Heads Up! Breech Conference
November 9-11, 2012
Thoughts & reactions
It was an exhausting, exhilarating three days at the 3rd International Breech Conference in D.C., sponsored by the Coalition for Breech Birth. Our schedule was packed from early morning until late in the evening. It's amazing to see the developments since the last breech conference in Ottawa in 2009.
Three years ago, Dr. Frank Louwen and Dr. Anke Reitter had just introduced their pioneering work doing upright breech birth in a hospital setting. Today, they presented the results of 900+ breech presentations at their clinic from 2004-2011. They've done a preliminary analysis of the data and hope to publish it soon.
Three years ago, obstetrician Michael Hall of Colorado first learned about hands & knees positioning and said, "That sounds really interesting; I'd like to give it a try." Now he's doing lots of upright breeches and has found that they require much fewer maneuvers.
Three years ago, Ottawa midwives were required to transfer care for a planned breech birth, even though doing breeches was within their scope of practice. This meant that some very experienced midwives had to transfer care to less experienced physicians; they could stay in the room but could not assist with the birth in any way. This also meant that some women ended up with cesareans if no physician willing or experienced enough was on call. Just this week, Montfort Hospital agreed to waive the mandatory transfer of care policy, becoming the first hospital in North America to allow midwives to attend breech births as the primary care provider.
One of my favorite things about this conference was seeing experts in breech birth from around the world hammering out the intricacies of how a breech baby navigates through the maternal pelvis, asking questions and challenging each other on their research and outcomes, and collaboratively building a new body of knowledge.
I met some amazing obstetricians, some of whom I'll introduce later in my conference notes. They're doing vaginal breech births, VBAMCs, water births, opening birth centers, and fighting to get midwives hospital privileges. They're working to re-train other obstetricians in how to attend breech births and gradually overcoming resistance from their colleagues. I've invited some to write guest posts and hope to share those with you soon!
And of course I can't forget to mention all of the other fantastic people I met or reconnected with. There are too many to name here, but please keep in touch.
Best of all, I came back to my hotel room before heading to the airport...and there was a woman in labor! (I was rooming with Canadian midwife Gloria Lemay, and she generously offered our room to the birthing family.) I packed as quietly as I could and whispered good luck wishes on my way out. Only at a conference like this...
After attending the Heads Up! Breech Conference, I came up with a wishlist of things I'd like to see happen:
1) An online, searchable database of breech catchers
This would be tricky to figure out with the illegal/alegal status of some midwives, so we'd have to figure out if we'd only include people who are "out of the closet." I'd like something that a person could search for online by country, then state/province/region, and get info on who will catch breech, where they work, and what they're like (are they hands-on or hands-off, have they done upright breeches, do they do 1st or 2nd twins, primips, etc). Kind of like the VBAC ban database.
The first thing to do is come up with a good domain name, something that's an obvious search term.
2) A website dedicated to information on breech birth.
There are lots of individual sites out there, but I'd like to have a good, visible website that is THE jumping off place for women seeking information on breech. We'd link to a lot of other sites, but also have our own content (abstracts and full texts of research on breech birth, ECV, and more). First step: obtain a domain name. Any ideas for this?
3) More research on women's experiences of breech birth.
I've actually done the research already but haven't ever written it up. Definitely a project I want to get to in the near future. I have hundreds of responses from women with both surprise & known breeches via a a short-answer and essay-response survey. I'm actively looking for co-authors--preferably with experience coding & analyzing qualitative research; please contact me if you're interested.
4) A comprehensive review of literature on breech birth since 2000.
I was talking with Benna Waites, author of Breech Birth, at the conference (and a few others at the breakfast table, please remind me of who you were!). We discussed the real need for a good review of the literature post-TBT. Benna's book was published in 2001 and I haven't seen anything else like it since since.
1st step: collecting all of the articles.
2nd step: organizing them into a table or spreadsheet. Even having all of the citations, abstracts, and a brief 1- paragraph discussion about methods and applicability would be so helpful.
3rd step: would be to write this up into an article for publication in a medical journal.
This is also something I'd like to be a part of, but it's too much for me to tackle on my own right now. Contact me if you'd like to be part of this project. The first 2 steps could be a collaborative effort, facilitated via shared Google docs.
5) Practical instruction on upright breech birth, written primarily for providers.
This would need to come from providers with extensive experience doing upright breech births (Betty-Anne Daviss, Dr. Louwen & Dr. Reitter, Jane Evans, etc.). I'm envisioning something with lots of practical how-to information and step-by-step illustrations--more of a textbook chapter for physicians and midwives than a consumer's guide. We need a good written resource for teaching upright breech birth, especially something written for providers working in a hospital setting. (OOH midwives have Anne Frye's textbook to turn to. I wonder what updates she might make to her chapter on breech after attending the conference?)
6) And, of course, more breech catchers!
I'd love for every woman to have access to a skilled breech catcher within a 60-90 minute radius. I know I'm just dreaming, but wouldn't it be fantastic if at least one hospital in every larger city had a breech team?
What's on your breech wishlist?