Tag Archives: women’s experiences

Keep an eye on Sydney

Warrnambool Dreaming Weaving Panel, Lightning Ridge

Warrnambool Dreaming Weaving Panel, Lightning Ridge, Boolarng Nangamai Aboriginal Art and Culture Studio — from a previous breech-related trip to Australia

On Sunday, I am heading off to New Zealand (Christchurch & Auckland), where doctors and midwives are keen to learn more about physiological breech birth. From there it’s on to Sydney for the Normal Birth Conference 2016, where I’m excited to be giving an oral presentation about my research into how professionals develop skills to support breech birth. This is my first Normal Birth Conference, and I can’t wait to soak up the influence of so many birth researchers, including the team from Sydney currently publishing some groundbreaking papers about breech (more below). You can follow the conference on Twitter at #NormalBirth16.

I am often asked by students with a budding interest in breech birth and a requirement to write a dissertation, if I can recommend any good/important breech research papers. Why, yes, I can.

  1. The easy and Kuhnian answer to this question is: As it happens, I’ve published a good handful of peer-reviewed research and professional publications concerning breech presentation and breech birth! History may or may not deem them to be important, but if you want to know what I think is important, the reference lists will reveal all.
  2. Read the Term Breech Trial. Read all of it, including all of the follow-up studies written by people who weren’t named Hannah. Critique the research and form your own opinions about if/how it is relevant to contemporary practice. Until you have completed this task, resist the urge to claim publicly that the TBT has been ‘disproven’ or ‘debunked.’ It hasn’t. It is still a powerful force, and in fact contains many relevant lessons. Finally, read the critiques of the TBT.
  3. Now do the same for PREMODA, and if you are reading this in a few months’ time, the Frankfurt studies. At this point it will start to become interesting if you compare the reference lists of the different ‘camps’ of breech thought.
  4. When I was starting my PhD, I did a PubMed search on ‘breech presentation,’ which returned over 4000 results. I read all of the abstracts related to management of breech presentation, and all of the articles where the abstract looked interesting/relevant. It took me about 6 months. My PhD supervisors suggested this strategy might be ‘inefficient.’ Fair point. However, it’s one of the best things I ever did, as I feel confident that I have a broad understanding of research related to breech. However, I’ve muted this suggestion, as it may not fit the time constraints of the pre-registration students. It’s just to say — there is no shortcut if you want to thoroughly understand the research base in your area of practice.
  5. Finally, keep an eye on the group in Sydney who are currently publishing some very important papers. Mixing qualitative and quantitative methods, and focusing on the experiences of women and health care professionals, this team is producing research which complements the observational studies which have predominated in the past 15 years. Although each piece of research contains its own question, underlying them all, the wider questions are lurking: How did we get in such a muddle about breech? And how can we get out of it?
Michelle Underwood, Anke Reitter, Shawn Walker, Barbara Glare

Remembering the last visit! Westmead Consultant Midwife Michelle Underwood, Obstetrician Anke Reitter, (me) Shawn Walker, and Lactation Consultant/Conference Organiser Barbara Glare

I will link a few of the Sydney papers below. Looking forward to seeing several members of this team at #NormalBirth16.

Catling, C., Petrovska, K., Watts, N., Bisits, A., Homer, C.S.E., 2015. Barriers and facilitators for vaginal breech births in Australia: Clinician’s experiences. Women Birth 29, 138–143. doi:10.1016/j.wombi.2015.09.004 — A qualitative study of interviews with 9 breech-experienced professionals (midwives and obstetricians) exploring what helped and hindered their ability to provide women with the option of a vaginal breech birth.

Catling, C., Petrovska, K., Watts, N.P., Bisits, A., Homer, C.S.E., 2016. Care during the decision-making phase for women who want a vaginal breech birth: Experiences from the field. Midwifery 34, 111–116. doi:10.1016/j.midw.2015.12.008 — Additional analysis from the qualitative study above, exploring how these professionals provide care during the decision-making phase, when women are choosing mode of childbirth for a breech-presenting baby.

Homer, C.S.E., Watts, N.P., Petrovska, K., Sjostedt, C.M., Bisits, A., 2015. Women’s experiences of planning a vaginal breech birth in Australia. BMC Pregnancy Childbirth 15, 1–8. doi:10.1186/s12884-015-0521-4 — A large qualitative study exploring women’s experiences and what women want when planning mode of breech childbirth. Open access too.

Petrovska, K., Watts, N.P., Catling, C., Bisits, A., Homer, C.S.E., 2016. Supporting Women Planning a Vaginal Breech Birth: An International Survey. Birth. doi:10.1111/birt.12249 — An international survey exploring the support women received when planning a breech birth. The researchers found that women were generally happy with their decision to plan a breech birth and would do it again in another pregnancy. However, lack of support from their primary care providers often made this difficult to achieve.

Petrovska, K., Watts, N., Sheehan, A., Bisits, A., Homer, C., 2016. How do social discourses of risk impact on women’s choices for vaginal breech birth? A qualitative study of women’s experiences. Health. Risk Soc. 1–19. doi:10.1080/13698575.2016.1256378

Petrovska, K., Watts, N.P., Catling, C., Bisits, A., Homer, C.S., 2016. “Stress, anger, fear and injustice”: An international qualitative survey of women’s experiences planning a vaginal breech birth. Midwifery 0, 464–469. doi:10.1016/j.midw.2016.11.005

Petrovska, K., Sheehan, A., Homer, C.S.E., 2016. The fact and the fiction: A prospective study of internet forum discussions on vaginal breech birth. Women and Birth. doi:10.1016/j.wombi.2016.09.012

Watts, N.P., Petrovska, K., Bisits, A., Catling, C., Homer, C.S.E., 2016. This baby is not for turning: Women’s experiences of attempted external cephalic version. BMC Pregnancy Childbirth 16, 248. doi:10.1186/s12884-016-1038-1 — Oh, thank goodness for this. The rhetoric around external cephalic version (ECV) is so strong, it almost feels a sacrilege to question it. Despite the Cochrane Review stating clearly that the evidence does not indicate that ECV improves neonatal outcomes, women are constantly told that ECV is ‘best for babies.’ Which says a lot about how reluctant to engage with the option of vaginal breech birth their providers are. This study of women’s experiences is a welcome balance to the dominant view that vaginal breech birth is only something to be considered after ECV has failed. ECV is a good option for many women, and a safe procedure in experienced hands. But it is not for everyone.

Andrew Bisits and Anke Reitter demonstrate breech skills

Andrew Bisits and Anke Reitter demonstrate breech skills

Borbolla Foster, A., Bagust, A., Bisits, A., Holland, M., Welsh, A., 2014. Lessons to be learnt in managing the breech presentation at term: An 11-year single-centre retrospective study. Aust. N. Z. J. Obstet. Gynaecol. 54, 333–9. doi:10.1111/ajo.12208 — Technically from another team, with one cross-over member, inspirational obstetrician Andrew Bisits. This observational study helps to shed light on the clinical context surrounding these researchers. Although the article makes no mention of use of upright positioning for labour and birth, Dr Bisits is well-known for his use of a birthing stool for breech birth. You can read more about this in a previous blog, Bottoms Down Under.

Andrew Bisits performing a gentle ECV

I may have missed something, or a new study may have been published while I am writing this. (I have updated the post with some recent editions.) Best to keep a look out yourself.

Shawn

Why midwives are sceptical

This blog is Part 2 in a discussion about on-going RCTs looking at induction of labour (IOL) at various gestations: Why midwives are sceptical about research on medical interventions

In theory, research like this is done in order to support clinical decision-making and to enable informed consent for proposed interventions. If midwives seem dubious about the merits of research concerning medicalised birth, it is because our experience indicates that truly informed consent is a rare beast. Once an RCT has decided that a certain course of action results in less risk for baby, any woman who wants to take a different course will most likely have a fight on her hands, with most health professionals, family, friends, even her partner.

Because it is socially unacceptable to say – It is okay for a woman to choose an option which appears more risky for her baby. Women are not just baby carriers. They live complex physical and emotional lives in which other factors are important too. – midwives end up in the awkward position of trying to argue with The Truth of big science.

Soon, someone will get funding to do an RCT looking at whether the outcomes for babies are better for low-risk primips who undergo elective CS at 39 weeks, or normal labour. And my guess is CS will come out on top for the Big Ones – reduced morbidity and mortality. And then what? Will all primips be offered a CS at 39 weeks? And those who refuse?

I’d like to think we could use the information from these trials to truly offer women an induction of labour, acknowledging that it will not be right for everyone, but as a midwife I see every day what happens to women who decline the Recommended Treatment. Take for example this recent Tweet:

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Is it really okay for an ‘anaesthesiologist’ and president of MSF-USA (Doctors Without Borders) to publicly discuss this tragic outcome, in a way which implies that a woman who declines a recommended CS is selfish, cold, heartless .. & uninformed (despite having definite, and accurate, reasons for refusing). Putting her own experience ahead of her baby’s life, as if losing a baby is ever a good experience, even for the most ambivalent. Are women who decline medical advice no longer entitled to respect and confidentiality? This so-called professional then used the MSF-USA twitter account to re-tweet this damning judgement to 361,500 followers. Midwives in the UK are struck off for less.

We need more research on how to increase the quality rather than the quantity of birth, and life in general; and the quality of women’s experiences will certainly improve with more compassion and less guilt-tripping. Childbirth is not a trip to Walmart.

I want women to have the choice of an early induction, or a CS, if research indicates it may benefit their baby. If they feel it is the best choice for them, so do I. But I want women who don’t want this to have their choices acknowledged as equally valid and equally supported. And I don’t have a lot of faith that will happen.

Finally, because it’s my blog: For me, going into labour was like falling in love. The agonising wait, wondering when it will happen. The brief period of terror when I realised it had. Followed by succumbing. Followed by a lot of hard work and ultimately, blessedly, joy. For me, it was worth waiting for.

Shawn