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Physiological Breech Birth
IMPROVING SAFETY THROUGH RESEARCH
SHAWN WALKER, RM PHD
MIDWIFERY LECTURER , K ING’S COLLEGE LONDON
ELAINE CARTY VIS IT ING SCHOLAR 2020, UNIVERS ITY OF BR IT ISH COLUMB IA
How can we
improve the
safety of
vaginal breech
birth?
18/06/2020 BREECHBIRTH.ORG.UK 2
Physiological management, including the use of upright maternal positioning
Teach when and how to put ‘Hands ONthe breech’
Repetition and reflection – Talk about it
Specialists: Higher degree of skill and experience, enabled to support the wider team
NHS Resolution Report 2017
Five years of cerebral palsy claims, 2012-2016
Breech presentation = 12% of all claims
2016 NHS Hospital statistics: Breech = 0.4% of
all births
5 / 6 claims were diagnosed late in labour
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Magro, M. (2017) Five years of cerebral palsy claims. NHS Resolution.
Breech training for the Regroupment Les
Sages-femmes du Québec,
Montreal 2017
Physiological Breech Birth
from the woman’s point of view …
“a breech birth in which the woman is encouraged to remain upright and active throughout her labour and supported to birth in the position of her choice.”
e.g. not required to lie on her back
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Squatting back to open the pelvic outlet
Video 005:
‘Birth of
Leliana’
Do not disturb!
... unless intervention is
required.
Marc Chagall, The Pregnant Woman / Maternity, 1913
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Physiological Breech Birth
from the professional’s point of view …
“a breech birth in which the management
is focused on anticipation of the need to
intervene (or not) based on careful
observation of the birth and progress.”
Spontaneous upright births:
Time between umbilicus & birth?
39 seconds
BREECHBIRTH.ORG.UK
Reitter, Halliday & Walker (2020). Practical insight
into upright breech births from birth videos: a
structured analysis. Birth: Issues in Perinatal Care
Findings
Median times (min:sec)
Pelvis → Head (n=36)
◦ Md=1:52 (IQR 1:05–2:46)
◦ Spontaneous Md=1:02 (IQR 0:23–1:31)
Umbilicus → Head (n=42)
◦ Md=1.26 (IQR 0:45–2:17)
◦ Spontaneous Md=0.39 (IQR 0:13–1:31)
Emergence
sacrum transverse
27/42 (64%)
Emergence
sacrum oblique
15/42 (36%)
BREECHBIRTH.ORG.UK 18/06/2020 8
Sp
ont
ane
ous
Sa
cro-A
nteri
or
Rota
tion
Complete rotation
27/42 (64%)
4/27 (15%)
manoeuvres
Partial rotation
12/42 (29%)
7/12 (48%)
manoeuvres
No rotation
3/42 (7%)
100%
rotational manoeuvres
Second stages
A passive second stage is common, even in
unmedicated women.
Do not encourage active pushing until the
buttocks are visible on the perineum.
(PREMODA, 2006)
Conclusions
Most upright breech births occur within 3 minutes
of the birth of the pelvis.
A pause at any point >90 indicates completely
spontaneous birth is unlikely.
Use maternal movement and effort to diagnose
obstruction before intervention.
“Just breathe …
Wait for the next
contraction …”
Why specialists? Why breech teams?
Because …
The Term Breech Trial.
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Why
specialists?
Why breech
teams?
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Who is on a Breech Team?
• Has attended enhanced training *
• At least 10 vaginal breech births, including
complications
• Regular breech births or simulations
• (3-6 per year)
• Teaches others
* Breech Birth Network training is fully evaluated at the same standard as other obstetric emergencies trainings
The Belfast Royal Victoria breech team:
Obstetricians Niamh McCabe and Janitha
Costa, and Breech Specialist Midwife
Jacqui Simpson
What does a Breech Specialist Midwife do?
Presentation diagnosis by USS
Counselling
ECV/moxibustion
Support other maternity staff at breech births, planned
or unplanned
Teach updates at mandatory events and for students
Reflective review after breech births / study group
Risk management related to breech / Audit
Research and conferences
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Questions & Discussion
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