Topics & Abstracts

The International MotherBaby Childbirth Organization (IMBCO) and the International Federation of Gynecology and Obstetrics (FIGO) joined forces developing a single global initiative to provide guidance and support for safe and respectful maternity care. This work was built upon their previous initiatives and incorporates the most recent evidence and insights relating to quality maternal, newborn and child health provision. It also reflects much of the work being carried out by many organizations involved in maternal and newborn health throughout the world.

This initiative, The International Childbirth Initiative (ICI): 12 Steps to Safe and Respectful MotherBaby-Family Maternity Care was launched as a FIGO Presidential Initiative for 2018-2021 during the World Congress in Brazil in 2018 in a special side event with presentations from key partner organizations. ICI provides clear steps for the implementation of evidence-based maternity care worldwide, acknowledging the interaction between the MotherBaby dyad and Family environment as well as their interactions with health providers-and-systems. It provides a web-based platform of support for implementation and a self-initiated and self-reflective quality improvement cycle.

Objectives:

Objective 1: Describe the model and principles for the International Childbirth Initiative (ICI);

Objective 2: Discuss disrespectful care in labour and delivery;

Objective 3: List the 12 steps and indicators in the International Childbirth Initiative

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“Wellness” is defined as an active process of becoming aware of and making choices towards a healthy and fulfilling life. As our understanding of epigenetics grows, it is obvious that pregnancy is a time when we need to be supporting our clients to take an active role in creating wellness in their lives. This presentation will review the pregnancy experience from start to finish, including preconceptional counseling; what it entails and why it is important. Review obstetric care from trimester to trimester with a focus on the key areas where opportunities for creating wellness exist. Both routine obstetric visits and high-risk pregnancies will be examined. Learn how to improve outcomes by engaging your clients in actively taking responsibility for improving their health and wellbeing through things such as healthy eating, exercise and self-care.

Objectives:

1. Describe what preconceptional counseling entails, why it is important and when it should occur.
2. Identify key components of obstetric care in each trimester and how to incorporate aspects of wellness in each visit
3. Describe what healthy eating means during pregnancy and what activities/exercises are recommended as safe for physical activity.

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Principles of palliative medicine can benefit all medical disciplines, but none more so than obstetrics and gynecology. I will be discussing fundamentals of symptom management and helping to illustrate how patient-centered medical decision-making is of critical importance to birth work and the support of women in healthcare. Learn more about the principles of palliative medicine, a palliative approach to birth planning, a framework for breaking bad news and the importance of holding space.

Objectives:

Objective 1: Explain management of pain, nausea, constipation, and anxiety.;

Objective 2: Demonstrate palliative approach to birth planning;

Objective 3: Describe the importance of holding space in scary times;

Objective 4: Utilize a framework for breaking bad news.

Live Presentation Schedule Nov 9, 2020

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09-11-2020 19:00 09-11-2020 20:15 35 How The Principles of Palliative Medicine Can Improve Your Obstetrics Practice Principles of palliative medicine can benefit all medical disciplines, but none more so than obstetrics and gynecology. I will be discussing fundamentals of symptom management and helping to illustrate how patient-centered medical decision-making is of critical importance to birth work and the support of women in healthcare. Learn more about the principles of palliative medicine, a palliative approach to birth planning, a framework for breaking bad news and the importance of holding space. GOLD OBGYN Online Conference false DD/MM/YYYY

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Background: Simply stated, preeclampsia is new-onset hypertension with proteinuria during gestation. However, preeclampsia is complex, virtually affects every organ and is often confused with other entities--imitators of preeclampsia.

Methods: My aim is to provide clinicians with a working framework. Such framework is key in identifying underlying disease processes that mimic or predispose patients toward developing hypertensive disorders and evolving manifestations (eg, renal failure in SLE).

Results: Select data will be reviewed to tie in insights with numerous portals and pathophysiologic processes that lead to pre-eclampsia, hypertensive disorders or pregnancy and the so-called imitators of preeclampsia (eg, AFLP, HELLP, SLE, TTP-HUS). Underlying processes or preexisting chronic diseases all lead to an assortment of physiologic dysfunctions affecting uterus and kidney with or without additional organ involvement.

Conclusion: Many disease processes predispose toward preeclampsia and/or imitators of preeclampsia. Regardless of background and ultimate pathway, over-arching principles are shared.

Objectives:

Objective 1: Describe the classification schema for both hypertension and hypertensive d/o’s of pregnancy;

Objective 2: Explain guiding pathophysiologic principles and the pathways/manifestations arising in each;

Objective 3: List imitators of preeclampsia.

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Breast cancer is the most common cancer diagnosed during pregnancy. The incidence of breast cancer in pregnancy is expected to rise since women tend to postpone childbearing and the incidence of breast cancer increases with age. The management of this situation is a clinical challenge for all the involved health care providers and relies on multidisciplinarity and shared decision making with the patient and her partner. Diagnostic imaging and staging may be safely performed during pregnancy, favoring methods without ionizing radiations (e.g. ultrasound and MRI). Surgery is possible throughout the whole pregnancy. Chemotherapy can be safely administered to the mother starting from the second trimester, without fetal impairment. Data about the impact of chemotherapy on subsequent child development are reassuring, but long term follow-up is needed.

In this lecture we will present an overview of the current knowledge about the biology, prognosis and treatment options of breast cancer during pregnancy, highlighting results of recent research on neonatal outcome and recommendations concerning prenatal care!

Objectives:

Objective 1: Understanding epidemiology and biology of breast cancer during pregnancy (20 min) An overview of recent data will be presented, outlining epidemiological and biological peculiarity of breast cancer during pregnancy;

Objective 2: Understanding treatment modalities of breast cancer during pregnancy (20 min) Surgery, chemotherapy and supportive care of breast cancer during pregnancy will be presented;

Objective 3: Understanding the impact of chemotherapy on fetal/neonatal development (20 min) Data on placental toxicity obstetrical management and neonatal development will be presented

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Women are delaying pregnancy until older ages and fertility treatments mean that age is no longer a barrier to reproduction. Therefore women are more likely to have co-morbidities such as diabetes, hypertension, obesity and other chronic medical problems. Medical problems represent a more common cause of death in pregnancy and the puerperium than direct obstetric conditions. The most common cause of death in pregnancy in the developed world is cardiac disease. This lecture will discuss the most serious and most common presentations of medical problems on the labour ward and highlight important aspects of management. Effective management requires team work particularly with physicians, midwives and obstetric anaesthetists.

Causes of breathlessness, chest pain, headache and seizures will be covered and the management of asthma, pneumonia, acute coronary syndrome, pulmonary oedema, aortic dissection, pulmonary embolism discussed.

Objectives:

Objective 1: List the causes of chest pain in pregnancy;

Objective 2: List the causes of breathlessness in pregnancy;

Objective 3: Describe the diagnosis and management of pulmonary embolism in pregnancy;

Objective 4: Discuss the differential diagnosis of headache in pregnancy.

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Placenta accreta spectrum (PAS) is a rare iatrogenic pregnancy complication with an increasing incidence worldwide. PAS can cause serious maternal morbidity and even mortality at delivery. The aim of this presentation is to discuss the pathophysiology of the condition including: an explanation of the risk factors and how they lead to developing different severities, current policies for screening and the evidence behind the recommended management strategies.

Objectives:

Objective 1: Explain management of pain, nausea, constipation, and anxiety;

Objective 2: Demonstrate palliative approach to birth planning;

Objective 3: Describe the importance of holding space in scary times;br>
Objective 4: Utilize a framework for breaking bad news.

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Continuous cardiotocography (CTG) remain widely used for intrapartum fetal monitoring, despite the conflicting evidence regarding the benefits of such approach when compared with intermittent auscultation. Existing evidence on this topic will be re-analysed, together with the need to improve specific aspects of the CTG technology in order to achieve the best outcomes. Central fetal monitoring and computer analysis of CTGs is also widely disseminated in industrialised countries. Existing systems will be compared with an emphasis on system characteristics and demonstrated benefit.

Objectives:

Objective 1: Discuss the limitations of the existing evidence regarding the benefits and risks of cardiotocography when compared to intermittent auscultation.

Objective 2: Explain how intrapartum monitoring can be improved in order to reduce adverse outcomes.

Objective 3: List and compare the benefits and limitations of central fetal monitoring systems and of computer analysis of CTGs

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This Presentation will prevent an update on the latest incidence, etiology and pathophysiology of a twin pregnancy. We will discuss ultrasound imaging and the importance of chorionicity's determination and then follow a typical patient through pregnancy with key points for the diagnosis and treatment of complications. Special mention will be made of the latest evidence of preterm birth prevention in twins and thereafter will talk about twin birth and particularly the twin birth study.

Objectives:

Objective 1: Describe the importance of chorionicity determination in pregnancy;

Objective 2: Discuss the latest evidence of preterm prediction and prevention in twins;

Objective 3: Discuss the latest evidence behind the conduct of a safe twin delivery

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Quality research evidence demonstrates that intrapartum Cardiotocography monitoring in either low or high-risk populations fails to improve perinatal outcomes but drives harm by increasing the surgical birth rate. This evidence is not new, and obstetrics claims to be an evidence-based profession, yet there has been little interest or success in reducing the use of intrapartum CTG monitoring. This presentation draws on doctoral research which makes visible why it is so hard to align practice with evidence and challenges clinicians and leaders in our profession to rethink intrapartum fetal heart rate monitoring.

Objectives:

1. Summarise evidence pertaining to intrapartum CTG monitoring

2. Identify systemic structures which support and enable the ongoing inappropriate use of intrapartum CTG monitoring

3. Identify local opportunities to influence clinical practice relating to the use of intrapartum CTG monitoring

Live Presentation Schedule Nov 23, 2020

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23-11-2020 22:00 23-11-2020 23:15 35 Why is it so Hard to Align Clinical Practice with the Evidence About Cardiotocography Monitoring? Quality research evidence demonstrates that intrapartum Cardiotocography monitoring in either low or high-risk populations fails to improve perinatal outcomes but drives harm by increasing the surgical birth rate. This evidence is not new, and obstetrics claims to be an evidence-based profession, yet there has been little interest or success in reducing the use of intrapartum CTG monitoring. This presentation draws on doctoral research which makes visible why it is so hard to align practice with evidence and challenges clinicians and leaders in our profession to rethink intrapartum fetal heart rate monitoring. GOLD OBGYN Online Conference false DD/MM/YYYY

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Antenatal breastmilk expression may be suggested to mothers, including mothers with diabetes and obesity to improve breastfeeding and maternal and infant outcomes postpartum. It can be a tool for use in these special circumstances, collecting colostrum prenatally can permit supplementation of newborns at risk for hypoglycemia at birth, reducing the use of formula. It is important also to know that teaching mothers hand expression techniques prenatally improves breastfeeding rates. Other clinical cases that can benefit from this practice are women with insufficient glandular tissue, polycystic ovaries, and mothers who have breast surgery. Learn more about the current literature on antenatal milk extraction, the complexity of labour induction and whether there is any truth to the belief that it is not possible to stimulate the nipples during pregnancy because it could start labor, and how and when to implement antenatal milk extraction in practice.

Objectives:

Objective 1: Describe what the literature says about antenatal breastmilk expression

Objective 2: Discuss the complexity of induction of labor.

Objective 3: Describe useful tools for mothers and health professional for antenatal breastmilk expression.

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Promoting and protecting breastfeeding is crucial in medical practice. Learn more about general principles when approaching clinical scenarios involving breastfeeding dyads and common diagnoses and management strategies. Learn how to assess the normal breastfeeding parameters throughout infancy and the “first do no harm” approach to breastfeeding patients’ concerns. I will review some special circumstances and how to advise your breastfeeding patient in such circumstances.

Objectives:

1. Describe how promoting and protecting breastfeeding is crucial in medical practice,
2. Assess the normal breastfeeding parameters throughout infancy
3. Explain the ""first do no harm"" approach to breastfeeding patients' concerns
4. Analyze differing approaches to common breastfeeding clinical problems, including some unique situations involving the breastfeeding dyad

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Many women plan to use various pain medications during labour, with epidural analgesia being the most common type of pain relief utilized in many North American hospitals. Medications used for pain relief during labour cross transplacentally to the infant, with varying effects demonstrated on infants and mothers with regards to breastfeeding. Here we will take a closer look at what is involved in pain transmission signals, the medications that help with pain relief during labour, and the effects of these medications on initiation of breastfeeding. We will discuss issues relating to cesarean delivery, and we will also spend a little time at the end reviewing considerations around general anesthesia for breastfeeding mothers.

Objectives:

Objective 1. List the major types of pain relief available to mothers in labour and postpartum.

Objective 2. Discuss possible effects on infant breastfeeding initiation related to systemic medications used by labouring mothers.

Objective 3. List specific challenges in breastfeeding related to cesarean delivery

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In this presentation, Dr Pound will discuss the evidence supporting the importance of physician support, in order to encourage and maintain successful breastfeeding. An overview of recent research of Canadian physicians’ attitudes, comfort and knowledge with regards to breastfeeding will be provided, with a particular emphasis on specific knowledge gaps. Clinical scenarios will be discussed, in which ways to address breastfeeding difficulties will be examined, from the physician’s standpoint. Common universal myths and pitfalls will be addressed, and ways to efficiently integrate breastfeeding assessment into one’s clinical practice.

Objectives:

1. Discuss the importance of breastfeeding support by physicians
2. Examine breastfeeding knowledge gaps identified in recent research about Canadian physicians
3. Review some quick ways to address common breastfeeding issues
4. Discuss some evidence-based resources specifically created for Canadian physicians and how they may be implemented in other areas.

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This lecture reviews nipple and breast pain during pregnancy and both the early and late postpartum periods. It describes the anatomy and physiology of the breast and nipple areolar complex, and explores why pain during pregnancy and lactation is so common. Specific topics include the relationship between engorgement and infant latch; pump and other nipple trauma; hypo- and hyperlactation and how pain presents in these populations; vasospasm; dermatitis; nipple blebs; and, mastitis and plugging. The lecture also covers infant considerations and defines the lack of evidence for fungal infections as a significant contributor to pain. It delineates identification and treatment of functional pain and overlap of perinatal mood and anxiety disorders with pain.

Objectives:

Objective 1: Describe the complex innervation of the breast and explain why referred pain from deep in the breast to the nipple-areolar complex and reverse is so common.

Objective 2: List the most common causes of breast and nipple pain and the lack of evidence for fungal infections as a significant contributor.

Objective 3: Explain the overlap between perinatal mood and anxiety disorders and chronic pain in breastfeeding.

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Low milk supply is a common reason for breastfeeding mothers to seek care from their obstetric provider. Causes are multifactorial, including chronic disease, endocrine dysregulation, and environmental factors. Learn more about the latest updates and research on the causes of low milk supply and identifiable risk factors during pregnancy that may predict low milk supply. Updates on diagnostic workup and management of low milk supply will be discussed.

Objectives:

1. Discuss risk factors for low milk supply
2. Discuss diagnostic workup for low milk supply
3. Discuss management strategies for low milk supply and provide updates on current research findings

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The perinatal period is a time of great transition and uncertainty. It is normal for women to experience increased stress and anxiety as they adjust to changes in their body and life. But experiencing anxiety is not the same as having an anxiety disorder. Anxiety disorders are associated with intense distress and significant impairment in functioning (which can include problems caring for self and baby). Anxiety Disorders are estimated to occur in 9% to 22% of women during pregnancy and 11% to 21% of women postpartum. The good news is that Anxiety Disorders are treatable. Psychotherapies such as Cognitive Behavioural Therapy (CBT) are effective and have no known contraindications for pregnant and breastfeeding women. The goal of this presentation is to help front line health care professionals recognize problematic anxiety during the perinatal period and identify evidence-based interventions.

Objectives:

Objective 1: Differentiate “normal” anxiety from anxiety disorders;

Objective 2: Identify the anxiety and related disorders that are most likely to occur during pregnancy and postpartum;

Objective 3: Name three types of interventions that can help mothers with perinatal anxiety and related disorders.

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Maternal and paternal depression rates are elevated during the perinatal period compared to the normal population. Historically, fathers were excluded from perinatal mental health research but there is strong evidence that fathers have their own unique experiences that are more recently being considered within research. Mothers and fathers express and report depressive symptoms differently, which may influence detection of depression. Both parents’ mental health has an impact on parenting behaviors and the family functioning, which ultimately have an impact on child health. Perinatal clinical treatment would benefit from a comprehensive examination of the family dynamic to best provide treatment of perinatal depression and improve child health. Fathers can be utilized as an asset to mothers and clinicians to support maternal mental health. Future research is needed to optimize clinical treatment of perinatal mental illness that accounts for the full family dynamic.

Objectives:

Objective 1: Select appropriate screening/measurement tools for depression in mothers and fathers, and assess depression that may be expressed differently in both genders;

Objective 2: Determine the impact of mother and father’s depression and parenting behaviors on children;

Objective 3: Create treatment plans that are informed by the full family dynamic.

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Women suffering major mental illness such as schizophrenia or bipolar affective disorder face multiple challenges in pregnancy. The need to balance maternal mental health with fetal development is a crucial challenge. The best information available on the safety profile of antipsychotic, antidepressant and other medications is needed, but this is often difficult to access, or is contradictory. This presentation will include data on medication safety as well as associated other management aspects for the woman with special needs due to mental illness. Monitoring and treatment of gestational diabetes, infant drug withdrawal syndromes, and mental health support for the woman will be discussed.

Objectives:

Objective 1: Identify special issues for pregnant women with pre-existing psychosis;

Objective 2: Understand more about antipsychotic medication use in pregnancy;

Objective 3: Understand more about an integrated mental – health system approach for pregnant women with mental ill health.

Live Presentation Schedule Nov 4, 2019

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04-11-2019 09:00 04-11-2019 10:00 35 Managing Mental Illness in Pregnancy Women suffering major mental illness such as schizophrenia or bipolar affective disorder face multiple challenges in pregnancy. The need to balance maternal mental health with fetal development is a crucial challenge. The best information available on the safety profile of antipsychotic, antidepressant and other medications is needed, but this is often difficult to access, or is contradictory. This presentation will include data on medication safety as well as associated other management aspects for the woman with special needs due to mental illness. Monitoring and treatment of gestational diabetes, infant drug withdrawal syndromes, and mental health support for the woman will be discussed. GOLD OBGYN Online Conference false DD/MM/YYYY

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Perinatal mental health is a long-standing important public health issue worldwide with well documented negative effects on children, including delayed cognitive and language development, higher rates of behavioral problems, insecure or disorganized attachment, lower school-leaving grades and higher rates of depression at 16 to 18 years of age. This presentation will discuss the prevalence of perinatal mental health issues including depression, anxiety, and comorbid depression and anxiety. Risk factors will be outlined and consequences highlighted. Good principle for screening will be discussed to ensure accurate identification and follow-up. Preventive strategies based on best evidence will be presented and a and innovative treatment option will be discussed that is based on maternal preference. The use of technology will be reviewed to increase access and clinical utility and a new approach to the management of perinatal mental health will be presented.

Objectives:

Objective 1: Delegates will be able to define what perinatal mental health is, current prevalence rates and consequences;

Objective 2: Delegates will be able to clearly describe strategies for the identification of depression and anxiety across the perinatal period;

Objective 3: Delegates will be able to clearly describe interventions for perinatal mental prevention and treatment.

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The importance of fathers’ mental health is increasingly recognized as a significant factor in family life. As the construct of traditional society changes, it is becoming more commonplace for the father to be the primary carer of the infant. Should the mother suffer from a mental illness or disorder, then often the father is her main carer too. Studies have shown that if the father also suffers from mental ill health, this can have a significant impact on the relationship with the mother and have a detrimental effect on the development of the infant. Historically, men are conscious of their role as the provider and protector. The social expectations of men often preclude them from disclosing their feelings; therefore there is a tendency for them to confide their personal concerns to smaller networks of individuals, as they often fear they risk rejection should they admit to them publically. Studies have shown that if the complexities of their relationship with the partner are too much of an encumbrance, fathers often become distressed, frustrated and either withdraw into an activity or sport with which they feel more in control or resort to negative coping skills and misuse drugs and /or alcohol. They are more likely to ask for help when they experience suicide ideation. There are approximately 6,000 suicides annually in the UK.

Objectives:

Objective 1: Perinatal Mental Health in Fathers;

Objective 2: How to engage with Fathers;

Objective 3: Why it is important to screen and support fathers.

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Recent reports suggest that the percentage of mothers who experience birth trauma is much higher than previously realized. Those of us who support mothers, babies and birth know that if a mother has an overwhelming birth, it affects her perception of herself, her partner and her baby.Many women carry memories of difficult births their whole lives. This presentation will outline trauma sensitive approaches to helping families heal from difficult births using somatic or body-oriented practices as a base. Recent trends in trauma resolution will be discussed, including trauma informed care in the perinatal period, and polyvagal theory and its application for birth. A new model of obstetric care will be introduced that includes somatic trauma resolution skills, especially what it looks like to weave these tools into medical or private therapeutic practice. It will also include the baby’s experiences to complete a package of holistic trauma sensitive care for the birthing family.

Objectives:

Objective 1: Name identifying factors of birth trauma;

Objective 2: Identify different states in the body that are hallmarks of traumatic response, especially in women and babies;

Objective 3: Understand trauma sensitive and somatic healing approaches to supporting families who have had difficult births.

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It is no secret that vaginal breech birth can be dangerous; but can it be safe? Published in 2000, the Term Breech Trial suggested that cesarean section is markedly safer for all term breech fetuses in all clinical settings. It has led to a dramatic decrease in rates of vaginal breech birth and a reduction in the obstetrical skill set needed to attend them. Increased maternal morbidity and maternal deaths from unnecessary cesareans are now being observed. Unfortunately the Term Breech Trial protocol did not include adequate measures in the selection, intrapartum management and delivery technique to ensure safety. Larger trials with stricter safety measures have demonstrated that with a cautious protocol, breech birth can be conducted safely in appropriately supported obstetrical units. What are the important selection criteria, intrapartum management measures, and delivery techniques needed to ensure safety with vaginal breech birth? Dr. Kotaska will outline the safety deficits of the Term Breech Trial and contrast them to the practice of obstetrical units that have successfully demonstrated safe breech birth. Together with participants he will explore our understanding of the physiology of breech birth, identify key components that can compromise safety, and outline clinical measures to avoid or rectify them.

Objectives:

Objective 1: Outline the physiological differences between breech and cephalic birth and their implications for safety.
Objective 2: List the appropriate selection and intrapartum management criteria for safe vaginal breech birth.
Objective 3: List techniques to deal with complications of vaginal breech delivery.

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Identify what you see at the perineum to know what is going on in the pelvis with the breech birth. Breech obstructions; Here’s what you see when it is time to act.

Objectives:

Objective 1:Identify the way a breech baby looks when the arms are stuck on the inlet.
Objective 2: Compare arms over the inlet with an arm WITHIN the symphysis pubis
Objective 3: Describe perineal characteristics and signs of the extended breech head

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Vaginal breech birth options are disappearing from hospitals. Even when allowed, restrictive protocols may diminish success. Fear has replaced confidence in most practitioners and its projection has been detrimental to our clientele. The speaker has been assisting women with breech birthing for over 30 years, the last six in the home setting. During this talk the participant will be informed about counseling women on the risks and benefits of vaginal v. cesarean and home v. hospital birthing. We will discuss proper client selection and review breech techniques and maneuvers using narratives and videos of real breech deliveries, to enable the participant to practice problem-solving in real time. Finally, Dr. Fischbein will present his data from six years of assisting breech birth out of the hospital.

Objectives:

Objective 1: Counsel clients with a better understanding of the true risks and benefits of term breech birthing options.
Objective 2: Properly identify good candidates for vaginal breech option using practical selection criteria.
Objective 3: Identify when a breech baby needs assistance and be aware of proper positions and maneuvers.

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A majority of physiological breech births unfold according to a recognisable pattern of movements as the fetus spirals through the maternal pelvis. Protecting and supporting this optimal process is the basis of physiological breech birth practice. Understanding how and why these movements occur, and how to recognise when a deviation has occurred, is key to determining how and when to intervene in a potentially dangerous situation. This presentation will help you become thoroughly familiar with the optimal process, and explain why understanding the normal mechanisms can facilitate resolution when head entrapment occurs.

Objectives:

Objective 1: Demonstrate the mechanisms of optimal breech birth
Objective 2: Explain why knowledge of the mechanisms are key to safe practice
Objective 3: Determine the level of the pelvis at which head entrapment has

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Breech births occur infrequently, yet their safe support requires skill, patience and discernment from the health professionals who attend them, whether planned or unplanned. In addition, recent research has prompted practice changes toward more physiological approaches. This presentation will discuss how research around how professionals learn complex breech skills, and modern technology, can help midwives and doctors to learn skills to assist breech births. We will cover the importance of respecting the mechanism of breech labour when it is working, and restoring it when it is not. We will discuss how to determine the level of the pelvis at which head entrapment has occurred – and how to teach others to resolve it. And we will discuss successful models of breech care with the potential to lead a revolution in the direction of choice, confidence and continuity.

Objectives:

Objective 1: Explain why knowledge of the mechanisms of breech labour are key to safe practice
Objective 2: Determine the level of the pelvis at which head entrapment has occurred
Objective 3: Discuss the benefits of a breech team/clinic model

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