Re: [ozmidwifery] Term Breech Trial

[Marilyn Kleidon]

Title: Message

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 ----- 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 Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Lynne Staff Sent: Saturday, 13 September 2003 8:05 AM To: [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 evolve new research paradigms methinks, to become evidence based for humanity's sake!