Session Descriptions

Friday, November 9

Plenary 1:

Birth on the Edge:  The View from Bumi Sehat
Ibu Robin Lim (Bali)

Ibu Robin will discuss her work at Bumi Sehat, from breech babies to tsunami rescue efforts to winning the CNN Hero of the Year award, illustrating the difference a single person can create in the world. 

Panel:  International Perspectives
Diego Alarcon (Ecuador), Andrew Bisits (Australia), Jane Evans (UK), Marek Glezerman (Israel), Michael Hall (CO), Savas Menticoglou (Canada), Anke Reitter (Germany)
Moderated by Betty-Anne Daviss (Canada/Germany)

Birth care providers around the world face similar challenges in offering vaginal breech birth. This session will offer participants the opportunity to hear speakers from around the world share their experiences, as well as to compare protocols and policies from the perspective of international benchmarking.

By the end of this session, participants will be able to:

1. List three challenges for offering vaginal breech birth that are common regardless of location;
2. List three international centres working towards the restoration of vaginal breech birth;
3. Explain why international benchmarking and consultation contributes to increasing the availability of vaginal breech birth.

Breakout Session 1:

Stories from Bumi Sehat – Ibu Robin Lim (Bali)
Following on her discussion in plenary, Ibu Robin will share stories of her work at Bumi Sehat.

Acupuncture for Breech – JoseLo Gutierrez (Washington DC)

This session will discuss acupuncture energetics during pregnancy and delivery, and the role of moxibustion and acupuncture for the treatment of breech presentation.

Chiropractic and Webster Technique – Nancy Salgueiro (Canada)

Women have been seeking chiropractic care in pregnancy for relief of symptoms such as sciatica, for general wellness care, and also to help when babies are breech.  Prenatal chiropractic care has been shown to help patients achieve optimal fetal positioning.  Constraint in the uterus can be the cause of a breech presentation.  Webster’s Technique is a gentle and specific chiropractic adjustment that helps remove pelvis misalignment and restriction, which can allow the baby to position themselves.  This session will be presented by Dr. Nancy Salgueiro, Prenatal and Pediatric Chiropractor and Fellow of the International Chiropractic Pediatric Association.

By the completion of this session:

  1. Participants will be able to list five ligamtenous connections from the pelvic bones to the uterus and cervix.
  2. Participants will understand the role of prenatal; chiropractic care, and specifically Webster’s Technique, for obtaining optimal fetal positioning.
  3. Participants will understanding the best practices regarding prenatal chiropractic care as a method of encouraging optimal positioning, including when to refer, who to refer to, and how to explain to patients what they will expect from the experience.

Tips and Tricks for the Management of Vaginal Breech Delivery – Michael Hall, OBGYN (Colorado)

At the conclusion of the discussion, the participants will have an understanding of the informed consent given to patients desiring a vaginal breech birth, the criteria used in choosing the appropriate candidate for vaginal breech birth, the technique and useful artful maneuvers during performance of vaginal breech birth, and an understanding of the effects and consequences of the Term Breech Trial.

Healing from Trauma (For Professionals) – Sharon Storton (Canada)

The impact of difficult births upon the professionals that attend them is rarely acknowledged; however the fear that a negative outcome can instil in a professional impacts not only their personal health and well being but the health and well being of their practice, as well – impacting the ability to offer true informed consent discussions and support in triggering situations. In addition to the traumatic birth itself, professionals are often then exposed to professional censure from colleagues, Colleges, and support systems whether or not they held any responsibility for the negative outcome.  This session seeks to provide professionals with tools for processing negative experiences, learning from them, and moving on to growth.

At the conclusion of this session, participants will be able to:

1.            List three major impacts of negative birth outcomes on the attending professionals.

2.            Discuss the compounding influence of professional censure, particularly where the professional is not at fault.

3.            List three strategies for managing triggering situations.

Breakout Session 2:

Preventing or Easing Breech Birth through Pelvic Balancing – Adrienne C Caldwell (MN) & Gail Tully (MN)

Breech presentation is not random. Generally, babies will get into the easiest position they can given available uterine space. We can make more space. Learn techniques to overcome hypertonicity and hypotonicity and balance the pregnant pelvis.

At the end of this session the participant will be able to identify two major soft tissue structures of the female pelvis, and to replicate a technique to resolve a soft tissue imbalance in the female pelvis.

Breech and the Politics of Midwifery –  Gloria Lemay (Canada)

Canada was a large, unsettled land mass for many decades.  In order to bring physicians into remote areas, doctors took over the role of birth attendant to earn the few extra dollars that it required for them to survive and midwives were virtually eliminated.  We now live in new times.  The re-emergence of the midwife in Canadian society has been a change that many in positions of power have resisted and thwarted with passion.

In this session, participants will hear from a woman who started in 1976 as a woman looking for choices in birth. Gloria Lemay has since been a midwife, birth attendant and skills teacher. In her 36 years of birth work, she has studied  (and been entangled in) the Canadian legal structure and politics which govern who will enter a family home to help at a birth. The woman with a breech birth, twins, and previous cesarean scar are a big problem for “systematized birth”.  We will look at the problems faced by real women in a system that wants someone else/anyone else to attend to the “problems”.

Healing from Trauma (For Parents) – Sharon Storton (Canada)

A traumatic birth experience has a lifelong impact on the family that experiences it. Although mother and baby may physically heal, the mental and emotional wounds can affect initial bonding, the continuing development of relationships between the parents as well as between parents and children, and future decision making on multiple fronts including place of birth, attendant, or whether to have more children at all. Lasting far beyond the generally accepted six-week postpartum period, the processing of difficult birth experiences may go on  literally for years.  This session seeks to provide parents and the professionals who support them with tools for processing a difficult birth experiences and strategies for coping with triggering situations.

At the conclusion of this session, participants will be able to:

1.            List three major factors that influence parents’ perception of the birth experience.

2.            List three long-term impacts of trauma on future decision making.

3.            List three strategies for managing triggering situations.

Physiological Breech Birth – Jane Evans (UK)

This session, conducted by the renowned English midwife Jane Evans, will explore breech birth scenarios of varying complexity with a skills-based focus. Participants should bring their own doll and pelvis models if possible.  At the conclusion of this session, participants will be able to:

1. Describe the uncomplicated descent of a breech baby.

2. List three observations that indicate the birth is progressing well.

3. Demonstrate three manoeuvres to assist the birth if there is indication that the birth needs to be expedited.

Plenary 2:

Panel: Breech Birth Research: Looking Back and Looking Forward
Andrew Bisits (Australia), Marek Glezerman (Israel), Savas Menticoglou (Canada), Anke Reitter (Germany)
Moderated by Ken Johnson (Canada)

Research into breech birth has been somewhat problematic over a long period of time. The conclusions of the largest breech study in history – the Term Breech Trial (TBT) – had a dramatic and permanent effect on breech birth protocols around the world, and scholarly criticisms of the study were largely ignored. The two-year follow up of the TBT negated its original conclusions – yet common practice remains unchanged. This session will make clear the problems with the TBT, discuss its continuing impact upon practice, and provide an update regarding key research that has happened since.

By the end of this session:

Participants will be able to:
1. List centres that opted out of the Term Breech Trial due to discomfort with the trial protocols.
2. List the typical challenges faced by researchers examining vaginal breech birth.
3. Identify the primary goals of research that is currently underway.

***

Saturday, November 10

Panel: Core Skills for Attending Breech Births
Betty-Anne Daviss (Canada/Germany), Jane Evans (UK), Ina May Gaskin (TN), Michael Hall (CO)
Moderated by Gail Tully (MN)

What are the core skills required for attending a breech? This question is key as care providers work towards gaining the skills they need to attend breech birth, a task with no clear finish line. At what point of skill can a doctor or midwife consider themselves competent – and equally important, confident – to offer vaginal breech birth to their clients? This panel will discuss both the core technical skills for attending breech births, and the “soft” skills required for supporting clients trying to maintain their confidence in the face of the mixed messaging from the medical community and society at large.

By the end of this session, participants will be able to:

1. List five skills important for attending a breech birth that is progressing smoothly.
2. List five common complications in breech births that may require intervention.
3. List five core skills for assisting with common complications.

Panel: The Impact of Choice
Kimberly Van Der Beek (CA), Cathy Harris (DC), Celine Ouelette (Canada), Ruth Mace-Tessler (UK), Benna Waites (UK)
Moderated by Robin Lim (Bali)

Options in breech birth vary from center to center, care provider to care provider. Some doctors and midwives feel comfortable offering vaginal breech birth only in an operating theatre; some are comfortable in a regular delivery room; some feel breech is reasonably safe at home. At the far end of the spectrum, some care providers offer only surgical birth, without bringing forward information regarding turning the baby to vertex or referral to a colleague who might attend a vaginal birth. The responses to “surprise” breeches are equally varied, and women experience everything from a spontaneous and smooth delivery, to being rushed to the hospital and into an emergency caesarean section with little or no consultation. This panel examines the impact of choice, and the impact of availability of choice, upon the mothers and families birthing a breech baby.

Objectives: by the end of this session:

1. Participants will discuss the long-term impact of limiting the choices available to women birthing a breech baby in relation to the mother’s long-term mental and physical health.
2. Participants will compare the impacts of the various choices offered, as presented by the mothers.
3. Participants will be able to describe the importance of offering free choice to mothers that is based on clear and complete information.


Panel: Breech Birth in American Hospitals: Challenges and Solutions
Martin Gimovsky (NJ), Michael Hall (CO), Dennis Hartung (MA)
Moderated by Stuart Fischbein (CA)

Vaginal breech birth is not widely available in American hospitals. Although the ACOG guidelines changed in 2006 in order to lift professional censure from skilled physicians wishing to offer vaginal breech birth to their clients, there has been little or no expansion in the number of physicians offering vaginal breech birth. This panel will examine the challenges faced by physicians offering breech birth in the hospital setting, as well as working and possible solutions and strategies.

Objectives: By the end of this session:

1. Participants will be able to discuss common and centre-specific challenges to offering vaginal breech birth in the hospital setting.
2. Participants will compare the availability of vaginal breech birth across the United States.
3. Participants will discuss strategies for increasing the availability of vaginal breech birth in the hospital setting.

Panel:  Breech Birth at Home: Considerations, Safety, and Informed Choice
Jane Evans (UK), Stuart Fischbein (CA), Diane Goslin (PA), Mary Hosteller (PA), Tammi McKinley (DC)
Moderated by Ina May Gaskin (TN)

The lack of availability of breech birth in many hospitals has what may have been an unanticipated effect:  many women are now choosing to birth their breech babies at home. Although the opinion that this is an unsafe choice is common among medical professionals, there are many communities where women have a strong personal, sometimes religious need to remain home for birth, especially when it is known that the available hospitals will not support a vaginal breech birth.  This session examines the special considerations involved in breech birth out of hospital.

Learning Objectives:  By the conclusion of this discussion:

1.            Participants will be able to list the chief risks of vaginal breech birth that may be exacerbated by an out-of-hospital setting.

2.            Participants will be able to list the key advantages of choosing an out-of-hospital breech birth.

3.            Participants will discuss the potential conflict between perceived medical risk and ethical support of the birthing woman’s choice of birthplace.

Panel: Selection of Candidates:  Factors to Consider
Sophie Alexander (Belgium), Andrew Bisits (Australia) , Jane Evans (UK), Martin Gimovsky (NJ), Merek Glezerman (Israel), Savas Menticoglou (Canada)
Moderated by Nancy Salgueiro (Canada)

Selection of candidates for breech birth is a subject of varied opinion. Multiple factors may influence the likelihood of success and the level of safety; different centers emphasize different issues which may include the baby’s positioning, its anticipated size, and whether the mother has birthed vaginally before. Some centers insist on completing assessing the mother’s pelvic size, others consider the “soft” factor of maternal mindset and commitment to a vaginal birth to be the only relevant criteria. This session will draw opinions from a panel of experienced doctors and midwives, examining the relative importance of these factors.

By the completion of this session:

1. Participants will be able to list three factors commonly considered important to the success and safety of a breech birth.

2. Participants will discuss the balance of science vs ethics in selecting candidates for breech birth.

3. Participants will compare the various technologies typically used to assess maternal and fetal size.

PREMODA:  Antidote to the Term Breech Trial?
Sophie Alexander (Belgium)

The PREMODA trial in France and Belgium mirrored the Term Breech Trial in its definitions of morbidity and mortality, yet the PREMODA outcomes were vastly better and support a policy of  maintenance of breech birth skills. Dr. Alexander, leader of the Belgian center, will explain the differences and discuss the current state of breech birth in Europe.

Cardinal Movements of the Breech Baby
Jane Evans (UK)

A baby is not passive during birth. An active participant with the mother, the baby is not merely  moved by uterine forces or the assistance of an attendant but initiates movement that facilitates its passage through the birth canal. Understanding of the movements made by the breech baby in tandem with the instinctive movements made by the active mother offers the doctor or midwife the ability to visualize what is happening within the mother’s body, and thereby resist applying interventions that are not yet needed.  This presentation will feature slides of breech births, and discussion between senior doctors and midwives who have done extensive analysis of the path the breech baby follows while descending.

By the end of this session, participants will be able to:

1. describe the normal descent of the breech baby;

2. identify variations on this normal descent that might indicate a need for intervention;

3. describe how the instinctive actions/movements of mother and baby while labouring facilitate the birth.

Hands and Knees Delivery Part One: The Frankfurt Videos
Anke Reitter (Germany) and Betty-Anne Daviss (Canada/Germany)

This session will include a series of videos that illustrate in live action the cardinal movements of the breech explored in the previous session, and follow up on the apparent benefits of the maternal hands-and-knees position for birthing a breech baby.

 

Sunday November 11

Hands and Knees Delivery Part One: The Frankfurt Data
Anke Reitter (Germany) and Betty-Anne Daviss (Canada/Germany)

The Frankfurt team has been compiling retrospective data regarding outcomes with the hands and knees position, and a preliminary summary of the results will be presented.

At the end of the session (parts one and two), participants will be able to:

  1. Describe the descent of the breech baby based on external examination.
  2. Explain how the use of the hands and knees maternal position became routine in Frankfurt.
  3. Explain the appropriate usage of the Louwen nudge.

Debate:  Is Breech a Sign of Underlying Pathology, or a Variation of the Norm?
Marek Glezerman (Israel) and Betty-Anne Daviss (Canada) 

Babies with an underlying pathology often present by the breech; does it therefore follow that breech is a sign of underlying pathology? Two breech experts will present their views, and open the floor for discussion with the audience.

 

Panel:  Turning the Breech:  Alternative Modalities
Adrienne Caldwell (MN), Marie-Julia Guittier (Switzerland), JoseLo Gutierrez (DC), Nancy Salgueiro (Canada), Lindsay Vick (DC)
Moderated by Gail Tully (MN)

When faced with a deficit of providers of vaginal breech birth, turning the breech baby to vertex can often be the only option available to the mother who desires a vaginal birth.  This panel will explore options for turning the breech baby to vertex, including the use of chiropractic techniques, acupuncture, bodywork, hypnosis, and external cephalic version (ECV).

At the completion of this session, participants will be able to:

1.            List at least four options for turning the breech baby to vertex.

2.            List the techniques in order of statistical efficacy.

3.            List three possible adverse outcomes to attempting to change the baby’s position in utero.

Panel:  Informed Choice:  What does the Client Need to Know?
Jane Evans (UK), Martin Gimovsky (NJ), Anke Reitter (Germany)
Moderated by Betty-Anne Daviss (Canada/Germany)

It can be argued that the principle of informed choice stands at the heart of the vaginal breech birth issue. This session will examine the questions around what a client needs to know in order to make an informed decision regarding the birth of her breech baby, who holds the ultimate responsibility for decision making, and the balance of the partnership between mother and birth attendant.

By the end of this session, participants will be able to:

1.            Define informed choice.

2.            List three real or perceived obstacles to conducting informed choice discussions with mothers.

3.            Discuss whether or not there are reasonable omissions from informed choice discussions.

Breakout Session 1

How to Deal with the Problem Breech: Scenarios on Catching Breech Babies  – Diane Goslin (PA)

In this session, participants will learn to identify problem breech presentations and explain the best approach in facilitating their delivery.  This will include:

  • Identifying different types of breeches: Where/ How/ When Problems can arise
  • Learning different techniques for delivering difficult types of breeches
  • Complications in delivering breeches

Breech Stories – Joy Horner (UK)

Using a narrative format Joy Horner shares a personal and professional history of learning to support vaginal breech working with British Midwife Mary Cronk MBE. This presentation seeks to tell the stories of breech births attended as part of their Independent Midwifery practice. Clients have shared photos of their births for teaching purposes. The images include home births of footling and frank breech presentations, breech VBAC, hospital breech birth and caesarean delivery.

Within the context of the overall conference, this session seeks to address the recurring theme of how breech birth skills have been lost so women are not always offered chance to birth naturally, without interference, in hospital.  This leads to women seeking out skilled care at home.  The information is given from perspective a skilled care-provider, the narrative format seeks to include the voices of birthing women who triumph over adversity, when they have been told they can’t or shouldn’t try to birth their breech babies vaginally and they do it anyway.

Included amongst the triumphs are the harsh realities: a cord prolapse at home and an unexpected stillbirth. Also, a poignant story of planned breech birth in hospital which ended in an emotionally moving caesarean.

Joy seeks to develop a birthing community of shared wisdom.  Midwives do face and survive investigations after poor outcomes, and from those experiences they can draw extra strength and knowledge.

At the end of this session participants will have learnt:
-That a variety of breech presentations that can be born vaginally.
-How the Independent Midwifery Practice facilitates spontaneous breech birth.
-Assessing when additional support is required during a breech birth.
-The impact on parents and practitioners when a breech baby dies.
-Joy’s approach to effect change in breech birth care and how this can be replicated.

Putting RCTs and other study designs into perspective – Ken Johnson (Canada)

Randomized Control Trials have become a gold standard of medical research.  However, critiques of the Term Breech Trial have highlighted questions about whether RCT’s are appropriate in gathering valuable information about birthing women. This presentation will discuss the value of RCT, critique RCTs and address other research study designs.

Connecting the Dots: The Future of Birth Advocacy – Rixa Freeze (USA)

In the past, birth activism has usually focused on changing one practice at a time–from natural childbirth, fathers in the delivery room, or Leboyer baths to water birth, home birth, or vaginal breech birth. While small, focused groups of consumer activists have succeeded in changing obstetrical practices over the years, they have often failed to make themselves relevant to women who don’t care about those particular issues. Dr. Rixa Freeze will look at alternative models of birth activism for the future. She will discuss how birth activism can make itself relevant to more women. She will also examine existing laws, rulings, and social structures that birth activism could build off of.

Plenary 3

Panel: Medicolegal Issues and Ethics in Breech Birth
Mark R. Bower (USA), Farah Diaz-Tello USA), Annette Fineberg (USA), Savas Menticoglou (Canada), Rebecca Spence (USA)
Moderated by Nick Rubashkin (USA)

The medicolegal panel will address the non-medical issues at play which either encourage or discourage birth care providers from making the investment in learning breech skills, and subsequently freely offering vaginal breech birth to women. These issues may include existing legislation, fear of litigation, fear of professional censure, and misunderstanding of or lack of confidence in informed choice discussions, as well as real or perceived conflict with hospital, clinic, or practice business policies. This panel is not intended to address vaginal breech training issues except in the context of medicolegal real or perceived obstacles.

Key questions the panel will address include:

1. What are the key medicolegal issues preventing birth care providers from offering vaginal breech birth?

2. What is the impact of the medicolegal climate on the principle of evidence based practice?

3. Is there a gap between perceived and actual legal risk?

4. What is the impact of the medicolegal climate on the human rights of the mother to privacy and autonomy over her body?

5. What strategies would need to be put in place in order to remove the medicolegal barriers, both real and perceived, to freely offering the choice of vaginal breech birth?

 

 

Comments are closed.