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Dear Marilyn
I would see a pudenal block and possibilly an
episiotomy - for the forceps I presume??
as intervention from what I was taught about
Vaginal Breech in england in 1977 and from what I have read, heard and seen from
MaggieBanks.
I saw such in the UK as a student and did the same
with an undiagnosed Breech in PNG!
So I do not have any recent expereince and
we all need to keep up but as it is rare and now sectioned as well as everyone
working in this fragmented system it will be hard!!
Another reason the
system needs to be changed!!
Denise
----- Original Message -----
Sent: Sunday, September 14, 2003 6:56
AM
Subject: Re: [ozmidwifery] Term Breech
Trial
Denise: this is an excellent critique. I feel
very strongly that you midwives who are experienced with vaginal breech birth
have to offer workshops all around the country so that those of us just
entering the profession feel confident to attend a woman whose baby is
presenting by the breech. I am amazed that the interventions: ARM, induction,
augmentation, epidurals were performed. My second daughter was a vaginal
breech 26 years ago in Brisbane and I was advised that none of those options
were available to me BECAUSE the baby was breech. I even avoided the enema,
which was standard at the time, because of this. The labour and birth were
quite simple the only intervention being the obstetricians preference for
using forceps to guide out the after coming head to slow it down. This gave
the birth a clinical feel, but I was so greatful to have a vaginal breech (I
was advised to have a c/s even then) it was fine at the time (a pudenal block
and an epis of course). My baby came out screaming and pink and is very proud
to have been a vaginal breech baby. As a midwife I have only attended 3 other
breech births, 2 of which were multi births and made a breech birth seem the
optimum way for a baby to be born. The other was a primip and though she had
to "deliver" in the OT she was not medicated or augmented, she was
standing and hands were off until the nape of the neck was on view and then
the head just would not be born. The mum walked back to the OT table, and the
ob used piper forceps to deliver the head. And believe it or not the mother
did not tear. Baby had apgars of 3, 8, 9 and is a thriving toddler today: gave
us all a few heart attacks though. Made me realise the value of someone who
can use forceps being around. The head had not deflexed and I have no idea why
if you could fit forceps in, the baby wouldn't come out by itself it just
wouldn't, but it lifted out very easily with the forceps. Rightly or wrongly I
do feel though that i need more experience with vaginal breech
birth.
marilyn
----- Original Message -----
Sent: Saturday, September 13, 2003 5:50
AM
Subject: Re: [ozmidwifery] Term Breech
Trial
Mary
Maggie Banks' web site has a critique ot the
Term Breech trial
at
Denise
----- Original Message -----
Sent: Saturday, September 13, 2003
1:52 AM
Subject: Re: [ozmidwifery] Term
Breech Trial
I do not have the paper in front of me, but from memory
there were many concerning issues. It was a multi centered trial
(121) in a number of countries(?) with obstetricians who were said
to be experienced in breech birth. I believe that those who weren't
experienced, attended workshops to bring them "up to speed". There
were many variables eg IUGR which were not excluded and which would
have had an impact on the outcome. I believe that the "normal"
hospital position for breech delivery was used. It would be really
good if someone who has read a critique of this paper, could post the
reference. Thanks, MM
----- Original Message -----
Sent: Saturday, September 13, 2003
6:23 AM
Subject: RE: [ozmidwifery] Term
Breech Trial
From
memory, there was about a 64% induction rate alone in the TBT and I'm
fairly sure all in Western hospitals had epidurals. There were no Birth
Centre, hands-free or homebirths to compare with. All of the women were
delivered in lithomy and all had intervention. Leilah McCraken from the
Birthlove website has done a comprehensive analysis of the TBT which is
worth reading.
cheers,
Cas
I imagine that the women were in the
lithotomy position. I haven't read it for a while - can anyone tell me
the rate of epidurals the women had? Whether they were all hooked up
to CTGs? The experience of the 'accoucheurs', whether the women were
able to be upright and active? Whether they had amniotomies? How often
they were disturbed in labour? How many people (not chosen by the
woman to be there) were present for the birth? Whether there were
time limits imposed on the women? I could go on and on.....There are
so many confounding factors in any study that involves
humans, thus encoaching on human rights. Time to evolve new
research paradigms methinks, to become evidence based for humanity's
sake!
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