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Friedrichsohn BK, Bauch SA, Starrach T, Pflanz M, Pecks U, Buechel J. [Ready to Care for Pregnant Women with Breech Presentation? - Results from an Online Survey for Midwives and Midwifery Students in Germany, Austria, and Switzerland]. Z Geburtshilfe Neonatol 2024. [PMID: 38830383 DOI: 10.1055/a-2309-4103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
The vaginal birth of breech presentation is an option for pregnant women supported by current German and international guidelines when favorable conditions and appropriately trained personnel are available. According to midwifery laws in the D-A-CH region, midwives should be able to provide care for a vaginal breech birth in emergencies. Therefore, imparting skills for breech delivery is enshrined in the curriculum for midwifery students. This study evaluated the knowledge and training needs of midwives and midwifery students in the German-speaking region. In May 2022, experiences, specific knowledge, and further training needs regarding vaginal breech birth were assessed through an online survey. Analysis of 467 questionnaires showed that only 30% of respondents currently attend vaginal breech births in their professional environment, but 50% would like to offer this service. 94% of respondents indicated that they would feel more confident if regular training opportunities, particularly simulations and virtual offerings, were provided for vaginal breech birth. However, currently only 10% of respondents receive regular training opportunities for vaginal breech births. The results suggest an increased provision of training opportunities for vaginal breech births to enhance midwives' safety in managing such births.
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Affiliation(s)
- Berit K Friedrichsohn
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Klinikum der Universität München, München, Germany
| | - Sebastian A Bauch
- School of Business and Health, Duale Hochschule Baden Württemberg, Stuttgart, Germany
| | - Teresa Starrach
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Klinikum der Universität München, München, Germany
| | - Mira Pflanz
- Lehrstuhl für maternale Gesundheit und Hebammenwissenschaften, Julius-Maximilians-Universität Würzburg, Würzburg, Germany
| | - Ulrich Pecks
- Lehrstuhl für maternale Gesundheit und Hebammenwissenschaften, Julius-Maximilians-Universität Würzburg, Würzburg, Germany
- Universitätsklinikum Würzburg, Frauenklinik und Poliklinik, Würzburg, Germany
| | - Johanna Buechel
- Lehrstuhl für maternale Gesundheit und Hebammenwissenschaften, Julius-Maximilians-Universität Würzburg, Würzburg, Germany
- Universitätsklinikum Würzburg, Frauenklinik und Poliklinik, Würzburg, Germany
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Practice and expectations regarding simulation for residents in obstetrics and gynecology. J Gynecol Obstet Hum Reprod 2021; 51:102306. [PMID: 34974149 DOI: 10.1016/j.jogoh.2021.102306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 12/10/2021] [Accepted: 12/29/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Simulation now has an important role in theoretical and practical aspects of medical education and training. METHODS We performed an epidemiological, observational, multicenter study based on nationwide data collection. French obstetrics and gynecologic residents were invited to complete an anonymous survey. RESULTS We received 305 answers. The most frequently offered gynecology sessions were laparoscopy on pelvitrainer (76%) and pelvic ultrasound (60%) while the most frequently offered obstetric sessions were breech delivery (61%), shoulder dystocia (62%) and postpartum hemorrhage (68%) managements. Regarding session frequency, 29.1% of residents thought that one session per month would be ideal. Two hundred and sixty three residents (96%) considered that simulation-training sessions were beneficial. One hundred and thirty-six residents (49%) had an opportunity to repeat sessions and a majority of them (96%) found a daily benefit following a training simulation session. CONCLUSION Simulation programs were extremely popular among the surveyed residents. To improve OBGYN resident training, simulation should be an integral part of residency programs.
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Yeoh SGJ, Rolnik DL, Regan JA, Lee PYA. Experience and confidence in vaginal breech and twin deliveries among obstetric trainees and new specialists in Australia and New Zealand. Aust N Z J Obstet Gynaecol 2018; 59:545-549. [DOI: 10.1111/ajo.12931] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 11/14/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Sara G. J. Yeoh
- Department of Obstetrics and Gynaecology; Monash Health; Melbourne Victoria Australia
| | - Daniel L. Rolnik
- Department of Obstetrics and Gynaecology; Monash Health; Melbourne Victoria Australia
| | - John A. Regan
- Department of Obstetrics and Gynaecology; Monash Health; Melbourne Victoria Australia
| | - Peter Y. A. Lee
- Department of Obstetrics and Gynaecology; Eastern Health; Melbourne Victoria Australia
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Chevreau J, Mercuzot A, Abou Arab O, Foulon A, Mancaux A, Sergent F, Gondry J. Management of labor during registrarship: A prospective study during a two-year registrarship program. J Obstet Gynaecol Res 2018; 45:331-336. [PMID: 30306666 DOI: 10.1111/jog.13835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 09/14/2018] [Indexed: 11/28/2022]
Abstract
AIM Labor management is often considered to be stressful. Increases in cesarean section (CSD) and assisted vaginal (AVD) deliveries rates have been ascribed to inexperience. To address this issue, we observed the obstetric management activity of four obstetrics and gynecology registrars throughout their 2-year registrarship program. METHODS We performed a prospective, observational study of urgent and semi-/nonurgent CSD and AVD in a tertiary maternity unit. The registrars' obstetric management was compared with that of a referral group. Changes over time in the registrars' practice were also monitored. RESULTS A total of 4328 deliveries (including 670 CSD and 736 AVD) were analyzed. The registrars and the experienced obstetricians managed 2930 and 1398 deliveries, respectively, with similar neonatal outcomes. There were no intergroup differences in either total CSD percentage (455 [15.5%] and 215 [15.4%] for registrars and experienced practitioners, respectively, P = 0.90) or AVD percentage (478 [16.3%] and 258 [18.5%], respectively, P = 0.08), or according to degree of urgency. Rates did not change over the course of the registrarship program, regardless of degree of urgency. CONCLUSION Lower degree of experience was not associated with elevated CSD or AVD rates. Skills required to appropriately manage an obstetric ward seemed to have been acquired at the end of residency.
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Affiliation(s)
- Julien Chevreau
- Department of Obstetrics and Gynecology, University Hospital of Amiens, CHU Amiens-Picardie, Amiens, France.,Inserm UMR 1105, GRAMFC (Groupe de Recherches sur l'Analyse Multimodale de la Fonction Cérébrale), Picardie Jules Verne University, Amiens, France
| | - Antonin Mercuzot
- Department of Obstetrics and Gynecology, University Hospital of Amiens, CHU Amiens-Picardie, Amiens, France
| | - Osama Abou Arab
- Department of Anaesthesiology and Critical Care Medicine, University Hospital of Amiens, CHU Amiens-Picardie, Amiens, France
| | - Arthur Foulon
- Department of Obstetrics and Gynecology, University Hospital of Amiens, CHU Amiens-Picardie, Amiens, France
| | - Albine Mancaux
- Department of Obstetrics and Gynecology, University Hospital of Amiens, CHU Amiens-Picardie, Amiens, France
| | - Fabrice Sergent
- Department of Obstetrics and Gynecology, University Hospital of Amiens, CHU Amiens-Picardie, Amiens, France
| | - Jean Gondry
- Department of Obstetrics and Gynecology, University Hospital of Amiens, CHU Amiens-Picardie, Amiens, France.,Inserm UMR 1105, GRAMFC (Groupe de Recherches sur l'Analyse Multimodale de la Fonction Cérébrale), Picardie Jules Verne University, Amiens, France
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Does vaginal breech delivery have a future despite low volumes for training? Results of a questionnaire. Eur J Obstet Gynecol Reprod Biol 2018; 229:123-126. [DOI: 10.1016/j.ejogrb.2018.08.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 08/13/2018] [Accepted: 08/14/2018] [Indexed: 11/20/2022]
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Chevreau J, Foulon A, Abou Arab O, Luisin M, Parent C, Sergent F, Gondry J. Management of breech and twin labor during registrarship: A two-year prospective, observational study. J Gynecol Obstet Hum Reprod 2018; 47:191-196. [PMID: 29510271 DOI: 10.1016/j.jogoh.2018.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 02/26/2018] [Accepted: 03/02/2018] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Breech presentation and twin pregnancy are regarded as stressful situations for medical staff. This stress is often associated with an increased likelihood of intervention during labor - especially when the on-shift obstetrician lacks experience. MATERIAL AND METHODS We performed a 2-year prospective, observational study of cesarean section (CSDs) and assisted vaginal (AVDs) deliveries in a tertiary maternity unit for attempted vaginal deliveries of breech presentations and twin pregnancies. The obstetric management decisions taken by a group of four registrars were compared with those taken by a group of 11 experienced obstetricians. Changes over time in practice were also monitored. RESULTS Registrars managed 66 and 52 breech presentations and twin pregnancies respectively (30 and 27 in the experienced group). Groups' neonatal outcomes were similar. There were no intergroup differences in proportions of CSDs for either breech presentations (25 [37.5%] vs. 15 [50%] in the registrar and experienced groups, respectively; P=0.26) or twin pregnancies (11 [21.1%] vs. 6 [22.2%], respectively; P=0.91) or in proportion of AVDs for twin pregnancies (41 [78.8%] vs. 21 [77.8%], respectively; P=0.91). Proportions of CSDs for breech presentation and AVDs for twin pregnancies did not change over time in either group. However, proportion of CSDs for twin pregnancies increased over time in the registrar group (P=0.004). DISCUSSION Well-trained registrars appeared to have acquired the skills required to safely manage an obstetric ward; this pleads to maintain clinical practice during residency to preserve low CSD and AVD rates.
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Affiliation(s)
- J Chevreau
- Department of Obstetrics and Gynecology, University Hospital of Amiens, CHU Amiens Sud, Amiens cedex 1, France; Inserm UMR 1105, GRAMFC (Groupe de Recherches sur l'Analyse Multimodale de la Fonction Cérébrale), Picardie Jules Verne University, CHU Amiens, avenue Laennec, 80054 Amiens, France.
| | - A Foulon
- Department of Obstetrics and Gynecology, University Hospital of Amiens, CHU Amiens Sud, Amiens cedex 1, France
| | - O Abou Arab
- Department of Anaesthesiology and Critical Care Medicine, University Hospital of Amiens, CHU Amiens Sud, Amiens cedex 1, France
| | - M Luisin
- Department of Obstetrics and Gynecology, University Hospital of Amiens, CHU Amiens Sud, Amiens cedex 1, France
| | - C Parent
- Department of Obstetrics and Gynecology, University Hospital of Amiens, CHU Amiens Sud, Amiens cedex 1, France
| | - F Sergent
- Department of Obstetrics and Gynecology, University Hospital of Amiens, CHU Amiens Sud, Amiens cedex 1, France
| | - J Gondry
- Department of Obstetrics and Gynecology, University Hospital of Amiens, CHU Amiens Sud, Amiens cedex 1, France; Inserm UMR 1105, GRAMFC (Groupe de Recherches sur l'Analyse Multimodale de la Fonction Cérébrale), Picardie Jules Verne University, CHU Amiens, avenue Laennec, 80054 Amiens, France
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Walker S, Scamell M, Parker P. Deliberate acquisition of competence in physiological breech birth: A grounded theory study. Women Birth 2017; 31:e170-e177. [PMID: 28969997 DOI: 10.1016/j.wombi.2017.09.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Revised: 07/05/2017] [Accepted: 09/08/2017] [Indexed: 11/24/2022]
Abstract
PROBLEM Research suggests that the skill and experience of the attendant significantly affect the outcomes of vaginal breech births, yet practitioner experience levels are minimal within many contemporary maternity care systems. BACKGROUND Due to minimal experience and cultural resistance, few practitioners offer vaginal breech birth, and many practice guidelines and training programmes recommend delivery techniques requiring supine maternal position. Fewer practitioners have skills to support physiological breech birth, involving active maternal movement and choice of birthing position, including upright postures such as kneeling, standing, squatting, or on a birth stool. How professionals learn complex skills contrary to those taught in their local practice settings is unclear. QUESTION How do professionals develop competence and expertise in physiological breech birth? METHODS Nine midwives and five obstetricians with experience facilitating upright physiological breech births participated in semi-structured interviews. Data were analysed iteratively using constructivist grounded theory methods to develop an empirical theory of physiological breech skill acquisition. RESULTS Among the participants in this research, the deliberate acquisition of competence in physiological breech birth included stages of affinity with physiological birth, critical awareness, intention, identity and responsibility. Expert practitioners operating across local and national boundaries guided less experienced practitioners. DISCUSSION The results depict a specialist learning model which could be formalised in sympathetic training programmes, and evaluated. It may also be relevant to developing competence in other specialist/expert roles and innovative practices. CONCLUSION Deliberate development of local communities of practice may support professionals to acquire elusive breech skills in a sustainable way.
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Affiliation(s)
- Shawn Walker
- City, University of London, Centre for Maternal and Child Health Research, Northampton Square, London EC1 V0HB, UK; King's College London, Florence Nightingale Faculty of Nursing and Midwifery, London SE1 8WA, UK.
| | - Mandie Scamell
- City, University of London, Centre for Maternal and Child Health Research, Northampton Square, London EC1 V0HB, UK
| | - Pam Parker
- City, University of London, Learning Enhancement and Development, Northampton Square, London EC1 V0HB, UK
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Hejl L, Perdriolle-Galet E, Gauchotte E, Callec R, Morel O. [Vaginal delivery in case of breech presentation: Impact of a service's incentive]. ACTA ACUST UNITED AC 2017; 45:596-603. [PMID: 28964728 DOI: 10.1016/j.gofs.2017.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Accepted: 08/23/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The mode of delivery in podalic presentation was controvertible since the 2000s, which led to a high rate of caesarean section. In our center, the delivery mode was physician-dependent before 2012. Since 2012, the management of podalic presentations was supervised by a protocol allowing a collegiate management to promote vaginal delivery. The objective of this study was to evaluate the impact of this policy on neonatal outcomes and obstetric practices. METHODS A retrospective study was carried out with comparison of 135 patients who gave birth in 2008 with 110 patients who gave birth in 2014, before and after the implementation of the protocol in a type III university maternity hospital. Two hundred and forty-five singleton pregnancies with podalic presentation and a gestational age more than 32 weeks of gestation were included in this study. The rate of vaginal delivery trial, the evolution of clinical practices and neonatal outcomes were respectively compared. RESULTS One hundred and twenty-six patients who gave birth in 2008 were compared to the 105 one of 2014. The rate of successful vaginal birth trial increased from 32.7% (n=16/49) to 63.8% (n=37/58) (P>0.05) between the two periods, this induced a decrease of 16.3% of planned caesarean sections rate [(77/126) versus (47/105) (P<0.02)] and of 6.2% of emergency caesarean sections rate [(33/126) versus (21/105) (P<0.001)]. No significant difference was observed regarding neonatal outcomes. CONCLUSIONS This work shows that it is possible to limit the rate of planned and emergency caesarean sections because of an incentive policy of service without impact on neonatal morbidity and mortality.
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Affiliation(s)
- L Hejl
- Service d'obstétrique et médecine fœtale, maternité du centre hospitalier régional universitaire de Nancy, 10, rue du Dr-Heydenreich, Nancy, France.
| | - E Perdriolle-Galet
- Service d'obstétrique et médecine fœtale, maternité du centre hospitalier régional universitaire de Nancy, 10, rue du Dr-Heydenreich, Nancy, France; Laboratoire IADI, unité Inserm U947, université de Lorraine, 54500 Vandoeuvre-lès-Nancy, France
| | - E Gauchotte
- Service d'obstétrique et médecine fœtale, maternité du centre hospitalier régional universitaire de Nancy, 10, rue du Dr-Heydenreich, Nancy, France
| | - R Callec
- Service d'obstétrique et médecine fœtale, maternité du centre hospitalier régional universitaire de Nancy, 10, rue du Dr-Heydenreich, Nancy, France; Laboratoire IADI, unité Inserm U947, université de Lorraine, 54500 Vandoeuvre-lès-Nancy, France
| | - O Morel
- Service d'obstétrique et médecine fœtale, maternité du centre hospitalier régional universitaire de Nancy, 10, rue du Dr-Heydenreich, Nancy, France; Laboratoire IADI, unité Inserm U947, université de Lorraine, 54500 Vandoeuvre-lès-Nancy, France; France PremUp Foundation, Paris, France
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Jordan A, El Haloui O, Breaud J, Chevalier D, Antomarchi J, Bongain A, Boucoiran I, Delotte J. Formation des internes de gynécologie obstétrique : évaluation d’un programme pédagogique intégrant cours théoriques et sessions pratiques sur simulateurs. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.gyobfe.2015.06.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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