In June, I spent a week in the Netherlands working with a committed group of lecturers. The midwifery universities of the Netherlands share a common curriculum, and following our meeting last year, they agreed to incorporate physiological breech birth into their training programme. My visit was to support the midwifery lecturers to implement the new skills into standard midwifery training.
While in Amsterdam, I collaborated with Midwifery Lecturer Bahar Goodharzi of Academie Verloskunde Amsterdam Gröningen (AVAG) to create a short series of films demonstrating the rotational arm manoeuvre we teach in Breech Birth Network study days. We agreed that this is a tricky manoeuvre to learn and teach, but it is incredibly effective in practice so worth the effort of learning. I’ve collected our short demonstrations in the film below, along with information about how to recognise that this manoeuvre is required.
Note: If you have difficulty rotating the baby initially, you may have to elevate the baby slightly to a higher station, so that the shoulder girdle rises above the pelvic inlet. It can then rotate to engage in the transverse diameter.
Thank you to Emma Spillane of St George’s Hospital in London, who has helped to refine the way we teach this manoeuvre following her own experiences of successfully using it in practice.
Midwifery Lecturers Merel Schoemaker and Bahar Goodarzi
Last week I visited the Academie Verloskunde in Amsterdam to provide a train-the-trainer workshop for midwifery lecturers. The four universities in the Netherlands work together to teach a consistent curriculum across the country. Incorporation of physiological breech birth training into that curriculum was inspired by last year’s Teach the Breech 1st Amsterdam Conference. I was honoured that lecturers travelled from as far away as Groningen and Maastricht to attend the training, so they have a common understanding of how physiological breech birth is taught. Many of them have significant experience teaching breech themselves, so we will continue to learn from each other.
The train-the-trainer workshop followed a similar format to our RCM-approved Breech Birth Network study days, but we kept the focus on the mechanisms and manoeuvres to enable the midwifery lecturers to understand the new methods thoroughly in order to teach them to students. Midwifery lecturers already have such a deep understanding of anatomy and physiology, and I have never had so many great questions from one audience! Amazing engagement.
Midwifery Lecturers from the universities of the Netherlands
The Netherlands is a hotbed of breech activity and debate, from researchers such as obstetrician Floortje Vlemmix and midwife Ageeth Rosman, and obstetricians like Leonie van Rheenen-Flach and midwives like Rebekka Visser. Vaginal breech births have continued to be facilitated throughout the Netherlands, albeit at a diminished rate this century. Because clinicians have maintained the skill, a shift to more physiological principles of facilitation is not so seismic. A recent case report indicates such a shift is in progress.
Thank you to lecturers Bahar Goodarzi and Merel Schoemaker for organising the workshop and seeing me safely to the other side of Amsterdam on my bike after the training! I look forward to working more closely with them to develop a physiological breech training programme, appropriate for the Dutch context, incorporating the existing skills and knowledge of the very experienced obstetricians and midwives of the Netherlands.