Presentation Information
Avoiding Another Friedman Curve: Are We Ready to Relax Timing Limitations in Vaginal Breech?
- Speaker: Betty-Anne Daviss , RM, BJ, MA
- Presentation Type:
- Duration: 60 Mins
- Credits: 1 ACM CPD, 1 ACNM CEU, 0.1 Midwifery CEU
Abstract:
Normal birth has been plagued for 67 years by attempts to make it shorter based on arbitrary timelines. A systematic review of cervical patterns of low risk women have called into question the universal application of clinical standards based on an expectation of linear labour progress in all women. The WHO has affirmed that Friedman’s Curve of 1954-55 and the one centimetre an hour dilation threshold should no longer be used to identify adverse outcomes, as it is not evidence-based.
Now, in the era of fear of vaginal breech, attempts to gauge the safe length of second stage in vaginal breech is based on research in hospitals where induction and augmentation are widely used and the amount of time permitted for second stage has already been artificially cut off by assumptive hospital protocols.
The largest sample of upright vaginal breech birth (UVBB) to date was done in a Frankfurt hospital that uses protocols that do not arbitrarily limit second stage but nevertheless produce good outcomes. This suggests that hospitals that use very strict timelines may be producing a self-fulfilling prophecy of what is “normal” that imposes time limits not necessarily required to keep birth safe. Manoeuvres used to rectify problems, such as fundal pressure and “the Crowning Touch” will be demonstrated at this presentation—with their indications based on the failure of the physiological cardinal movements of the breech to transpire after several contractions, or when concerns about the fetal condition or maternal stamina arise. Reviewing problems with how proposed timelines in the breech have been developed and their shortcomings, it will be argued that focus should be on the condition of the fetus and mother rather than the clock.
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01-02-2022 08:00
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Avoiding Another Friedman Curve: Are We Ready to Relax Timing Limitations in Vaginal Breech?
Normal birth has been plagued for 67 years by attempts to make it shorter based on arbitrary timelines. A systematic review of cervical patterns of low risk women have called into question the universal application of clinical standards based on an expectation of linear labour progress in all women. The WHO has affirmed that Friedman’s Curve of 1954-55 and the one centimetre an hour dilation threshold should no longer be used to identify adverse outcomes, as it is not evidence-based.
Now, in the era of fear of vaginal breech, attempts to gauge the safe length of second stage in vaginal breech is based on research in hospitals where induction and augmentation are widely used and the amount of time permitted for second stage has already been artificially cut off by assumptive hospital protocols.
The largest sample of upright vaginal breech birth (UVBB) to date was done in a Frankfurt hospital that uses protocols that do not arbitrarily limit second stage but nevertheless produce good outcomes. This suggests that hospitals that use very strict timelines may be producing a self-fulfilling prophecy of what is “normal” that imposes time limits not necessarily required to keep birth safe. Manoeuvres used to rectify problems, such as fundal pressure and “the Crowning Touch” will be demonstrated at this presentation—with their indications based on the failure of the physiological cardinal movements of the breech to transpire after several contractions, or when concerns about the fetal condition or maternal stamina arise. Reviewing problems with how proposed timelines in the breech have been developed and their shortcomings, it will be argued that focus should be on the condition of the fetus and mother rather than the clock.
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