LETTERS TO THE EDITOR Teaching Infrequently Used Skills: Vaginal Breech Delivery

To the Editor: I enjoyed reading the editorial titled “Teaching Infrequently Used Skills: Vaginal Breech Delivery.” Despite the present emphasis on delivering breech babies by cesarean, vaginal delivery skills should be taught effectively to all residents who plan to deliver babies. Perhaps you remember that I taught myself to perform external cephalic version for breech babies during the last trimester. Eventually I became skillful enough with versions so that about 80% of breech babies had been turned to cephalic presentation before the time of labor and delivery. Of course, this left a much smallerthan-average number of breech babies when labor started. Of these, I delivered 20% by cesarean for a number of specific reasons. This left a very small number of breech babies at term in labor, which could be used to give residents experience and training. Yet, in our small residency training program (1955 through 1981) every resident who completed his training was capable of performing an indicated vaginal breech delivery. We accomplished this by simple methods. There were regular training sessions with the manikin. Then, in the unusual instance when a mother entered the hospital with her fetus in breech presentation, the resident and I would study the proper chapter in the obstetric textbook for several minutes. Then we would go to the manikin for some more practice. Finally, when we were scrubbing our hands before the delivery, I would inform the resident that he should perform the delivery carefully, as practiced. I also warned him, or her, that if a particular part of the delivery was not progressing as it should, I would nudge the resident discreetly aside to complete the procedure myself, during which time he could learn by observation. The next time he could apply this knowledge. By using these methods, it took only a few patients for the resident to learn the techniques of indicated safe vaginal breech delivery.