Author Identifier
Sara Morris
ORCID: 0000-0002-2714-1538
Document Type
Conference Proceeding
School
School of Nursing and Midwifery
Abstract
The safest mode of birth for breech babies has long been a topic of debate among researchers and clinicians. The publication of the Term Breech Trial (TBT) claimed that planned caesarean section (C/S) was the optimal mode of birth when compared to vaginal breech birth (VBB). Management of breech birth changed world-wide, with caesarean section becoming the principal mode of birth for breech presenting babies. Despite evidence demonstrating there is no significant difference in long term outcomes irrespective of birth mode, caesarean section remains the primary mode of birth for breech babies. This has led to the de-skilling of midwives and obstetricians and a limitation of birth choices for women.
The most current Green Top Guidelines, state that breech presentation alone is not an indication for a caesarean section. In order to increase women’s birth choices and address the lack of skilled clinicians, my proposed study is to plan/implement Western Australia’s first specialty breech clinic through action research, in order to provide women with all relevant information to make a fully informed decision and support regarding the choice of birth mode for their baby, as well as provide occasions for the re- or up-skilling of midwives and obstetrician in vaginal breech birth in a supportive, collaborative environment and hopefully reduce the culture of fear surrounding breech birth. The “clinic” would be run collaboratively by midwives and obstetricians in a continuity of care model, much like Midwifery Group Practices and the Community Midwifery Program, with midwives and obstetricians being called in as necessary.
This project has the potential to lead to practice changes to the benefit of childbearing women through an increase in autonomy and birth choices and perhaps a reduction in the C/S rate for breech presentation at term, reducing the financial burden on the health care system and maternal morbidity related to operative births. The increased confidence that may be gained by clinicians will benefit current and future midwives and obstetricians as vaginal breech birth techniques might become common practice. These benefits could lead to the normalisation of breech presentation, leading to (resulting in) a culture change and the fostering of collaborative partnerships between women, midwives and medical staff. It will also contribute to addressing a gap in the literature and may lead to a change in the culture of fear surrounding breech birth.
Comments
Morris, S. (2018). Specialty breech clinic: The development and implementation of a dedicated breech service in Western Australia. Paper presented at the Moving Midwifery Forward Conference, Joondalup, Western Australia, 17 March 2018.