The Art and Science
of
Breech Birth
Breech Birth is an elegant and worthy art, the respectful cultivation of which helps to preserve woman’s sovereignty in childbirth by providing true choice.
Breech is in every way a more challenging presentation than vertex and, as the greater risk is to the baby and not the mother, it is completely understandable that women willingly consent to surgical birth for breech, for every mother wants the best for her baby.
Resorting uniformly to surgical birth for breech does not necessarily diminish the risk of morbidity and mortality to the baby; however, surgical birth does increase many times over the risk to the mother’s life.
Some breeches can be accomplished skillfully out-of-hospital and many are more wisely referred to a doctor for planned cesarean section.
Special circumstance maternity care, such as breech, highlights anew the importance of skillful physical assessment, respect for the birthing woman's sovereignty, and the necessity of fully informed consent.
This weekend intensive is for everyone interested in discovering the art and science of breech birth: mothers, pregnant women, their families; midwives and their apprentices; nursing, midwifery, and medical students; doctors and allied health professionals are all invited.
Pregnant women presenting breech will gain a greater understanding of their clinical picture and be better informed about their options.
Clinicians will develop a basic plan to handle a surprise breech and will gain greater skill in breech assessment and the ability to counsel clients.
Primary maternity care providers will strengthen their foundation in breech and consider anew the wisdom of including breech birth in their scope of practice.
This weekend intensive covers fetal predisposition to breech presentation, the importance of identifying the breech early; various modalities effective in converting breech to vertex; principles and techniques of external version and their contra-indications.
The student will learn why breech birth is not for the novice and will gain renewed respect for the very real risks breech birth entails.
The student will learn to identify frank, complete, kneeling and footling breeches, and the importance of observing the 'sacred hour.'
The student will learn to anticipate, identify and resolve specific complications, and develop strategies and techniques to prevent others.
We will consider indications for surgical birth and examine the statistics on infant and maternal morbidity/mortality for breech, for both vaginal birth and cesarean section.
Do breech scoring indexes provide reliable guidance in predicting outcome? We will take a look at several examples: historic and contemporary, from medicine and midwifery. Students will consider the significance variables play in breech assessment: maternal age, parity, pelvimetry, gestational age, estimated fetal weight, fetal position, dilation and station.
In this class the student will learn the importance of the doctrine of informed consent/informed refusal and the meaning of fiduciary duty, as specifically apply to breech, through examination of midwifery legislation, regulation, and case law in California, with special focus on the Osborne decision.
We will consider the position on breech of diverse state, national and international professional organizations: California College of Midwives (CCM), California Association of Midwives (CAM), Midwives Alliance of North America (MANA), American College of Nurse-Midwives (ACNM), of Obstetricians and Gynecologists (ACOG), the World Health Organization (WHO), and the International Confederation of Midwives (ICM).
A sample of written informed consent for breech birth will be provided for use as a template for professional disclosure.
Charting
For
Midwives
The
mother's chart is the midwife's record of the care provided; clear,
concise and accurate record keeping safeguards both the mother and her
midwife, and serves as essential communication between health care
providers.
Charting for Midwives examines issues of fiduciary duty, informed
consent and informed refusal, practice guidelines, protocol, scope of
practice, standards of care, and principles of charting, including a
detailed explication of SOAP notation.
Included is a thorough discussion of both chart review and formal peer review.
