Breech Competency Documentation (Mobile and Upright Breech)

Breech birth called me to it through my own birth of Nilaya who is now 12.  I didn’t initially seek out the knowledge of such skills, but I did have a core belief that breech was a variation of normal birth.

I’ve created and compiled documents for Breech Competency Documentation and have received input from various people along the way.  I originally naively thought I’d just ask NARM to take it on so I formatted it similarly so as to be familiar to midwives and students.  Thank you to all who have contributed to my project.  I’m sure many have thought I could have improved the list, but you still have your chance, because it is still open for input.  I do want to thank those who have spent the time caring about my growth as a midwife who cares about the craft of midwifery and breech birth.  Thanks go to those mentors who have taught me and continue to teach me including Gail Tully, Diane Goslin, Shawn Walker, Jane Evans, Anke Reitter, Adrienne Caldwell,  and Stuart Fischbein.   Many have not seen or given input on these documents, but they must be mentioned here as they, and others like Betty Anne-Davis, Frank Louwen, Andrew Bisits, Mary Cronk, Peter J. O’Neill, and Mary Cooper, are dedicated to this work in a way that is changing birth.  A special thank you to Gail Tully, Diane Goslin, Shawn Walker and Vickii Gervais for supporting me and combing through the skills lists –  editing, correcting, working on improving language, and educating me about important details.  

As a midwife, I’ve realized that learning the details of attending breech may just be the doorway for learning head down birth!  The attention to details of what Shawn Walker has called “Respecting the Mechanism” and “Restoring the Mechanism” applies to life in general.  I use these terms for teaching or mentoring “Normal Birth,” “Shoulder Dystocia” and “Breech Birth.” 

Why document competency?  The nice thing about competency documentation is that it helps those who have done the work and have experience document it.  It also helps us keep track of new information of breech alongside one’s history of trainings and continuing education if ever a birth comes under scrutiny.  Documentation can also be one way to keep breech legal as state after state begins to give away breech as there is no bar of competency.  It also can be kept by the person who has done the work and doesn’t need to be part of a larger body although both could be an option.  I’ve tried to include provisions for breech mentors to be able to continue practicing with a wide variation of normal.  Who am I to limit those with experience or tell them how it is done?   I’m open to suggestions in the language where I might now have followed through on these points.  

These documents were actually compiled for me and by me.  How can I become and document my road to competency when breech birth isn’t always readily available to attend?  What is next on this journey of mine?  What steps can I take and how can I refine what I know to keep this craft alive and reteach and know in my bones the art of breech?   Maybe others’ vision of a breech center for learning will be brought to reality at some point as well, and I can be its student.  

The list of skills focuses on upright breech for a mobile person.  I have some of the assists as being retrospective review so that previously attended births can be used.  One of the most difficult parts of this paperwork is deciding who is a preceptor and who isn’t.  The best standard out there is presented in The Delphi Study which having attended 20 vaginal breech births is the minimum for expertise.  However, we do acknowledge that some may have 20 uncomplicated breech deliveries and others may need to use their skills sooner.  Understanding how to resolve complications at all levels of the pelvis and understanding the list of skills would also be part of qualifying.   The preceptor paperwork is still under development and should really be created by a group of qualified preceptors themselves.

Anyways, I’m posting this compilation publicly since I’ve been sitting on it for so long.  I’m ready for discussion and suggestions as this discussion is worth having. I know there will be hard questions that we may have to grapple with as a community as to what could be the effects of having such documentation.  I’m ready to move forward and humbly post this as others have asked me to do.

Feedback welcomed! Please contact Nicole Morales.