A breech conference, 60 years ago

On November 22, 1957, the Obstetrics & Gynaecology section of the Royal Society of Medicine held a conference on breech. Conference notes were published in the March 1958 edition of the Proceedings of the Royal Society of Medicine (PDF).

It is a fascinating read. As I have been finishing conference summaries from the 2017 Sheffield breech conference, I reflected on how similar these two conferences were in spirit, although miles apart in content. I found the same collegiality, curiosity, and desire to improve outcomes. However, many of the practices seem quite out-of-date now. (Which makes me wonder: 60 years from now, what innovations discussed in Sheffield will have stood the test of time?)

I also noticed a marked gender shift in conference presenters, from exclusively male in 1958 to majority female in 2017 (with the 2017 audience predominantly female).

Here's a breakdown of speakers & topics and a "summary of the summaries," if you will. I would definitely read the originals, so I hope my brief teasers are enough to get you interested.

Dr. G. F. Abercrombie (London): The Timing of External Version. He advocates early external version beginning around the 30-32 weeks. Reports on his personal series of ECVs.

Mr. John Hamilton (Liverpool): Discusses the Burns-Marshall technique developed in and used by the Liverpool Maternity Hospital. General advice on selection criteria and labor management. A pithy statement about breech birth at home: "I will say at the outset that there is only one place for breech delivery, whether multigravida or primigravida, and that it in hospital." (Remember, at this time in England and Wales, around 33% of births still took place at home. See the UK Office of National Statstics report on home births.)

Mr. J. H. Peel (London): Makes an argument for ECV to lower the rate of breech deliveries and thus the overall mortality rate due to breech. Advocates for ECV around 34 weeks. Reports on both a personal series and a hospital series.

Mr. David Methuen (Oxford): Presents a series of 448 breech deliveries from his department in Oxford between 1952-1956. Advocates for using pudendal block or epidural anesthesia rather than general anesthesia for breech deliveries.

Mr. C. K. Vartan: Advocates for inducing all breeches at 38 weeks to produce "smaller babies which would not need to be extracted." A brief discussion of FHR after the baby is born to the shoulders.

Mr. Gilbert Dalley: Prefers ECV to breech delivery. Presented a 10-year series of births at West Hill Hospital in Dartford, both vaginal breech births and ECVs. Advocates performing ECV before the 35th week.

Mr. J. S. Hesketh: Concerned about the amount of traction described by Mr. Hamilton in the Burns-Marshall technique.

Mr. Wilfrid G. Mills: We should distinguish between extended (frank) and flexed (complete/incomplete/footling?) breech. Strong advocate of ECV, although he thinks it should be performed whenever the breech presentation is diagnosed, rather than at a set time. Gives an alternate explanation for why intracranial hemorrhage occurs in some breech deliveries.

Dr. J. Vincent O'Sullivan: Supports Mr. Peel's plea to do ECVs and suggests between 30-34 weeks. Discusses a different technique for delivering the aftercoming head by "rolling" the head over the perineum and pressing the nape of the neck close against the symphysis.

Mr. John Hamilton then replied to some of the earlier comments.