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Practical insight into upright breech birth from birth videos: A structured analysis.

ABSTRACT: BACKGROUND:We aimed to identify common features of upright vaginal breech births with good outcomes to refine a physiological approach to teaching breech birth. METHODS:We performed a structured analysis of 42 videos of successful upright breech births (eg, kneeling, hand/knees), facilitated by obstetricians (n = 34) and midwives (n = 8) in nine different countries. Precise timings and relevant clinical details were recorded on an Excel spreadsheet. Each video was analyzed twice by at least two members of the research team. Time-to-event intervals, frequencies of interventions, and descriptive statistics were calculated using SPSS. RESULTS:A completely spontaneous (labor mechanisms and maternal effort only) birth occurred in 14/42 (33%) cases. The median time between the birth of the fetal pelvis and the head in all births was 1:52 (IQR 1:05,2:46; min:sec). Lack of spontaneous rotation to a sacro-anterior position by the time the fetus had emerged to the nipple line was strongly associated with fetal arm entrapment. The following maneuvers were used: shoulder press to flex the aftercoming head in midpelvis or outlet (n = 24), sweeping down arm/s (n = 12), buttock lift to assist shoulder press (n = 6), modified Mauriceau (n = 6), rotational maneuvers to release an entrapped arm (n = 6), elevate and rotate fetal head to assist engagement (n = 2), and conversion into supine maternal position (n = 2). CONCLUSIONS:Most upright breech births occur within 3 minutes of the birth of the fetal pelvis. Upright breech birth attendants use variations of traditional maneuvers. We introduce a physiological breech algorithm as an initial timekeeping framework for teaching, research, and practice.

SUBMITTER: Reitter A

PROVIDER: S-EPMC7318698 | biostudies-literature | 2020 Jun

REPOSITORIES: biostudies-literature

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Practical insight into upright breech birth from birth videos: A structured analysis.

Reitter Anke A Halliday Alexandra A Walker Shawn S

Birth (Berkeley, Calif.) 20200120 2

<h4>Background</h4>We aimed to identify common features of upright vaginal breech births with good outcomes to refine a physiological approach to teaching breech birth.<h4>Methods</h4>We performed a structured analysis of 42 videos of successful upright breech births (eg, kneeling, hand/knees), facilitated by obstetricians (n = 34) and midwives (n = 8) in nine different countries. Precise timings and relevant clinical details were recorded on an Excel spreadsheet. Each video was analyzed twice b ...[more]

PMID: 31960492

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Project description:BackgroundEvidence-informed decision-making and better use of scientific information in societal decisions has been an area of development for decades but is still topical. Decision support work can be viewed from the perspective of information collection, synthesis and flow between decision-makers, experts and stakeholders. Open policy practice is a coherent set of methods for such work. It has been developed and utilised mostly in Finnish and European contexts.MethodsAn overview of open policy practice is given, and theoretical and practical properties are evaluated based on properties of good policy support. The evaluation is based on information from several assessments and research projects developing and applying open policy practice and the authors' practical experiences. The methods are evaluated against their capability of producing quality of content, applicability and efficiency in policy support as well as how well they support close interaction among participants and understanding of each other's views.ResultsThe evaluation revealed that methods and online tools work as expected, as demonstrated by the assessments and policy support processes conducted. The approach improves the availability of information and especially of relevant details. Experts are ambivalent about the acceptability of openness - it is an important scientific principle, but it goes against many current research and decision-making practices. However, co-creation and openness are megatrends that are changing science, decision-making and the society at large. Against many experts' fears, open participation has not caused problems in performing high-quality assessments. On the contrary, a key challenge is to motivate and help more experts, decision-makers and citizens to participate and share their views. Many methods within open policy practice have also been widely used in other contexts.ConclusionsOpen policy practice proved to be a useful and coherent set of methods. It guided policy processes toward a more collaborative approach, whose purpose was wider understanding rather than winning a debate. There is potential for merging open policy practice with other open science and open decision process tools. Active facilitation, community building and improving the user-friendliness of the tools were identified as key solutions for improving the usability of the method in the future.

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Dataset Information

Practical insight into upright breech birth from birth videos: A structured analysis.

Publications

Practical insight into upright breech birth from birth videos: A structured analysis.

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