Re: [ozmidwifery] term breech trial - ECV option
Title: Re: [ozmidwifery] Fwd: term breech trial There are 2 OBs at Rosebud Hospital who do ECVs. One of them will attend standing vag beech on insistent request at the level 2 units on the Peninsula. But women don't request it, they opt for C/S instead. With kind regardsBrenda Manning www.themidwife.com.au - Original Message - From: Helen and Graham To: ozmidwifery@acegraphics.com.au Sent: Wednesday, October 11, 2006 12:52 PM Subject: [ozmidwifery] term breech trial - ECV option I think it would be good to get a list of providers in each state who are performing External Cephalic Version ECV. I know, having just been to Box Hill Maternity for an inservice, they have one or two progressive obstetricians who have a regularECV clinic. They have theatre on standby if needed. I am sure plenty of women would be prepared to travel far and wide if they knew this option existed and could possibly avoid the need for LUSCS. I know this is not optimal, but at least some women may avoid LUSCS if ECV is offered. I think it is performed at 37 weeks to be the most successful. I would also be interested in other units offering this service to tell the women in my care if anyone knows of them. Thanks Helen Cahill - Original Message - From: Justine Caines To: OzMid List Sent: Wednesday, October 11, 2006 11:08 AM Subject: Re: [ozmidwifery] Fwd: term breech trial Hi ChrisI am a rural consumer, with knowledge of practices pretty much across the country.The term breech trial has done us in. I agree the paper turning it on its head (no pun intended!) is basically being ignored. The only vaginal breech I hear of or see in the stats, (other than those at JHH with Andrew Bisits) in the system are the undiagnosed ones and if a woman is very lucky the 2nd twin who is dragged out by forceps after she has consented to an epidural (often the only way she will be allowed to have twins vaginally).So what to do?Midwives: Raise this in clinical forums and instead of presenting the evidence for vaginal breech ask Drs what their evidence is for routine c/s. If you come across women with a breech on board provide them with all the info Consumers: Put it out there that breech does not necessarily equal c/s and continue to mount the arguments of the furphy of risk (for much of obstetrics). Support women we meet to demand choice.JCJustine CainesNational Policy Co-ordinatorMaternity Coalition IncPO Box 625SCONE NSW 2329Ph: (02) 65453612Fax: (02)65482902Mob: 0408 210273E-Mail: [EMAIL PROTECTED]www.maternitycoalition.org.au__ NOD32 1.1797 (20061010) Information __This message was checked by NOD32 antivirus system.http://www.eset.com
RE: [ozmidwifery] term breech trial - ECV option
Title: Re: [ozmidwifery] Fwd: term breech trial further to supporting ECV is osteotherapy. My osteopath recently shared with me her experience of treating a client with a breech baby who was being forced into having a c/s. Her Dr's were very synical of the idea. Working with both, the woman had scans etc but also had a treatment before (not sure how long) the ECV. Osteo can treat both Mum and baby, creating a nice spacious environment and perhaps addressing some fears the baby has etc. In this case, bubs turned beautifully, much to the astonishment of the medical Dr's. I have personally experienced an Osteo treatment with my 3rd baby who was very much responding to the hands on my belly. I could feel him hidingand eventually he came to her and it was incredibly clear to me what was going on. After, the osteo who was also my friend, was able to express some very interesting stuff about my baby that made sense. as said, if an ECV is a womans only option for a breech lay then supporting it is important. cheers Megan From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of nunyaraSent: Thursday, 12 October 2006 9:12 AMTo: ozmidwifery@acegraphics.com.auSubject: RE: [ozmidwifery] term breech trial - ECV option Hi all! Most of you probably already know that acupuncture can help turn a breech baby. I know of some mothers who have used Moxa (a Chinese herb Mugwort in a rolled form which is lit and applied to a specific acupuncture point Bladder 67) successfully to turn a breech bub and for others it has not worked. However, I would recommend that professional acupuncture treatment be sought as acupuncturists use Moxa as well. I have recently read an article in the Journal of Complementary Medicine (which is a journal for doctors and pharmacists who are trying to get in on natural therapies) which covered a scientific trial in the use of acupuncture to turn breech babies. Of the group who had acupuncture treatment, most of those babies turned but out of the group who received no treatment, only a couple of the bubs turned. The outcome of the trial was that acupuncture was successful with breech presentations. I am madly trying to find which Journal this article was in but I have safely put it away (which means that I probably wont ever be able to find it again!) I am a Bowen therapist as well and have used bowen a couple of times with breech and the bubs have turned. I think trying acupuncture and/or Bowen though is preferable to doing nothing and ending up with a C/S. Cheers, Ramona Lane Nunyara, Bargara Beach, Qld. From: owner-ozmidwifery@acegraphics.com.au [mailto:owner-ozmidwifery@acegraphics.com.au] On Behalf Of Honey AcharyaSent: Wednesday, 11 October 2006 2:18 PMTo: ozmidwifery@acegraphics.com.auSubject: Re: [ozmidwifery] term breech trial - ECV option Here in Townsville Qld some of the Ob's in the Townsville Hospital perform ECV's. David Watson is particulary successful at this and I have seen him perform a few and he seems to have the right touch and technique, the women who had other Ob's try on them firstand then himsaid he was much more gentle and it looked that way too. He has the woman lie on her side slightly and rests his knee behind their back, and using ultrasound on and off to monitor baby's position, then pushes the baby around getting them to either do a forward somersault or backward one. The private Ob's here refuse to do it all together. I noticed they are also performing the EECV trial (EarlyECV) around 33-34 weeks? One of the women I was with was being offerred this optionbut declined preferring to give her baby further time to turn and then at 37-38 weeks when baby was still in the breech position had a successful ECV and went on to have a straightforward normal vaginal birth at 41 weeks. Honey - Original Message - From: Helen and Graham To: ozmidwifery@acegraphics.com.au Sent: Wednesday, October 11, 2006 12:52 PM Subject: [ozmidwifery] term breech trial - ECV option I think it would be good to get a list of providers in each state who are performing External Cephalic Version ECV. I know, having just been to Box Hill Maternity for an inservice, they have one or two progressive obstetricians who have a regularECV clinic. They have theatre on standby if needed. I am sure plenty of women would be prepared to travel far and wide if they knew this option existed and could possibly avoid the need for LUSCS. I know this is not optimal, but at least some women may avoid LUSCS if ECV is offered. I think it is performed at 37 weeks to be the most successful. I would also be interested in other units offering this service to tell the women in my care if anyone knows of them. Thanks Helen Cahill - Original Message - From
Re: [ozmidwifery] term breech trial - ECV option
Title: Re: [ozmidwifery] term breech trial - ECV option As a British midwife I have experienced lots of breeches but this was the first time in the water. It was amazing as the water stopped that hang and the pressure that the cord is sometimes under. Apart from dropping my trousers there was no contact with the woman and her baby, just whispers and encouragement. She did it totally unassisted complete hand off the breech. I feel so proud to be involved with women who have such confidence in their birthing ability. That's half the problems we are facing here. Both women and lots of midwives are scared and don't trust birth. As a midwife we should be highly skilled and knowledgeable, but knowing when to get involved and when to just watch is the greatest skill of all. Lisa Barrett Hi Lisa, Mary and All What a great story! My 2nd twin was breech and was also born into water (untouched until the very end). I had caught twin 1 but wasnt as quick with twin 2 so as she slid out one of our wonderful midwives lightly pushed the babe back towards the front so she would not bob up behind me and instead floated to the front and was essentially caught by me. My babe was footling breech (single). First I knew was our midwife said theres a foot. I remember thinking as her body slid out, brace yourself for the head but it was really quite easy (yes I had just birthed another babe I know!!). She had apgars of 9 and 9. The only discernable difference between her cephalic sister and her was she was a teeny bit shocked and had a wee cry. I am going to try and upload the photos somehow as quite a few people have contacted me (out of interest re twins) JC
Re: [ozmidwifery] term breech trial - ECV option
Justine I would LOVE to see these !!JoOn 12/10/2006, at 9:49 PM, Justine Caines wrote: As a British midwife I have experienced lots of breeches but this was the first time in the water. It was amazing as the water stopped that hang and the pressure that the cord is sometimes under. Apart from dropping my trousers there was no contact with the woman and her baby, just whispers and encouragement. She did it totally unassisted complete hand off the breech.I feel so proud to be involved with women who have such confidence in their birthing ability. That's half the problems we are facing here. Both women and lots of midwives are scared and don't trust birth. As a midwife we should be highly skilled and knowledgeable, but knowing when to get involved and when to just watch is the greatest skill of all. Lisa Barrett Hi Lisa, Mary and All What a great story! My 2nd twin was breech and was also born into water (untouched until the very end). I had caught twin 1 but wasn’t as quick with twin 2 so as she slid out one of our wonderful midwives lightly pushed the babe back towards the front so she would not bob up behind me and instead floated to the front and was essentially caught by me. My babe was footling breech (single). First I knew was our midwife said there’s a foot. I remember thinking as her body slid out, brace yourself for the head but it was really quite easy (yes I had just birthed another babe I know!!). She had apgars of 9 and 9. The only discernable difference between her cephalic sister and her was she was a teeny bit ‘shocked’ and had a wee cry. I am going to try and upload the photos somehow as quite a few people have contacted me (out of interest re twins) JC
Re: [ozmidwifery] term breech trial - ECV option
Title: Re: [ozmidwifery] Fwd: term breech trial Well I birthed with a woman on the weekend (and asked her permission before posting this) She had a breech birth in the water. As far as I'm concerned it is a normal vaginal birth and although it was a compound presentation it was very straight forward indeed. Maybe if the attitude of more people is that it's just a variation of normal (and it is) then women wouldn't be so scared. Ultimately it's not up to Obs to "do it" or not it's up to the women. The thought of using ECV to put the baby into the correct position just a choice. Just as breech position maybe the baby's choice. Lisa Barrett - Original Message - From: Honey Acharya To: ozmidwifery@acegraphics.com.au Sent: Wednesday, October 11, 2006 1:47 PM Subject: Re: [ozmidwifery] term breech trial - ECV option Here in Townsville Qld some of the Ob's in the Townsville Hospital perform ECV's. David Watson is particulary successful at this and I have seen him perform a few and he seems to have the right touch and technique, the women who had other Ob's try on them firstand then himsaid he was much more gentle and it looked that way too. He has the woman lie on her side slightly and rests his knee behind their back, and using ultrasound on and off to monitor baby's position, then pushes the baby around getting them to either do a forward somersault or backward one. The private Ob's here refuse to do it all together. I noticed they are also performing the EECV trial (EarlyECV) around 33-34 weeks? One of the women I was with was being offerred this optionbut declined preferring to give her baby further time to turn and then at 37-38 weeks when baby was still in the breech position had a successful ECV and went on to have a straightforward normal vaginal birth at 41 weeks. Honey
[ozmidwifery] term breech trial - ECV option
Title: Re: [ozmidwifery] Fwd: term breech trial resending this message as it didn't seem to appear the last time I posted it Lisa Barrett From: Lisa Barrett To: ozmidwifery@acegraphics.com.au Sent: Wednesday, October 11, 2006 4:27 PM Subject: Re: [ozmidwifery] term breech trial - ECV option Well I birthed with a woman on the weekend (and asked her permission before posting this) She had a breech birth in the water. As far as I'm concerned it is a normal vaginal birth and although it was a compound presentation it was very straight forward indeed. Maybe if the attitude of more people is that it's just a variation of normal (and it is) then women wouldn't be so scared. Ultimately it's not up to Obs to "do it" or not it's up to the women. The thought of using ECV to put the baby into the correct position just a choice. Just as breech position maybe the baby's choice. Lisa Barrett - Original Message - From: Honey Acharya To: ozmidwifery@acegraphics.com.au Sent: Wednesday, October 11, 2006 1:47 PM Subject: Re: [ozmidwifery] term breech trial - ECV option Here in Townsville Qld some of the Ob's in the Townsville Hospital perform ECV's. David Watson is particulary successful at this and I have seen him perform a few and he seems to have the right touch and technique, the women who had other Ob's try on them firstand then himsaid he was much more gentle and it looked that way too. He has the woman lie on her side slightly and rests his knee behind their back, and using ultrasound on and off to monitor baby's position, then pushes the baby around getting them to either do a forward somersault or backward one. The private Ob's here refuse to do it all together. I noticed they are also performing the EECV trial (EarlyECV) around 33-34 weeks? One of the women I was with was being offerred this optionbut declined preferring to give her baby further time to turn and then at 37-38 weeks when baby was still in the breech position had a successful ECV and went on to have a straightforward normal vaginal birth at 41 weeks. Honey
RE: [ozmidwifery] term breech trial - ECV option
Title: Re: [ozmidwifery] Fwd: term breech trial Lisa, could you describe this for us? MM She had a breech birth in the water. As far as I'm concerned it is a normal vaginal birth and although it was a compound presentation it was very straight forward indeed.
RE: [ozmidwifery] term breech trial - ECV option
Title: Re: [ozmidwifery] Fwd: term breech trial I like this article J: http://www.birthinternational.com/articles/andrea13.html From: owner-ozmidwifery@acegraphics.com.au [mailto:owner-ozmidwifery@acegraphics.com.au] On Behalf Of Lisa Barrett Sent: Wednesday, October 11, 2006 11:06 AM To: ozmidwifery@acegraphics.com.au Subject: [ozmidwifery] term breech trial - ECV option resending this message as it didn't seem to appear the last time I posted it Lisa Barrett From: Lisa Barrett To: ozmidwifery@acegraphics.com.au Sent: Wednesday, October 11, 2006 4:27 PM Subject: Re: [ozmidwifery] term breech trial - ECV option Well I birthed with a woman on the weekend (and asked her permission before posting this) She had a breech birth in the water. As far as I'm concerned it is a normal vaginal birth and although it was a compound presentation it was very straight forward indeed. Maybe if the attitude of more people is that it's just a variation of normal (and it is) then women wouldn't be so scared. Ultimately it's not up to Obs to do it or not it's up to the women. The thought of using ECV to put the baby into the correct position just a choice. Just as breech position maybe the baby's choice. Lisa Barrett - Original Message - From: Honey Acharya To: ozmidwifery@acegraphics.com.au Sent: Wednesday, October 11, 2006 1:47 PM Subject: Re: [ozmidwifery] term breech trial - ECV option Here in Townsville Qld some of the Ob's in the Townsville Hospital perform ECV's. David Watson is particulary successful at this and I have seen him perform a few and he seems to have the right touch and technique, the women who had other Ob's try on them firstand then himsaid he was much more gentle and it looked that way too. He has the woman lie on her side slightly and rests his knee behind their back, and using ultrasound on and off to monitor baby's position, then pushes the baby around getting them to either do a forward somersault or backward one. The private Ob's here refuse to do it all together. I noticed they are also performing the EECV trial (EarlyECV) around 33-34 weeks? One of the women I was with was being offerred this optionbut declined preferring to give her baby further time to turn and then at 37-38 weeks when baby was still in the breech position had a successful ECV and went on to have a straightforward normal vaginal birth at 41 weeks. Honey
Re: [ozmidwifery] term breech trial - ECV option
Title: Re: [ozmidwifery] Fwd: term breech trial Hi Mary, do you mean the birth? Well baby was in a type of yoga positionsitting onone foot . She birthed a foot then the bum then the rest of one leg, next came a knee and the rest of the second leg and foot followed on. she slide out to her abdomen and the water was holding her beautifully the cord not stretched as there was no real downward traction due to the water. She was cycling her legs. First arm came very easily. Second arm didn't seem to be appearing and we could see the arm pit. After two contractions I admit I took off my socks and shoes and was just dropping my trousers when an elbow appeared. Trousers back up. hand must have been at face as it was a few more minutes, then once hand came she slide to the nape of her neck. Chin and mouth appeared showing her head was well tucked in and the woman just breathed this out slowly catching her baby through her legs. cord around the neck x2 apgar 5 at1 9 by 3 mins. She birthed the first foot at 0.55 and completed her birth at 1.18. As a British midwife I have experienced lots of breeches but this was the first time in the water. It was amazing as the water stopped that hang and the pressure that the cord is sometimes under. Apart from dropping my trousers there was no contact with the woman and her baby, just whispers and encouragement. She did it totally unassisted complete hand off the breech. I feel so proud to be involved with women who have such confidence in their birthing ability. That's half the problems we are facing here. Both women and lots of midwives are scared and don't trust birth. As a midwife we should be highly skilled and knowledgeable, but knowing when to get involved and when to just watch is the greatest skill of all. Lisa Barrett - Original Message - From: Mary Murphy To: ozmidwifery@acegraphics.com.au Sent: Wednesday, October 11, 2006 10:09 PM Subject: RE: [ozmidwifery] term breech trial - ECV option Lisa, could you describe this for us? MM She had a breech birth in the water. As far as I'm concerned it is a normal vaginal birth and although it was a compound presentation it was very straight forward indeed.
RE: [ozmidwifery] term breech trial - ECV option
Title: Re: [ozmidwifery] Fwd: term breech trial Hi all! Most of you probably already know that acupuncture can help turn a breech baby. I know of some mothers who have used Moxa (a Chinese herb Mugwort in a rolled form which is lit and applied to a specific acupuncture point Bladder 67) successfully to turn a breech bub and for others it has not worked. However, I would recommend that professional acupuncture treatment be sought as acupuncturists use Moxa as well. I have recently read an article in the Journal of Complementary Medicine (which is a journal for doctors and pharmacists who are trying to get in on natural therapies) which covered a scientific trial in the use of acupuncture to turn breech babies. Of the group who had acupuncture treatment, most of those babies turned but out of the group who received no treatment, only a couple of the bubs turned. The outcome of the trial was that acupuncture was successful with breech presentations. I am madly trying to find which Journal this article was in but I have safely put it away (which means that I probably wont ever be able to find it again!) I am a Bowen therapist as well and have used bowen a couple of times with breech and the bubs have turned. I think trying acupuncture and/or Bowen though is preferable to doing nothing and ending up with a C/S. Cheers, Ramona Lane Nunyara, Bargara Beach, Qld. From: owner-ozmidwifery@acegraphics.com.au [mailto:owner-ozmidwifery@acegraphics.com.au] On Behalf Of Honey Acharya Sent: Wednesday, 11 October 2006 2:18 PM To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] term breech trial - ECV option Here in Townsville Qld some of the Ob's in the Townsville Hospital perform ECV's. David Watson is particulary successful at this and I have seen him perform a few and he seems to have the right touch and technique, the women who had other Ob's try on them firstand then himsaid he was much more gentle and it looked that way too. He has the woman lie on her side slightly and rests his knee behind their back, and using ultrasound on and off to monitor baby's position, then pushes the baby around getting them to either do a forward somersault or backward one. The private Ob's here refuse to do it all together. I noticed they are also performing the EECV trial (EarlyECV) around 33-34 weeks? One of the women I was with was being offerred this optionbut declined preferring to give her baby further time to turn and then at 37-38 weeks when baby was still in the breech position had a successful ECV and went on to have a straightforward normal vaginal birth at 41 weeks. Honey - Original Message - From: Helen and Graham To: ozmidwifery@acegraphics.com.au Sent: Wednesday, October 11, 2006 12:52 PM Subject: [ozmidwifery] term breech trial - ECV option I think it would be good to get a list of providers in each state who are performing External Cephalic Version ECV. I know, having just been to Box Hill Maternity for an inservice, they have one or two progressive obstetricians who have a regularECV clinic. They have theatre on standby if needed. I am sure plenty of women would be prepared to travel far and wide if they knew this option existed and could possibly avoid the need for LUSCS. I know this is not optimal, but at least some women may avoid LUSCS if ECV is offered. I think it is performed at 37 weeks to be the most successful. I would also be interested in other units offering this service to tell the women in my care if anyone knows of them. Thanks Helen Cahill - Original Message - From: Justine Caines To: OzMid List Sent: Wednesday, October 11, 2006 11:08 AM Subject: Re: [ozmidwifery] Fwd: term breech trial Hi Chris I am a rural consumer, with knowledge of practices pretty much across the country. The term breech trial has done us in. I agree the paper turning it on its head (no pun intended!) is basically being ignored. The only vaginal breech I hear of or see in the stats, (other than those at JHH with Andrew Bisits) in the system are the undiagnosed ones and if a woman is very lucky the 2nd twin who is dragged out by forceps after she has consented to an epidural (often the only way she will be allowed to have twins vaginally). So what to do? Midwives: Raise this in clinical forums and instead of presenting the evidence for vaginal breech ask Drs what their evidence is for routine c/s. If you come across women with a breech on board provide them with all the info Consumers: Put it out there that breech does not necessarily equal c/s and continue to mount the arguments of the furphy of risk (for much of obstetrics). Support women we meet to demand choice. JC Justine Caines National Policy Co-ordinator Maternity Coalition Inc PO Box 625 SCONE NSW 2329 Ph: (02) 65453612 Fax: (02)65482902
[ozmidwifery] term breech trial - ECV option
Title: Re: [ozmidwifery] Fwd: term breech trial I think it would be good to get a list of providers in each state who are performing External Cephalic Version ECV. I know, having just been to Box Hill Maternity for an inservice, they have one or two progressive obstetricians who have a regularECV clinic. They have theatre on standby if needed. I am sure plenty of women would be prepared to travel far and wide if they knew this option existed and could possibly avoid the need for LUSCS. I know this is not optimal, but at least some women may avoid LUSCS if ECV is offered. I think it is performed at 37 weeks to be the most successful. I would also be interested in other units offering this service to tell the women in my care if anyone knows of them. Thanks Helen Cahill - Original Message - From: Justine Caines To: OzMid List Sent: Wednesday, October 11, 2006 11:08 AM Subject: Re: [ozmidwifery] Fwd: term breech trial Hi ChrisI am a rural consumer, with knowledge of practices pretty much across the country.The term breech trial has done us in. I agree the paper turning it on its head (no pun intended!) is basically being ignored. The only vaginal breech I hear of or see in the stats, (other than those at JHH with Andrew Bisits) in the system are the undiagnosed ones and if a woman is very lucky the 2nd twin who is dragged out by forceps after she has consented to an epidural (often the only way she will be allowed to have twins vaginally).So what to do?Midwives: Raise this in clinical forums and instead of presenting the evidence for vaginal breech ask Drs what their evidence is for routine c/s. If you come across women with a breech on board provide them with all the info Consumers: Put it out there that breech does not necessarily equal c/s and continue to mount the arguments of the furphy of risk (for much of obstetrics). Support women we meet to demand choice.JCJustine CainesNational Policy Co-ordinatorMaternity Coalition IncPO Box 625SCONE NSW 2329Ph: (02) 65453612Fax: (02)65482902Mob: 0408 210273E-Mail: [EMAIL PROTECTED]www.maternitycoalition.org.au__ NOD32 1.1797 (20061010) Information __This message was checked by NOD32 antivirus system.http://www.eset.com
Re: [ozmidwifery] term breech trial - ECV option
Title: Re: [ozmidwifery] Fwd: term breech trial Here in Townsville Qld some of the Ob's in the Townsville Hospital perform ECV's. David Watson is particulary successful at this and I have seen him perform a few and he seems to have the right touch and technique, the women who had other Ob's try on them firstand then himsaid he was much more gentle and it looked that way too. He has the woman lie on her side slightly and rests his knee behind their back, and using ultrasound on and off to monitor baby's position, then pushes the baby around getting them to either do a forward somersault or backward one. The private Ob's here refuse to do it all together. I noticed they are also performing the EECV trial (EarlyECV) around 33-34 weeks? One of the women I was with was being offerred this optionbut declined preferring to give her baby further time to turn and then at 37-38 weeks when baby was still in the breech position had a successful ECV and went on to have a straightforward normal vaginal birth at 41 weeks. Honey - Original Message - From: Helen and Graham To: ozmidwifery@acegraphics.com.au Sent: Wednesday, October 11, 2006 12:52 PM Subject: [ozmidwifery] term breech trial - ECV option I think it would be good to get a list of providers in each state who are performing External Cephalic Version ECV. I know, having just been to Box Hill Maternity for an inservice, they have one or two progressive obstetricians who have a regularECV clinic. They have theatre on standby if needed. I am sure plenty of women would be prepared to travel far and wide if they knew this option existed and could possibly avoid the need for LUSCS. I know this is not optimal, but at least some women may avoid LUSCS if ECV is offered. I think it is performed at 37 weeks to be the most successful. I would also be interested in other units offering this service to tell the women in my care if anyone knows of them. Thanks Helen Cahill - Original Message - From: Justine Caines To: OzMid List Sent: Wednesday, October 11, 2006 11:08 AM Subject: Re: [ozmidwifery] Fwd: term breech trial Hi ChrisI am a rural consumer, with knowledge of practices pretty much across the country.The term breech trial has done us in. I agree the paper turning it on its head (no pun intended!) is basically being ignored. The only vaginal breech I hear of or see in the stats, (other than those at JHH with Andrew Bisits) in the system are the undiagnosed ones and if a woman is very lucky the 2nd twin who is dragged out by forceps after she has consented to an epidural (often the only way she will be allowed to have twins vaginally).So what to do?Midwives: Raise this in clinical forums and instead of presenting the evidence for vaginal breech ask Drs what their evidence is for routine c/s. If you come across women with a breech on board provide them with all the info Consumers: Put it out there that breech does not necessarily equal c/s and continue to mount the arguments of the furphy of risk (for much of obstetrics). Support women we meet to demand choice.JCJustine CainesNational Policy Co-ordinatorMaternity Coalition IncPO Box 625SCONE NSW 2329Ph: (02) 65453612Fax: (02)65482902Mob: 0408 210273E-Mail: [EMAIL PROTECTED]www.maternitycoalition.org.au__ NOD32 1.1797 (20061010) Information __This message was checked by NOD32 antivirus system.http://www.eset.com
[ozmidwifery] term breech trial.
Hi Andrea, Was reading your online diary and was very interested to learn about this new article. As you can see it is in the current issue of AJOG. Lets hope that all Obs. are taking note. Lisa Five years to the term breech trial: The rise and fall of a randomized controlled trial. American Journal of Obstetrics Gynecology. 194(1):20-25, January 2006.Glezerman, Marek MD Abstract: Objective: On the basis of the end points of neonatal morbidity and death, the authors of the term breech trial concluded unequivocally that cesarean delivery was safer for breech babies. Study design: Analysis of the original and new data gives rise to serious concerns as far as study design, methods, and conclusions are concerned. In a substantial number of cases, there was a lack of adherence to the inclusion criteria. There was a large interinstitutional variation of standard of care; inadequate methods of antepartum and intrapartum fetal assessment were used, and a large proportion of women were recruited during active labor. In many instances of planned vaginal delivery, there was no attendance of a clinician with adequate expertise. Results: Most cases of neonatal death and morbidity in the term breech trial cannot be attributed to the mode of delivery. Moreover, analysis of outcome after 2 years has shown no difference between vaginal and abdominal deliveries of breech babies. Conclusion: The original term breech trial recommendations should be withdrawn. (C) Mosby-Year Book Inc. 2006. All Rights Reserved.
Re: [ozmidwifery] term breech trial.
Lisa Barrett [EMAIL PROTECTED] wrote: Was reading your online diary and was very interested to learn about this new article. As you can see it is in the current issue of AJOG. Lets hope that all Obs. are taking note. Sadly I dont think they are- the reason it was so well received in the first place was that it gave them a great reason to CS another group of women, and because of that a whole generation of new OB's have never developed the skills needed. Many midwives have the skills - but over here (Canada) we are expected to have the OB do the birth. At the conference in MArch we are discussing the use of these trials and the damage they have caused in OB, and have an Australian OB coming to talk on how skills are being taught to new residents/midwives and how we can teach the next generation. Interestingly the majority of the delegates so far are midwives - agghh, preaching to the converted. If you know of any OB's who may be interested in coming up to speed on the latest in breech birth - feel free to pass on conference info. Best wishes Jane www.breechbirthconference.com -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] Term Breech Trial
Title: Message
Prof Marc Keirse (editor of Effective Care) has
done quite allot ofvery critical critiquing of the TBT. He has
written a number of things about the failures of the TBT. I don't know
when they have been published but know that they have been published in the
Birth Perinatal Issues Journal (Blackwell science). He sent me them "for
some light reading over xmas" a few years agoI would have to ask his
permission to send them to anyone directly, but sure you will find them in
Birth. Prof has been one of the most outspoken critics of the
TBT.
yeah, I know I was going off list, but haven't had
time yet!!
Jo Bainbridgefounding member CARES SAwww.cares-sa.org.au[EMAIL PROTECTED]phone: 08 8388
6918birth with trust, faith love...
- Original Message -
From:
Mary
Murphy
To: [EMAIL PROTECTED]
Sent: Saturday, September 13, 2003 6:22
PM
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 -
From:
Wayne
and Caroline McCullough
To: [EMAIL PROTECTED]
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
-Original Message-From:
[EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED] On Behalf Of Lynne
StaffSent: Saturday, 13 September 2003 8:05 AMTo:
[EMAIL PROTECTED]Subject: Re: [ozmidwifery] Term
Breech Trial
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 evolvenew research paradigms
methinks, to become evidence based for humanity's sake!
Re: [ozmidwifery] Term Breech Trial
Title: Message
Yes please
Denise
- Original Message -
From:
Jo
Dean Bainbridge
To: [EMAIL PROTECTED]
Sent: Sunday, September 14, 2003 12:15
AM
Subject: Re: [ozmidwifery] Term Breech
Trial
Prof Marc Keirse (editor of Effective Care) has
done quite allot ofvery critical critiquing of the TBT. He has
written a number of things about the failures of the TBT. I don't know
when they have been published but know that they have been published in the
Birth Perinatal Issues Journal (Blackwell science). He sent me them "for
some light reading over xmas" a few years agoI would have to ask his
permission to send them to anyone directly, but sure you will find them in
Birth. Prof has been one of the most outspoken critics of the
TBT.
yeah, I know I was going off list, but haven't
had time yet!!
Jo Bainbridgefounding member CARES SAwww.cares-sa.org.au[EMAIL PROTECTED]phone: 08 8388
6918birth with trust, faith love...
- Original Message -
From:
Mary
Murphy
To: [EMAIL PROTECTED]
Sent: Saturday, September 13, 2003 6:22
PM
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 -
From:
Wayne and Caroline McCullough
To: [EMAIL PROTECTED]
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
-Original Message-From:
[EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED] On Behalf Of Lynne
StaffSent: Saturday, 13 September 2003 8:05 AMTo:
[EMAIL PROTECTED]Subject: Re: [ozmidwifery] Term
Breech Trial
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 evolvenew research paradigms
methinks, to become evidence based for humanity's sake!
Re: [ozmidwifery] Term Breech Trial
Title: Message 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 - From: Wayne and Caroline McCullough To: [EMAIL PROTECTED] 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 -Original Message-From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Lynne StaffSent: Saturday, 13 September 2003 8:05 AMTo: [EMAIL PROTECTED]Subject: Re: [ozmidwifery] Term Breech Trial 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 evolvenew research paradigms methinks, to become evidence based for humanity's sake!
RE: [ozmidwifery] Term Breech Trial Critique--long
(2 damaged caesarean babies v. 26vaginal) and those with a high perinatal mortality rate (12 v. 13). Sobreech babies born vaginally in richer countries were twice as likely to bedamaged as babies in poor countries.From Breech Birth Beyond the Term Breech Trial by Midwife Maggie Banks:http://www.birthspirit.co.nz/TermTrial.htmThe medical literature frequently acknowledges doctors lack expertise invaginal breech birth. Obstetric training schemes are inadequate due to theproliferation of delivery by elective Caesarian section which means doctorsare simply not able to develop the skills necessary for safe vaginal breechbirth...The report notes reduced benefit of Caesarian section in somecountries - the authors postulate possibly because of higher levels ofexperience with vaginal breech delivery in those countries.Maggie Banks has also written an outstanding book for birth attendants aboutbreech birth. It contains many photos and diagrams too. 'Breech BirthWoman-Wise' http://www.birthspirit.co.nz/BBWW.htmBirthLove's breech birth stories, articles and references:http://www.birthlove.com/pages/stories/breech.htmlA breech birth website: http://www.breechbabies.com/ Note that thiswebsite by Patricia Blomme contains many breech birth resources, including avideo list, links, birth stories and breech birth photos.Midwives and Mothers: use the BirthLove site to share your wisdom aboutbreech birth. I will publish all you need to say- as anonymously as youwish. And I am in the early stages of creating a book all about vaginalbreech births. Send me your stories to share- and together we will put theHannah study to shame. Email me- [EMAIL PROTECTED]Leilah McCracken[EMAIL PROTECTED]Mother of eight beautiful children, and the BirthLove website.http://www.birthlove.com Living the future of birth and parenting, today! -Original Message-From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Mary MurphySent: Saturday, 13 September 2003 6:53 PMTo: [EMAIL PROTECTED]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
Re: [ozmidwifery] Term Breech Trial
Title: Message The following are all critiques of the TBT , first 2 are freely available on the web .I can email a copy of the third one off list if required. Cheers, David Banks M (2001) Breech Birth Beyond the Term Breech Trial ,sighted at http://www.birthspirit.co.nz Somerset, D (2002) Managing term breech deliveries : Term breech trial does not provide unequivocal evidence [Letters] BMJ ,5 January 2002,Volume 324(7328) p 50 Keirse M (2002) Evidence-Based Childbirth Only For Breech Babies? Birth ,Volume 29 Issue 1 Page 55 - March 2002 - Original Message - From: Mary Murphy To: [EMAIL PROTECTED] Sent: Saturday, September 13, 2003 6:52 PM 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 - From: Wayne and Caroline McCullough To: [EMAIL PROTECTED] 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 -Original Message-From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Lynne StaffSent: Saturday, 13 September 2003 8:05 AMTo: [EMAIL PROTECTED]Subject: Re: [ozmidwifery] Term Breech Trial 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 evolvenew research paradigms methinks, to become evidence based for humanity's sake!
Re: [ozmidwifery] Term Breech Trial
Title: Message Mary Maggie Banks' web site has a critique ot the Term Breech trial at http://www.birthspirit.co.nz/ Denise - Original Message - From: Mary Murphy To: [EMAIL PROTECTED] 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 - From: Wayne and Caroline McCullough To: [EMAIL PROTECTED] 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 -Original Message-From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Lynne StaffSent: Saturday, 13 September 2003 8:05 AMTo: [EMAIL PROTECTED]Subject: Re: [ozmidwifery] Term Breech Trial 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 evolvenew research paradigms methinks, to become evidence based for humanity's sake!
Re: [ozmidwifery] Term Breech Trial
Title: Message
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 -
From:
Marilyn
Kleidon
To: [EMAIL PROTECTED]
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 oraugmented, 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 -
From:
Denise Hynd
To: [EMAIL PROTECTED]
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
http://www.birthspirit.co.nz/
Denise
- Original Message -
From:
Mary
Murphy
To: [EMAIL PROTECTED]
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 -
From:
Wayne and Caroline McCullough
To: [EMAIL PROTECTED]
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
-Original Messa
Re: [ozmidwifery] Term Breech Trial
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 evolvenew research paradigms methinks, to become evidence based for humanity's sake! - Original Message - From: Marilyn Kleidon To: [EMAIL PROTECTED] Sent: Thursday, September 11, 2003 12:09 PM Subject: Re: [ozmidwifery] Term Breech Trial Well, it couldn't have been a randomised controlled trial if the women could have chosen either a c/s or a vb. it must have been approved by the ethics committee, so the women must have agreed to be in the trial and so must have known they would be randomally assigned? I hope, one can only hope. I have read critiques of the trial and I think the main problem was the variability of experience of the birth attendants also I think they had to be obstetricians not midwives. Could be very very wrong, am very willing to be corrected. marilyn - Original Message - From: Kristin Beckedahl To: [EMAIL PROTECTED] Sent: Tuesday, September 09, 2003 11:02 PM Subject: [ozmidwifery] Term Breech Trial To all you wise and inspiration women on this list; I'm a C.B.E student hoping to get some feedback on the Term Breech Trial - what are your opinions on the limitations of this trial..? Do you think it should have continued for the full 5 years? Is the fact that these women were 'randomly assigned planned CS or planned VB' contradict the purpose of this trial? Do you think if all of them had the opportunity to choose themselves which type of birth they would have liked, results would have been different? Any feedback would be most welcomed! Cheers, Kristin E-mail just got a whole lot better. New ninemsn Premium. Upgrade now! -- This mailing list is sponsored by ACE Graphics. Visit to subscribe or unsubscribe.
RE: [ozmidwifery] Term Breech Trial
Title: Message 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 -Original Message-From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Lynne StaffSent: Saturday, 13 September 2003 8:05 AMTo: [EMAIL PROTECTED]Subject: Re: [ozmidwifery] Term Breech Trial 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 evolvenew research paradigms methinks, to become evidence based for humanity's sake!
[ozmidwifery] Term Breech Trial
To all you wise and inspiration women on this list; I'm a C.B.E student hoping to get some feedback on the Term Breech Trial - what are your opinions on the limitations of this trial..? Do you think it should have continued for the full 5 years? Is the fact that these women were 'randomly assigned planned CS or planned VB' contradict the purpose of this trial? Do you think if all of them had the opportunity to choose themselves which type of birth they would have liked, results would have been different? Any feedback would be most welcomed! Cheers, Kristin E-mail just got a whole lot better. New ninemsn Premium. Upgrade now! -- This mailing list is sponsored by ACE Graphics. Visit to subscribe or unsubscribe.
Re: [ozmidwifery] Term Breech Trial
Well, it couldn't have been a randomised controlled trial if the women could have chosen either a c/s or a vb. it must have been approved by the ethics committee, so the women must have agreed to be in the trial and so must have known they would be randomally assigned? I hope, one can only hope. I have read critiques of the trial and I think the main problem was the variability of experience of the birth attendants also I think they had to be obstetricians not midwives. Could be very very wrong, am very willing to be corrected. marilyn - Original Message - From: Kristin Beckedahl To: [EMAIL PROTECTED] Sent: Tuesday, September 09, 2003 11:02 PM Subject: [ozmidwifery] Term Breech Trial To all you wise and inspiration women on this list; I'm a C.B.E student hoping to get some feedback on the Term Breech Trial - what are your opinions on the limitations of this trial..? Do you think it should have continued for the full 5 years? Is the fact that these women were 'randomly assigned planned CS or planned VB' contradict the purpose of this trial? Do you think if all of them had the opportunity to choose themselves which type of birth they would have liked, results would have been different? Any feedback would be most welcomed! Cheers, Kristin E-mail just got a whole lot better. New ninemsn Premium. Upgrade now! -- This mailing list is sponsored by ACE Graphics. Visit to subscribe or unsubscribe.
Re: [ozmidwifery] Term Breech Trial
In a message dated 10/09/03 4:04:39 PM AUS Eastern Standard Time, [EMAIL PROTECTED] writes: To all you wise and inspiration women on this list; I'm a C.B.E student hoping to get some feedback on the Term Breech Trial - what are your opinions on the limitations of this trial..? Do you think it should have continued for the full 5 years? Is the fact that these women were 'randomly assigned planned CS or planned VB' contradict the purpose of this trial? Do you think if all of them had the opportunity to choose themselves which type of birth they would have liked, results would have been different? Any feedback would be most welcomed! Cheers, Kristin Hi Kristin and everyone, there has been much discussion of the results of the term breech trial in the midwifery communitynot all interpretations of the study's findings that planned CS is better than planned vaginal birth for term breech babes has been embraced by all. The study was a RCT of over 2000 women, across 26 countries involving 121 different centresI always felt that even with the strictest study measures and compliance with the study protocolsthere would still be inconsistencies with how breech birth is 'conducted' in these 121 centres and potentially could be enough to instil some bias as to the results even with the best of study designs Scientifically speaking, the 'robustness' of the term breech trial was rooted in the 'clinical experience' of the clinician's experience in working with vaginal breech birth. However, according to Lumley (2000) this bias was 'managed' by "four different definitions of the clinicians experience" in vaginal breech birth. Over 80% of the women who birthed vaginally, had a clinician who self declared to having greater than 10 years 'experience' with vaginal breech birththis being another of the study's limitations Further limitations of the study I feel are the scant details as to how these women birthed their breech babies (other than the clinical characteristics I mean) What we do know is that of the 1042 women who were allocated to planned vaginal birth, 591 (56.7%) birthed vaginally...15% of these women were induced with oxytocics or prostin, just under 50% of them had ARM and labour augmentation with oxytocics and 25% of the women had epidurals.What we don't know is how prepared these women were for vaginal breech birth, what attitudes, skills and knowledge did their caregivers have to work with women during labour or their attitudes to vaginal breech birth, what positions etc...were adopted by the woman or facilitated by the 'clinician' to successfully achieve vaginal breech birth etc etcIn a nut shellthe greatest limitation of the study was that it was based on highly managed birth...be it vaginal or not. Finally, the greatest criticism comes in how the authors analysed their data on PMR...where they failed to exclude growth restricted babies and babes that died from circumstances than those directly related to vaginal breech birth.Many researchers in the literature have cited this point as a major downfall of the term breech trial...believing that the results would demonstrate a more equal PMR and neonatal mortality rates in both the planned LUSCS and vaginal birth groups if these stats had be excluded (Giuliani et al 2002). Ref: Lumley J. (2000) 'Any room left for disagreement about assisting breech births at term?' Commentary cited in the Lancet Vol 356 No. 9239 Oct 2000. Guliani A., Scholl WMJ, Basver A., et al (2002) 'Mode of delivery and outcome of 699 term singleton breech deliveries at a single centre.' American Journal of Obstetrics and Gynecology , vol 187, no 6, December 2002, pp 1694-1698 Yours in reforming midwifery Tina Pettigrew. B Mid Student ACU Melb http://groups.yahoo.com/group/BMidStudentCollective/ " As we trust the flowers to open to new life - So we can trust birth" Harriette Hartigan. ---
