms), enabling you to distinguish between normal progress and dystocia

* Hands-on simulation of complicated breech births and resolutions, using narratives and videos of real breech complications, to enable you to practice problem-solving in real time

* Models of breech care that work within modern maternity services

* An accompanying booklet containing handout versions of all of the slides and resources used in the training

* One year’s access to the on-line learning space following the training, to continue viewing and reflecting on birth videos (one per month) in a secure forum, and resources for sharing teaching with professionals in your practice community

* Lunch and refreshments

Registration begins at 8:30 for a 9:00 start

Hosted by the University of East Anglia University Midwifery Society. Profits from the study day will benefit the UEA Midwifery Society annual charity, the Orchid ProjectSee here for directions to the Edith Cavell Building, and to Norwich from further afield.


Feedback from study days in Christchurch & Auckland, October 2016:

My main concern was lack of training of staff leading them to believe that breech birth is an emergency. Our RMOs and MWs loved the day and I think feel more empowered. — SMO (Consultant Obstetrician, Senior Medical Officer)

Thank you so much, this has been the best study day ever! — Midwife

Information was clear and concise and well presented. Myths dispelled and physiological VBB and when to intervene very clearly explained. Methods to resolve when there are issues during delivery explained and demonstrated. Clear examples given with supporting video and photographs. Extremely valuable. — RMO (Registered Medical Officer)

Honest, real explanations. How to intervene in a timely manner as opposed to be hands off the breech. — Midwife

Thank you for a brilliant day of teaching and training. You covered a lot of material not taught as part of our training and it has been valuable. — RMO

Learning about manoeuvres to use in upright position, eg. shoulder press; visual components have been amazing, the broken down physiology of a breech birth. — Midwife


Facilitators:

  • Dr Anke Reitter, FRCOG
  • Shawn Walker, RM, MA
  • Victoria Cochrane, RM, MSc
  • Mr Eamonn Breslin, MRCOG

Dr Anke Reitter, FRCOG, IBCLC, is the lead Consultant Obstetrician and Fetal-Maternal Medicine Specialist at Krankenhaus Sachsenhausen, Frankfurt am Main. Although originally from Germany, she worked in India and the United States during her medical studies, and in England (including Liverpool) for 4 years during her obstetric training. After returning to Germany, she specialised in perinatal medicine. Prior to her move to Krankenhaus Sachsenhausen, where she initiated a new breech care pathway in a unit which had not supported breech births for years, Reitter practiced in the Obstetrics and Gynaecology department at the University Hospital Frankfurt. A large observational study of the hands/knees breech births in Frankfurt is due to be published soon in the FIGO journal. Her special interests lie in breech, multiple pregnancies, high risk pregnancies and prenatal ultrasound. She is an internationally known speaker, teacher and researcher in several areas, but especially breech birth.

Shawn Walker, RM, MA is a UK midwife and PhD candidate researcher who studies how professionals learn skills to safely facilitate breech births. Clinically, she has worked in all midwifery settings – labour wards, freestanding and alongside birth centres, and home births. She led the development of a breech clinic pathway at the James Paget University Hospital (2012-2014), where she worked as a Breech Specialist Midwife. Her research focus on breech birth is part of a wider interest in complex normality – working with obstetric colleagues to enable women at moderate and high risk to birth and bond physiologically where possible. She currently works as a bank midwife at the Norfolk & Norwich University Hospitals NHS Foundation Trust, in addition to periodic teaching, consultancy and breech support across the UK and internationally.

Victoria Cochrane, RM, MSc is the Consultant Midwife for Normality at the Chelsea and Westminster NHS Trust. RM, MSc, Supervisor of Midwives. The majority of her clinical career has been working in and developing caseload and continuity models for women and their families in the community.  She is deeply passionate about working with colleagues to support women making pregnancy and birth choices that sit outside of routine guidance.  In her current role she works to support normality for women in all aspects of pregnancy and birth. Breech presentation became a special interest in 2009 when her daughter spent a few weeks in that position at the end of pregnancy; it’s amazing what one can learn in a short space of time when faced with challenging choices.  This led to carrying out a cross-site service evaluation of the management of undiagnosed breech for her MSc dissertation.


References

Reitter, A., Daviss, B.-A., Bisits, A., Schollenberger, A., Vogl, T., Herrmann, E., Louwen, F., Zangos, S., 2014. Does pregnancy and/or shifting positions create more room in a woman’s pelvis?Am. J. Obstet. Gynecol. 211, 662.e1-662.e9.

Walker, S., Scamell, M., Parker, P., 2016. Standards for maternity care professionals attending planned upright breech births: A Delphi study. Midwifery 34, 7–14.

Walker, S., Scamell, M., Parker, P., 2016. Principles of physiological breech birth practice: a Delphi study. Midwifery 43, 1-6. FREE DOWNLOAD until 13 December.

Walker S, Cochrane V (2015) Unexpected breech: what can midwives do? The Practising Midwife, 18(10): 26-29

Evaluating breech training in North America

ShawnPortsmouthBusy packing … leaving London for the US on Friday. Originally, I planned to attend the celebration of 20 Years of the Kelly Writers House and my college reunion at Penn, as well as the annual ACOG meeting where our film on upright breech birth is being shown, followed by a family wedding. But it turns out the first two conflicted, so instead I will be spending half of my holiday teaching breech in collaboration with other health professionals along the east coast of the US and Canada. With ‘renewed interest’ in vaginal breech birth from the ACOG, and Canadian SOGC guidelines fully supporting planned breech birth since 2009, the will to revive breech skills is in full swing in North America!

Some of the health professionals and birth activists collaborating to provide breech training in their communities include:

  • Atlanta, Georgia – See Baby Midwifery is dedicated to providing options and support to women and families in the birth community.  Patients travel near and far, for birth options such as Water Birth, VBAC, Vaginal Twin Birth and of course, Vaginal Breech Birth (singleton & twin pregnancies). The SeeBaby Team will lead a panel discussion on ways forward in the support of vaginal breech birth, and Dr Brad Bootstaylor is collaborating on the analysis of the evaluation data from this series of training days. (Places available.)
  • Asheville, North Carolina – This is a community which values co-operation, and the study days here have been organised collaboratively by obstetricians, CNMs, CPMs and doulas. Dr David Hayes of Harvest Moon Women’s Health is also contributing to the analysis of the evaluation data. Thanks especially to Kathleen Davies and Jennifer White.
  • Philadelphia, Pennsylvania – Thank you to Julie Cristol, CNM, of Lifecycle WomanCare for enabling this workshop.
  • Tillsonburg, Ontario – Thank you to Christine McGillis and Sheila Stubbs for making this workshop happen in Ontario.
  • Montreal, Quebec – Thank you to Rivka Cymbalist for organising this workshop and raising awareness of the need to increase vaginal breech birth options in this community. (Places available.)

This is a brief welcome message for those attending the Physiological Breech workshops.

The training provided by Breech Birth Network is different from obstetric emergencies training because it is based on physiological birth principles, including the importance of maternal movement in facilitating the birth process. Decisions on when or whether to intervene in a breech birth are determined by careful observation of the unfolding mechanisms, recognition of deviations from the norm and strategies to restore the mechanism. These strategies include maternal movements, as well as hands-on help from birth professionals. In Breech Birth Network training, which follows recommendations outlined in primary research with experienced professionals, birth videos are central resources, enabling both experienced and inexperienced professionals to develop and expand their pattern recognition skills, even in communities where actual breech births remain a rarity. Therefore, the training is supplemented by secure access to the resources and videos, which cannot be downloaded, but can be used to refresh training by those who attend the hands-on workshops when preparing for a birth within their local teams — the Virtual Community of Practice (VCOP).

Thank you to the women, midwives and obstetricians who have made this possible in order to increase the safety of breech birth for others.

Training programmes are often evaluated according to Kirkpatrick’s hierarchy, which has 4 levels:

Kirkpatrick model

Image from : http://www.kirkpatrickpartners.com

Thorough evaluations of breech birth training packages are lacking. Evaluating impact of training on maternal/neonatal outcomes is a longer-term project, easier to achieve when considering the effect of training within one site, rather than professionals working in many different contexts; we have plans to begin such a project later in the year. However, for this series of study days in North America, we are collecting data on how many breech births those participating have attended in the year before and after training (change in behaviour), as well as changes in confidence levels before and after training (change in learning).

networklearningThose attending these training days include obstetricians, CNMs, CPMs, students, and birth activists keen to support cultural change in their communities. The results of the evaluation will help us to determine whether providing breech birth training based on conceptual understanding of physiological principles, within a community of practice/network learning model, will increase women’s access to the option of vaginal breech birth by increasing provider confidence and skills to provide this service.

The evaluation data will also contribute to answering two fundamental questions, which will require on-going research in the future:

  1. How can vaginal breech birth skills be revived within communities which have few or no experienced providers?
  2. How does training based on physiological principles impact the safety of breech birth for mothers and neonates?

Thank you to all the health professionals participating in this training and evaluation. I am looking forward to meeting you and learning from your communities!

Shawn

P.S. Of course, we aren’t the only source of physiological breech birth training. Others include:

We advocate that all professionals including breech within their sphere of practice access breech training from multiple providers, consider the underlying principles and how they fit with your own understanding and experiences of birth, and maintain an open mind.

Laura Latina: new study day co-ordinator

Laura picI’m pleased to introduce a new co-ordinator for the Breech Birth Network study days: Laura Latina, MSc, RM. Laura is now taking the lead on organising study days, and if you would like to make an enquiry, you can contact her on the form below. Read more about Laura in her own words below.

I love being a midwife. I believe midwifery is an art; the art of empowering women in discovering their capacity of giving birth.

I work at St Thomas hospital as a caseload midwife. I advocate and believe in normal births. I like working closely together with women. My relationship with women and her partner is based on respect and trust. Empowering her and the partner to make their informed choice is also important for me. In my work I prioritise continuity of care; this means I look after women since the beginning of the pregnancy, during birth and post-natal. Pregnancy and birth are a journey; accompanying women and being part of this journey it’s amazing!

Lara at homeI have worked in all settings: midwife led unit, consultant led unit, home and as independent midwife. I encourage women to believe in their bodies and in their babies and I feel full of oxytocin when they have a positive birth experience.

My interest in vaginal breech births has started from my work in developing countries. I have been in many countries of Africa and Afghanistan where I assisted, supervised and taught to more than 30 vaginal breech births also in upright positions.

I love teaching too; I have participated to trainings as facilitator and as ALSO instructor.

My experience in Africa encouraged me to deepen my knowledge in developing countries, for this reason I own a MSc in Reproductive & Sexual Health Research at London School of Hygiene and Tropical Medicine.

I love reading and teaching and I am also interested in research.

I love spending long time chatting in front of a coffee and I go often to walk in a park!

 

Read more about Breech Birth Network study days on the pages below:

 

Videos: Essential Birth Prep

videosOver and over again, in my research and in personal conversations, I hear how important videos are to health professionals who are self-educating themselves about breech birth. I am still exploring the role of video as a learning tool, but they seem to assist professionals to develop pattern recognition abilities, and enable discussions about clinical decision-making. By watching and talking through what happens in birth videos, these skills can be practiced before they are required in a real-life context.

Here is a list of publicly available on-line videos for health professionals to watch when preparing to attend a breech birth, or to periodically update. Some of them may be close to your idea of ‘ideal,’ and some of them may present a different perspective, or an opportunity for discussion. All of them offer learning opportunity.

Suggested activities:

  • Identify key movements and rotations in the mechanism of breech birth
  • Consider and discuss what prompted intervention, if the video includes intervention
  • What would you do?

You can link to the original posting of the YouTube videos by clicking “View on YouTube” in the bottom right hand corner of the viewer.

Birth Video of a Breech Baby – Lisa Barrett’s Blog

Frank Breech Birth Video – Lisa Barrett’s Blog

Frank Breech Home Birth – Spinning Babies Blog, with Gail Tully

The Breech Home Birth of Annaka Faith

Nascimento Mariana, parto natural hospitalar pélvico – 04/jul/2013 – Natural breech hospital birth from Além D’Olhar fotografia on Vimeo.

Thank you to the very brave and generous mothers, fathers, midwives and doctors who have shared these videos so that others can learn about breech birth.

If you have posted a video of your breech birth, and would like to share that with others, please do include a link in the comments below. Alternatively, if you would like it to be used only in secure circumstances, you can e-mail to discuss using the link below.

– Shawn