Pushing before the breech is visible

Today’s story is about the line in the 2017 RCOG Breech guideline that says: While involuntary pushing may occur earlier, encouragement of maternal effort should not start until the breech is visible.

Physiological Breech Birth Algorithm, June 2022 -- https://optibreech.uk/wp-content/uploads/2023/04/algorithm-june-2022.pdf Seidler AL, Libesman S, Hunter KE, et al. Short, medium, and long deferral of umbilical cord clamping compared with umbilical cord milking and immediate clamping at preterm birth: a systematic review and network meta-analysis with individual participant data. Lancet. 2023;402(10418):2223-2234. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)02469-8/abstract Walker S, Scamell M, Parker P. Standards for maternity care professionals attending planned upright breech births: A Delphi study. Midwifery. 2016;34:7-14. https://doi.org/10.1016/j.midw.2016.01.007 Spillane E, Walker S, McCourt C. Optimal time intervals for vaginal breech births: a case-control study. NIHR Open Res. 2022;2:45. https://openresearch.nihr.ac.uk/articles/2-45/v2 Walker S, Das S, Stringer K, et al. How safe is it to plan a vaginal breech birth with OptiBreech collaborative care?: analysis of cumulative data within the OptiBreech Multiple Trials Cohort. NIHR Open Res. 2023;3:61. https://openresearch.nihr.ac.uk/articles/3-61/v1

Shawn's ORCID research page with contact information Rowe R, Li Y, Knight M, Brocklehurst P, Hollowell J. Maternal and perinatal outcomes in women planning vaginal birth after caesarean (VBAC) at home in England: secondary analysis of the Birthplace national prospective cohort study. BJOG. 2016;123(7):1123-1132. doi:10.1111/1471-0528.13546 Bayrampour H, Lisonkova S, Tamana S, Wines J, Vedam S, Janssen P. Perinatal outcomes of planned home birth after cesarean and planned hospital vaginal birth after cesarean at term gestation in British Columbia, Canada: A retrospective population-based cohort study. Birth. 2021;48(3):301-308. doi:10.1111/BIRT.12539 Li Y, Townend J, Rowe R, et al. Perinatal and maternal outcomes in planned home and obstetric unit births in women at ‘higher risk’ of complications: secondary analysis of the Birthplace national prospective cohort study. BJOG An Int J Obstet Gynaecol. 2015;122(5):741-753. doi:10.1111/1471-0528.13283 Alfirevic Z, Gyte GML, Cuthbert A, Devane D. Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour. Cochrane Database of Systematic Reviews 2017, Issue 2. Art. No.: CD006066. DOI: 10.1002/14651858.CD006066.pub3. Accessed 20 May 2024. Small KA, Sidebotham M, Fenwick J, Gamble J. Intrapartum cardiotocograph monitoring and perinatal outcomes for women at risk: Literature review. Women and Birth. 2020;33(5):411-418. doi:10.1016/J.WOMBI.2019.10.002

Physiological Breech Birth Training (online) Blog: Continuous Cyclic Pushing: a non-invasive method of optimising descent in vaginal breech births References for optimal time intervals in vaginal breech births: Reitter A, Halliday A, Walker S. Practical insight into upright breech birth from birth videos: A structured analysis. Birth. 2020;47(2):211-219. doi:10.1111/birt.12480 Spillane E, Walker S, McCourt C. Optimal time intervals for vaginal breech births: a case-control study. NIHR Open Res. 2022;2:45. doi:10.3310/nihropenres.13297.2 Birth video in which we began to encourage pushing following slower-than-expected descent, with no underlying concerns about fetal well-being prior to the birth of the pelvis: Adventures of the 'Dropped Foot' Baby

More information: Join us for our Breech-COS consensus meeting, Wednesday 8th May 2024, from 1 pm Zoom link here Book via the EventBrite page. OptiBreech publications, including Breech-COS work Savchenko J, et al. Comparing apples and oranges? Variation in choice and reporting of short-term perinatal outcomes of term labor: a systematic review of Cochrane reviews. Eur J Obstet Gynecol Reprod Biol. 2022;276:1-8. Molloy EJ, et al. Developing core outcome set for women’s, newborn, and child health: the CROWN Initiative. Pediatr Res 2018 843. 2018;84(3):316-317. COMET (Core Outcomes in Effectiveness Trials) website

Resources NIHR's Research Masterclass for Nurses, Midwives and Allied Healthcare Practitioners Shawn Walker's ⁠ORCID research profile⁠ Breech Birth Network Publications OptiBreech Publications If you are a student midwife or a recently qualified midwife, and you would like support to talk through clinical academic career pathways, you are welcome to book in via my calendar for a chat. Transcript Hello, and welcome to this brand spanking new OptiBirth podcast.   My name is Dr Shawn Walker, and I created this podcast to share new maternity care research in an accessible way. My goal is to help more maternity care professionals and members of the public understand research that can improve practice and outcomes for mothers and babies. I’m aiming to deliver this information in bite-sized chunks, along with references and resources you can use to apply the research in practice.   First, I’ll introduce myself and my background. I am a consultant midwife and clinical academic. My role as a consultant midwife is defined by what are called the four pillars of Advanced Practice.   1)         The first is that I am practising as an expert. My general area of expertise is in care during labour, particularly for women whose pregnancies are more complex than usual and are planning a physiological or vaginal birth. I also have specialist expertise in caring for women planning a vaginal breech birth and do consulting work in this capacity. 2)         The second pillar is strategic and enabling leadership. I do this by supporting services around the country that are improving their breech care pathways in line with research evidence. I also do it by supporting junior clinical academic midwives and other healthcare scientists who are developing their own clinical academic careers. 3)         The third pillar is learning, developing and improving across the system. I do this strategically and nationally through my quality improvement work. 4)         And the final pillar is research and innovation. Over half of my week is devoted to the design and delivery of new research to inform practice innovation.   The fact that I do both research and practice defines me as a clinical academic. I have recently completed an Advanced Fellowship funded by the National Institute for Health and Social Care Research (known as the NIHR). This is a post-doctoral award, awarded to someone who has completed a PhD, or doctoral research.   This means I have several extra years of research training beyond my professional qualification as a midwife. In this podcast, I hope to use that training to help more people use and understand maternity care research, and how it applies to their practice and their lives. You can find relevant links and more information about clinical academic career pathways for midwives at the OptiBirth Podcast link.   I hope to release a new episode every Monday morning at 6 am, so you can listen for a bit of inspiration on your way into a new work week, or on your way home from a night shift. Thanks for joining me.