Category Archives: Study Days

Stockholm and the breech

This weekend, I have been lucky enough to visit Stockholm, Sweden, at the invitation of the Södersjukhuset (BB SÖS), with Dr Andrew Kotaska, author of the 2019 Canadian breech guideline. We delivered training in breech research and practice to obstetricians and midwives from across Stockholm, a contribution to their recent effort to establish city-wide guidelines.

Breech Team Leader Tove Wallström and Breech Midwife Monica Berggren

The day was organised by senior obstetrician Julia Savchenko (pictured with Andrew above). Julia and fellow senior consultant Tove Wallström lead the Labour Ward and the SÖS breech team. These inspirational women presented their local audit results, showing how their vaginal breech births have increased from 9 in 2014 to 50 so far in 2019. Almost all women give birth in an upright position, and all births are attended by a breech-experienced obstetrician and a breech-experienced midwife from the breech team.

Danish midwifery student Pernille Ravn on her elective placement, demonstrating the movement of baby to mother’s abdomen when performing the shoulder press manoeuvre

It was exciting to see a ‘Breech Team‘ service working so well in the largest maternity hospital in Stockholm. The team are able to take referrals for women pregnant with a breech-presenting baby at term who wish to give birth at SÖS. They can also provide training for other teams in Sweden who wish to improve the safety and delivery of their own services, using their own resources and presentation materials provided by the Breech Birth Network.

To ask about referral or training, please contact Julia and Tove using the form below.

Typical Swedish post-birth meal — a step up from British tea and toast!

Each family places a pin in the board to celebrate their birth as she leaves SÖS

Busy hospital!

For more information about training outside of Sweden, please see our Booking a Study Day page.

For information about training or referrals for a vaginal breech birth in Sweden, contact Julia and Tove:

Breech Training in Quebec

After training with the Breech Birth Network, Isabelle Brabant gave us her feedback from her first training session teaching midwives in the far North of Canada:

Teaching Breech in Inukjuak

 “I have to tell you a bit about Maternity up North. There are seven villages on the Hudson Bay Coast (just about 1200km long!). There’s a maternity service in three of the biggest villages: Salluit, Puvirnituq and Inukjuak. There is no road to get there, you can only go by plane or by cargo – if you have a couple of weeks to spare for the trip. The Inukjuak maternity services have around 40 births per year, and if a baby remains breech in the pregnancy they would offer an external cephalic version, but if unsuccessful the woman would be sent to services further south (to Montreal!) to have her baby – alongside the other approximately 15% of women who are referred for medical reasons. If ever a woman needs to be transferred in labour it takes no less than 8 hours as there is no plane in the village itself – yes 8 hours! In an undiagnosed breech situation the decision would be made to transfer, but the chances are that the baby would be born before transfer. This explains the interest and need for Breech Birth training with the midwives being very interested in the training – of course they have a small volume of births, but the possibility remains of having an undiagnosed breech birth at any time.

Teaching Breech in Inukjuak

The training was given to a small group of enthusiastic midwives in Inukjuak, where we started the day with what is normal for Breech which the midwives enjoyed alongside teaching essential skills and manoeuvres. I will be delivering this training three times to Quebec midwives in May and June.”

 

 

 

There are three more training sessions planned in Canada throughout May and June and the details are as follows:

  • 6th May 2019: MdN de l’Estrie, Sherbrooke
  • 31st May 2019: MdN Mimosa, Lévis
  • 13th June 2019: Montréal (lieu à déterminer selon la taille du groupe)

Please visit: Regroupment les sages – femmes du Quebec

 


From Shawn:

A picture of my lovely Innukshuk, given to me by Kay Guruswami of Kensington Midwives in Ontario, as a symbol of what we are trying to do together: lead the way forward for breech. Thanks Kay  ❤️

Upcoming conferences

You and your colleagues may be interested in these two upcoming conferences, led by obstetricians. First, a two-day breech conference in Denmark featuring a number of internationally known teachers and researchers:

Denmark 2019

And in November, Breech Birth Network will be offering physiological breech training alongside the British Intrapartum Care Society Conference in Leicester.

BICS 2019

 

Bruxelles et le siège

Training in Lewisham on November 12 — Book here.

“We believe that we do well what we do often.” – Caroline Daelemans

Drs Caroline Daelemas and Sara Derisbourg

Contact Hōpital Erasme Clinique du Siège on Tel 00 32 2 5553325, or siege.clini-obs @ erasme.ulb.ac.be.

This month I visited Hōpital Erasme, in Brussels, Belgium. Led by Lead Obstetrician Caroline Daelemans, Erasme began to offer a dedicated Breech Clinic in December 2015. Much of the organisation and development of the clinic has been done by Dr Sara Derisbourg, who continues to research the impact of instituting a dedicated breech service.

I came to Brussels to provide our usual physiological breech study day. The breech team has transitioned to using physiological methods, including upright maternal positions (Louwen et al 2016), after attending training in Norwich in 2017. They now needed the rest of the team to understand the philosophy behind this approach. But the day began with Caroline describing the impact of instituting a dedicated Breech Clinic, and this was particularly exciting for me.

Josephine and Thiago talk about their experience of Ulysse’s breech birth at Erasme

My own research concerning the development of breech competence and expertise, and the recovery of these skills within a service, indicates that developing a core team with significant experience is the most effective method of safely offering a vaginal breech birth service (Walker et al 2016). This skilled and experienced core is more important than the ‘selection criteria’ that are used to predict the likelihood of a good outcome (but in fact are not very predictive). Skill and experience facilitate good outcomes and enable other colleagues to develop competence (Walker et al 2018). The Erasme team even encourage other health care professionals to come with their clients and attend them in labour with their support, to encourage the growth of breech skills.

The need for new ways of organising care has been emphasised in an on-line survey of Dutch gynaecologists just published by Post et al (2018, Does vaginal breech delivery have a future despite low volumes for training?): “Potential suggested alterations in organization are designated gynecologists within one centre, designated teams within one region or centralizing breech birth to hospitals with a regional referral status. Training should then be offered to residents within these settings to make the experience as wide spread as possible.”

Daphne Lagrou of Médecins Sans Frontières demonstrates shoulder press

Daelemans and Derisbourg began with a small team of 5 people. This has gradually expanded and now includes eight members who together provide 24/7 cover for all breech births within the hospital. Women with a breech presentation are referred by colleagues and increasingly by other women. The environment at Erasme is ideal because the hospital has a very positive approach to physiological birth in general, and a 15% overall caesarean section rate in 2017. This compares to 20.2% in Brussels and much higher in many places globally.

Practising collaborative manoeuvres for resolving head extension at the inlet of the pelvis (elevate & rotate)

What has the Breech Clinic changed? Before the introduction of the clinic, the planned vaginal breech birth rate was 7.19%, and in just a few years this has climbed to 42.7% of all breech presentations. Neonatal outcomes have remained stable. Actual vaginal breech births have climbed from 4.2% to 35.96% of all breech presentations within the hospital. The success rate for planned vaginal breech birth is 76.3%, which suggests that within experienced teams, the emergency caesarean section rate is also reduced. (The RCOG guideline suggests about 40% of planned breech births end in CS.)

All of this is very impressive. The message is clear: a physiological approach and an organised care pathway, including a breech clinic and experienced on-call team, can reduce the caesarean section rate significantly without negatively impacting neonatal outcomes. We should all look out for Derisbourg’s papers when they are published.

If you are a woman seeking support for a physiological breech birth, or a health care professional looking to refer a woman to the breech clinic, they can be contacted on Tel 00 32 2 5553325, or siege.clini-obs @ erasme.ulb.ac.be. Caroline Daelemans will be teaching with me in Lewisham, London, on 12 November.

— Shawn

Building confidence and changing practice through participation on training days

Emma Spillane

Emma Spillane, Training Co-ordinator at the Breech Birth Network, has attended six breech births in the last six months in an NHS hospital. Rebuilding breech skill is possible, guided by evidence about how breech competence develops. Emma writes about how she gained confidence in teaching and attending physiological breech births by assisting at Physiological Breech Birth study days.

In January 2017 I attended a Physiological Breech Birth study day in Norwich by Dr Shawn Walker and Dr Anke Reitter.  Breech birth had always interested me from my first breech birth as a newly qualified midwife.  I didn’t understand the physiology of breech birth at this time, it had always been taught as something abnormal, an obstetric emergency.  I could never understand though, how breech birth could be so abnormal if babies were on occasion born like this.  My interest had been piqued, and so a few years later, and a few more breech births later, I found myself on the study day to develop my knowledge and skills in vaginal breech birth.

The study day taught me the tools required for supporting women to have a physiological breech birth and to resolve possible complications whilst supporting physiology.  Following the training I went and introduced myself to Shawn and told her of my interest in breech birth, I felt so inspired to start a breech birth service within the trust I work.  On my return to work I started putting plans in place to develop a service within the trust.  Shawn contacted me  a few days later and invited me to help teach the hands on clinical skills on her next Physiological Breech Birth training day in South Wales.  I jumped at the chance to attend and found it so useful to listen to the day again and then help with the hands on teaching.  It helped to embed what I had already learnt previously and give me the confidence to teach the skills within my own trust.

I started talking about breech, a lot!  Shawn continued to invite me to help on training days and with each one my confidence grew. I started viewing the videos differently. Instead of looking for what was ‘normal’ and ‘abnormal’ I started analysing them with a deeper understanding of the physiology.  Shawn also encouraged me to start teaching parts of the presentation. Admittedly I was more than a little ropey to begin with but with Shawn’s nurturing and encouragement and the more I learnt from each training day, each time I attended my confidence grew.  Eventually I was able to transfer this new knowledge, understanding and confidence into practice.  I was asked to attend a breech birth!

I supported a woman with a physiological breech birth, along with a consultant obstetrician colleague and one other midwife.  An arm complication occurred with the birth, and I was able to resolve using the manoeuvres I had learnt and taught on the course. The baby was born in good condition, and I felt relieved and elated!  I immediately contacted Shawn to tell her about the birth but it had also sparked an interest in the consultant obstetrician who had attended. We debriefed from the birth and I spoke about the Breech Birth Network and the training it offers.  I took the opportunity to ask if my obstetric colleague would like to be the lead consultant in my quest to set up a breech birth service, to which they agreed.  It had taken me nine months – the length of a full term pregnancy – from when I first attended the training until this physiological breech birth. It was the birth of an exciting change in knowledge and culture.

Claire Reading, Emma Spillane and Shawn Walker

Attending training days has not only helped to embed my own learning but it has given me the skills and confidence to set up a service within the trust I work, support women who choose to have a vaginal breech birth and support colleagues to facilitate breech births themselves.  I have found repeating the information and skills has been the key to my learning and enabling change within practice. It has given me the confidence to attend births and increased the number of breech births within the trust by instilling confidence in others.  If you would like to build your confidence in vaginal breech birth, develop a service within your trust and teach others I highly recommend coming along and helping at future training days. You can view a list of upcoming opportunities to help deliver training here. Please let us know by getting in contact via email or the contact form.

Emma

Research indicates that providing teaching is an important part of the development of breech expertise. Read more: Expertise in physiological breech birth: A mixed-methods study