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Dear Belinda, I always become somewhat dismayed when I hear about trusts adopting "knee jerk" reactions to isolated incidents. Where is the evidence for implementing the practice of scanning all nulliparous women in labour? I would also question where they intend to obtain the resources for such a policy, particularly out of office hours. Are they going to rely upon the already over burdened junior doctors? Perhaps the consultant will be called each time a woman is admitted in labour? If they intend to train all the midwives in ultrasonography I would argue that the time and resources required would be better spent developing their basic midwifery skills and confidence in abdominal palpation in the antenatal period. Perhaps you could suggest that an audit of all women admitted to your unit in labour with an undiagnosed breech presentation be undertaken to ascertain how many women this actually affects. Once you have obtained the figures a clinical skills and education initiative could be implemented which focuses on diagnosis and management of breech presentation both antenatally and in the intrapartum periods followed by another audit to assess whether this has been effective in reducing the incidence. I think developing midwives' skills seems rather more sensible than an over reliance upon USS and a consequent decrease in basic midwifery. Claire Claire Davenport Research Midwife Research Midwives' Office, Level 6, Leazes Wing, Royal Victoria Infirmary, Newcastle Upon Tyne. NE1 4LP Tel: 0191 2820436 ________________________________ From: A forum for discussion on midwifery and reproductive health research. [mailto:[log in to unmask]] On Behalf Of Belinda Cox Sent: 11 May 2010 14:27 To: [log in to unmask] Subject: Breech presentation Dear all, Apologies for cross posting this. I really need some advice and support here - I'm almost in tears!! The Trust I work for has identified that we're having an increased number of women diagnosed with breech presentation in established labour, and are exploring the implementation of scanning all nulliparous women on admission in labour to confirm presentation!! My view is that we need to look at why the presentation isn't being confirmed PRIOR to labour if there's a query about it (e.g USS), and then if breech presentation is confirmed offering appropriate counselling and ECV. IF a woman chooses to have a CS for breech presentation it's better that she gives true consent (not in labour) and that it's done electively and calmly rather than her being 'encouraged' to have an emergency CS in labour. Have any other Trusts identifed this as a problem? does anyone have any teaching or assessment tools that they use which would support the midwives and obstetricians to decrease the number of breech presntations that are missed prior to labour? Any other thoughts on this? Best wishes, Belinda