A Different Birth

664730Brighton Breech Conference, 11 November 2014

Wow! On my way home to Norwich after an amazing day in Brighton.

The day was organised by Jenny Davidson, currently Acting Deputy Head of Midwifery at the Royal Sussex Hospital in Brighton. Jenny is an inspirational midwife, and doing great things to empower both midwives and women with breech babies. She’s nearing the end of a PhD and started the study day off with a research round-up, exploring why the heavily criticised Term Breech Trial has had such an impact on breech practice, and presenting other evidence which widens the discussion and decision-making process for breech. (See Premoda and Toivonen for a start, but Jenny had several pages of references.) The increasing amount of qualitative research revealing women’s experiences of breech pregnancy and childbirth was also discussed. (See Guittier for a start.)

Following this, Benna Waites discussed ‘talking breech’ – how we counsel women with breech-presenting babies. She stressed the importance of recognising that the risks to women of CS are not inconsequential, and of remaining non-judgemental even when women are making decisions which professionals may not feel are the ‘right’ ones. Benna, author of the ‘breech bible’ – Breech Birth – is a Consultant Clinical Psychologist, as well as the mother of a breech-born baby. She brings these important perspectives into her presentations. I hope that well-informed, deeply immersed service user advocates like Benna can in the future participate more fully in discussions around national guidelines, such as those written by NICE and RCOG.

Jane Evans continues to inspire a new generation of midwives presenting her excellent knowledge of the mechanisms of breech birth, and how to assist when help is required, built upon decades of clinical practice. Jane has authored many articles, but her more recent publications in Essentially MIDIRS should be essential reading for professionals seeking to modernise their breech practice.

Today was the first time I have had the opportunity to hear from Dr Michele Mohajer, co-author of this UK-based study) and Consultant Obstetrician at the Royal Shrewsbury Hospital in Shropshire. Michele has run a breech clinic there since 1997, where both breech and ECV have been well supported. Her ECV success rate is excellent, approximately 60%. She shared with us several of her methods for increasing the likelihood of succeeding. There are few things I like more than hearing someone with excellent clinical skills discuss their techniques. I especially admired Dr Mohajer’s discussion of the influence of gaining the woman’s trust and co-operation to her success rates. Her ECV films were excellent and a really useful practice update. I hope Dr Mohajer is also able to reach wider audiences to share her classic obstetric skills. Women who wish to have their babies turned deserve for the practitioners attempting this to have success rates as high as possible.

Hopefully others will share their personal highlights from the day. And (although this study day was sold out), we all look forward to more obstetricians and midwives attending future study days. Please do get involved, share your experiences, develop your services. As several people remarked today, it really does feel like the green shoots of change are growing for breech.

Shawn

What are your thoughts?