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:
“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.
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)
Earlier this month (May 2016), I completed a road trip from Montreal to Atlanta to share the results of our international consensus research (Walker et al 2016), explain how it can be used to guide practice and education, and deliver physiological breech birth training based on that research to approximately 130 health professionals and other birth workers.
Wall mural depicting the Maison de naissance, Côte-des-Neiges
The goal was to enable these professionals to learn new skills, equip them to continue learning using an on-line Virtual Community of Practice, and empower them to disseminate the knowledge to others in their local communities. I met so many wonderful people, and feel confident they will work to extend the availability of skilled support for planned vaginal birth. I am going to tell the story of this amazing road trip in a blog mini-series. I hope you will join us … there is a special surprise at the end! 😉
The first workshop was attended by Certified Midwives from Quebec, Ontario, Maine, and Massachusetts, as well as doulas and CPMs from these communities. In Quebec, midwives work mostly in community settings and are not legally able to attend breech births except in emergencies (undiagnosed). However, some of the midwives have begun to work with obstetricians who will accept planned breech births, and they are working towards woman-centred, physiological care for these women. They also want to ensure emergency skills training is up-to-date, including physiologically-based strategies appropriate to midwifery-led settings.
As physiological breech birth gradually becomes the standard of practice, especially for midwives, breech skills will increasingly be taught by trainers who may or may not have much breech clinical experience themselves, much like they are now. It is therefore important that trainers be able to become ‘qualified’ to teach physiological breech methods, in the same way they teach supine-based emergency delivery techniques, and that they are teaching methods underpinned by research and consensus. Several skills trainers from throughout Quebec attended the workshop, and by using the resources made available, hope to disseminate the training to others in their local communities. I especially enjoyed meeting Sinclair Harris, the grandmother of this midwifery community, who has nurtured so many young midwives and is still actively teaching. Sinclair completed her RN training at St Mary’s in London. ❤️
Anyone in Quebec interested in receiving training
in the facilitation of physiological breech births —
The midwives told me that use of ‘prayer hands’ in rotational manoeuvres to release the arms struck a chord with them. The shoulder press manoeuvre also made sense, but some midwives felt that the two disctint versions of this manoeuvre needed independent descriptive terms, to capture subtly different techniques which are applicable in various circumstances. This cluster of manoeuvres have been taught as “Frank’s Nudge,” in honour of Frankfurt obstetrician Professor Frank Louwen. But because research indicates eponyms (named after people rather than descriptive terms) can lead to confusion and inadequate documentation, we try to use a description which ‘does what it says on the tin’ in the Breech Birth Network training, and we continually listen to feedback about what works to help novices learn breech better. More on the distinction between these manoeuvres coming up in a future blog …
CPM and doula Rivka Cymbalist with the world’s youngest breech catcher
Following the workshop, midwife Bronwen Agnew was kind enough to take me on a tour of the Maison de naissance, Côte-des-Neiges. This local birth centre is housed in a wonderful old rectory building, complete with wooden floors. It reminded me of my grandmother’s house, warm and simple. A beautiful place to give birth! Thank you, Bronwen.
The Montreal workshop was organised by Montreal doula and CPM, Rivka Cymbalist, and held at Studio L’équilibre en mouvement, ave Van Horne, a wonderful venue. We also enjoyed lunch at Rivka’s cafe, Caffe della Pace. Thank you, Rivka and family for your hospitality! If you are ever in Montreal, I also recommend relaxing at La Société Textile, a crafts shop / café where you pay by the hour to hang out, work on your knitting/sewing project, and drink unlimited tea from the kitchen. What more could a midwife ask for?
The current plan is to provide a 2-day breech train-the-trainers course in Toronto in late July / early August 2017, involving myself and some of the midwives who have taken the training this year and will be disseminating the skills in their communities. This is due to abundant feedback from the participants that they would like the training to be longer to allow for more discussion, reflection, fellowship and hands-on practice — of course we support all of the above! Follow this blog or the Breech Birth Network Facebook page to keep updated on our plans.