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No way. But they can. Can you hear now? People on the online. Okay, they can hear me. All right. Uh, can you hear doctor? Right? No response. And then I I I sent that we would need to use just one. Any joint that you mean? Uh, it's quiet, but they can hear you. Good. They They say they can hear you, though. Yeah, so just say, yeah, I think. I mean, we might just get started, but I know we got 20 minutes. So, um, how's my joint here now? By Catherine. So her Sophie? Well, for a little bit, that second stages by way of context and then concentrates on the munchies on different one. Hasn't had a chance to see their system of paper. GM. As you well know, that's not Rebus evidence really on the second stage. But we try to taper. What happened? I was together. So you have it? Well, no, it starts, actually. Some rising and remind everyone does not have a target. I think that's really important because I still get sometimes talking about to do that just has, like, a TV. I was out of the direction. Great. That were very clear. There was no carpet. It's out what people on every every called yet like I would hold it is important, although that's going infection alive people only on one of the biggest reasons cited, that is college is a fear of instruments in a lot of skills. We heard about that already today that we need to really focus on not only training a cystic number today about attitudes, reasons why not similar Nolan's that usually hard Africa admitted women will waste Saban's because, you know, so he's gonna be a champion infection challenge of colleges, types of years of what you do travel in assisted living is really the father of politics. Stage program. You across all Sergio, I think three was inSaint. Second stage for all of us is probably we were general birth ourselves is the most dangerous part of our lives, are saying it's dangerous for babies potential, but it's also potentially dangerous into the leg days. We've already heard of today about difficulties. The second stage started in sections. It's not doing too. Cultures are instructions, but it's more difficult. Tomorrow there are some rays and cockroach review to tell us whether we should be using lotions off pulls that detail. Maybe we can discuss that later. Jesus, What we're going to talk about today, I have to say for me personally, trying to the north of England we were trying to. I spoke to a later life and my train my duties and I love to do it properly. Very good. But it does make a mustard difference with this one. People familiar with Oh, don't have you seen it? This is tender a cops work looking at, whether on long device, my essentially being alternative to both on Tues on full sex and the initial little soft by promising. But we have to watch. You have to think it has, I know in another station look more detail, but I think this is really reported that we recognize this as an emergency well trained in what you do. If we're going to attempt vaginal with assisted vaginal births when they might be difficult, we do need to know how to push the baby's head back holding, perhaps because I think it's very important that our knowledge base is all covers across a lot of being stables, not just a specific techniques actually, although we estimate that it only has to do for sent in the UK, where the difficulty with people had after his area in terms of all the medication. Really talk about this more time, and I'm sure it works. But it's different from you this that we're looking at trying to on the side but states of that. So we'll seven stage safety generally take that. We're no longer fixated on reducing, moving away from too much too soon to to make sure we optimize the bosses bacteria that reduces absence of bike place. I'm sure you will. Six, I told. Do you have a big prize? If I Yeah, with professional. But something is biting, negative using horses. You look at how it works. Seen on the train together in that decision making, I don't really think about what's the best thing for that woman. So these are the big things workshops that we do will be doing on wanting a lonely and go again next year. This is the last, but that's your life. What we did actually in the virtual, so it's quite exciting to be all that, so we'll focus on the rest of this particular shop, particularly on juice. Is that any better thinking? Is that back to the people on line? But I, you know, like I'm great mostly any thought we had to use to use that was a pain to it. Like I have to go to learn new tricks on me. It was relation every so then how to use a bunch. He's probably on, and what we really need to do is to, But it's all that flexion point. So those you obstetricians say, I don't I love cheese cheese for me and it every day that I say it was just which I did when I was young. I know that needs to be absolutely sure the position of the baby before we would have a lot of juice cuts 11 innings do it five points. So imagine infection. What you said in the urine shows, almost like they said, it's just now and that's why the united facing up on the babies. That was recent to me, to the way from that cost a fortune on where you do the combination back. So I need to do that. So I said he was just saying this is really in quarter you thinking like an egg. If the baby's basically take always in my position on the diameter zones equator and therefore you end up with a relative to help support in, even though the actual diameter would pick through the total pelvis. There is really cool to be thinking about how deflect the baby's head and why, and actually it never flexion poignantly, actually, flexibilities head, by the way, is those little so well she flaccid eyes had it will come out. So this is looking at blacks, and the lady had, based on it's in that much of a point, right? And if you do the failure rate of on Tuesdays only 4% I think that's really important because we have been close, not higher, actually. Come outside in the seventies said, If we get that section point, if you just put the bottle and you just put a couple of hoping that it's lower and this is what so But you might have seen these. Unfortunately, he's in the past, I think, given the Jews about name, whereas if we use it properly and safely, this will know that you got back from being tried popping myself. So what? It comes to choose in the cup experience Court congressman knew that was possible, particularly off steering oxidants, posterior positions. So 81 of them has one. Teo that direction. That's quite a long way away. And it's really important that we get a copy by the back, which is difficult to do on the old cops that we used to use with the vacuum was Anyone use us also. Yeah, you see, like with football, the bed nets of battery also like this one, you can believe that that's really important. The New Jersey is useful to show you again. Have some of the old bones walls, you come back in the back. So this is just a little bit of time. So you want to do something. And if I lay back, tortures quite warm is to the pain place. There's a seven straight in, like a little cereal on 10 ounce three sent me to the way on that before faction Point is, So we need to know what his Ishan of a little back, please. And follow that material is Hold on that, huh? So you want to get in with this way. That's why you have the Cubans got see very well cup and we'll see you in a sense that you just said you did. You did well with infection points. I'm always down the line. Say, Say it was distressing. Hear that a pushing? What's this? Do you want the sensor off? He would have to be sent actually here, So I feel like this pushing it down the line allows it, which is why you have to mention it to seven. So I think that's the biggest thing to do it because there's always tendency, especially you have got some experience with it last when it should be that way. But actually it's always in the midline, and that's one of the Big East. There is always in the I said it was just saying It's really important to measure. So we measure from the Troy Tous where the action point is that medicine so that you have Ms is on the sand, so you're more likely with your right. So the next thing is to create a vacuum on those in today and she goes back and then that by using a thing. So um some people like to use like a baby techniques you in order to be a spray conception with the vacuum you need, but precious it outside, and then we'll see about having you touch base next week. Next, feel that sense? It's well, See that shot you heard People's and it's getting bored. Kind of used to think is inside. I'm following the hell this same time it swells when sure you go up. So actually, my father heard of the pelvis, Has it comes around, but that's in the traction is really important, actually interesting. And I didn't get to stay in the debate, but the meat chicken wise to do that to you. So actually, that's a bit of doctors way. Pelvic of a whole physiology past. We did it actually like favorites they put in a day. But there are doctors. We have to nose really slow because sometimes the temptation, if you could expect to think what I would do very quickly and actually you don't. You always thought that extra 30 seconds to take time. Allow the parent to stretch, try and minimize the chance of period control is we're following the access. It help this as well. So I said we should do the non funny. How important study that on, to pass on once before, when he's really important. All the happens when the baby's head is not coming is that normal physiology is sold forever. Reason whether that's how it is. Ishan, Get inflection point. Just I baby, it will both sides. So selection back to the reporters. Are you showing the measurement between being tried? This on the election point is very important. That gets and this is what I was saying that the last appointment stay in the midline, which which was just a regulations about that, but I believe it. So I'll just quit because it made me sort of want to have a quick go with something. So how does anybody we won't put you on the spot will carry on okay and just really great below that in stage, obviously and short in a second station. It's a benefit of the obvious reasons yesterday about whether HIV is a culture sent a shin. It isn't particularly, but it but it measures, you know, show how high loaded. So I think that's something you need for that particularly with our sleep thing. We're looking at training in countries where the HIV is prevalent. Um, when? So it is not related. Strictly speaking, we shouldn't Most of those probably do if we're confident that that's kind of a bit outside. But sometimes you just have to do what we think is actually the original expired. But it's not as the surgery way and very importantly, make always retact hernia. Unless he's do you want to? Sometimes we just need to go out or looking off having assistant assistant. So I'll say just any questions, other, Any problems? Here's a little sad, but you promise Great. Okay, so you just feel that people Hello. Hi part. It's not I don't know. I remember situation where I thought I just needed a way. You say you were older? Yeah, he's a very good question. I think it has to be. Oh, so you have to say Friday, I feel I think it was I think that's the station and I great, you know, where you what is it? Began almost accusing. So I remember is beating find out of my I think, Yeah, I think by the way, I think in this situation of why you chose that? Because I think it. I don't think this is like, I think I'm having a really online somebody's asked, How do you measure the finger length when you're doing it on Tuesday? Livery. So the tingling would be so most things about his exceptional. So you made it from the enteritis. Too much of it is literally with your fingers on those that he has a guide on it for life. So that's how much, literally the beginning find the posterior functional three centimeters from It's a long substitute teacher, and then that's a 30.2, which oh, so she was saying It's so It's usually near the channel way that so you have to measure that by five words, is measuring things in addition to that? So it's not an exact science, but a rough guys number send you to the point you away. Thank you on. Unless if I wanted him on some of my consult. This is a Metal Cups. What's your files on? This Simponi is go outside today, 6 10 11. I think he has been attraction with base with Mexico's, I think I think when I was talking difficulty is that something is a little setting five people. Useful is a big issue with active sometimes about, you know, just nothing that I absolutely great. You should be looking up. Supposing it usable for weight? Yes, I am. He wanders. We thought she did one. This attraction caved us for a huge around. Busy 1 lbs. Okay, but it's different with this manages change. Way to do that for the others. So see that? Yeah. That's less than you might think, isn't it? It's one. Yeah, I've got five more minutes left in this room. So if anybody wants have a girl or have any other questions? Oh, Bill, Base a cat around. I want to say, if you want to tell you Yeah, So I said before because I have colleagues one being low setting I e. I think so. Just a people working in places holding his last year. I do. It's course if you wait. Wait. He's hard to get the numbers Also Night. So you what, like this way? So great. See, cycle is you have to be trying way, way, way high cultures that, you know, when I stopped using, it was It was really bad for you. I just really these about having people, like, just like a state champions on the ground sounding that, actually, no, you don't say that. Inside the exception of getting the you know, Dr Yeah, he's actually very brutal. Yeah, yeah, yeah, yeah. Thank you very much. I think that's all we got time for in this groups. And Lucy is gonna take this group on to your next workshop. Okay? How is people that asking? They did awesome? Yeah, online people. So you can now leave this session and select a new session. Hello? Is that better? Oh, no. It's all right. How's your Your colleagues know you that's better. And then I'm positive. And your your number is all right. Right high. People have just arrived. Can we check on you? Hear us? Doctor writes. Just gonna check the microphone, see if you can hear. Can hear that. Hello can hear us. You're welcome to call me Alison. Catherine, By the way. No said anything yet. I think so. They can show them properly and thank you. Bring him here one. Just get a minute. Yeah, you know, So I think I think it's all right. They say they can hear it. Yeah, brilliant show is shall we start? So I'm also might I'm going to just run through some basics off second stage because I think it's really important that we put you on a Tuesday in a context. I know that you're gonna be speaking about forceps in more detail that workshop tomorrow, and there's another workshop on impacted fetal head. But I think it's really important that we look at everything in the round. If anyone hasn't managed to see this, obviously I would say that something is a good paper and there isn't a great deal off Rebus data when it comes to second stage management. But we have tried to gather what there is ourselves on the confederation of mid wives. So it's it's worth looking at this. We will need to be updating that even in the next few years, actually, so I don't need to tell anyone that cesarean section rate is rising. I'm glad on a pill often to do actually is here because it's really important that we remind people that we don't sell your section right has to be 10 to 15% anymore. I think it's really interesting when we talked to doctor colleagues and midwifes around the world. What are the reasons that we are doing? Our office is Aaron sections. Increasingly, some of you will know much more than then I'm saying here, but just very basically lack of skills and assisted vaginal birth is often quoted as worn off. The reasons Glenn Molehills, some of you may know, is a doctor in pop in New Guinea. Andi has been a really champion of assisted vaginal birth, and he stood up it a conference a few years ago. Very mold Lee quite rightly challenges ultrasound A water. You was a little comment Fiego organizations watch you doing about assisted vaginal birth training. Very similar to Bomber Nolan's, who Andrew Weeks was talking about, he was working with substance or in Africa and seeing women waiting for cesarean hours and hours because nobody knew how to put on um on Tuesday. So this is really important, and this is why we started this quest to trying that people trained in second stage skills. Being in the second stage is the most dangerous part of all of our lives. Assuming you were hard with vaginal birth one day going through our mothers Canal is the most dangerous. Stay off our lives by a long way. He's also very dangerous for the mother. We know that I was on oxygen levels drop very quickly in the second stage. We know also that Mother has potential to bleed on. It, have other complications, sepsis and so one in the second stage. So second stage skills are absolutely crucial, and I'm really glad that we're focusing on them today. There's a lot of discussion which we can talk about later. Chemo or forceps, whether we choose one or the other. I was trained in the north of England. We tend to use full fat, So that was my training. Initially, I came to you on Tuesday, relatively late in life. I don't want telling you I had to kind of re learn promptly how to use one two's, because when I was a youngster, we would just thought just to put the bomb, to use our and pull on. Now, obviously our training is a lot more skilled and sophisticated, which makes a month of difference. There was a cop from review is quite old know, I don't know of any back today to sense. Looking at how we choose between about human four sets that maybe we can talk about that later. I think it's worth mentioning. Oh, Dawn. Anyone who knows him drink holes in his work on him is I'm hearing this, and it was developed by someone in Argentina. Car mechanic, actually looking at the physics and what happens in childhood. The old on theoretically is good because you don't need to know the position, but but I think it's still working progress. I think you really interesting to see what happens as old all goes through, its trials impacted little handle. Just mention because I think it's important and one, but trading an assisted vaginal birth. It's really important that we know what to do when the baby's head gets stuck. And I know one of the other work shops were gonna be looking back in a lot more detail. But it's important because it leads to think about because although it only happens in probably 2 to 4% of cases, actually, it's double that in terms of the case that then go to ST Gatien, so attention very complicated and something that we all need to know how to manage. They're very different maneuvers, but I think that the key point for May isn't to know the position of the baby's head before you go for Cesarean. Even if you're going to do a cesarean knowing where the baby's head is being able to flex it, you could break the top much more easily on that will come on, too, with the vantas is well, so just before we move onto onto specifically, I would say, Take the key, take up messages here that's safe to a second state is that we have to optimize. This is Aaron section rate. Use Robson's criteria. Listen to women. Don't use what we think is a target that was in days gone by. I really class that the Sony Mattress A mid wives in the room, Any conference doctors, no other rational. So I'm really important that we all work together with the team. No matter what our professional, what are rolling in terms of supporting women, I'm not that well trained together. This is one of our workshops. This is probably the last time we did a A proper happens on face to face. It's really great to be able to make today. Hopefully we're going to get back to doing that all the time now. So just mentioned the late, great album Blocker On. Also here is Ross, who so his colleague who trained may involve in twos. We're just going to talk about the importance of the collection point first, so you're embarking upon to use, unlike what I described when I was a youngster, when someone says, Just put it on however, you think I'm ashamed, saying what we need to do is to be absolutely sure of the position of the baby, and we have some discussion with the last group. What if you're not sure, so we can talk about that later? But generally we should just be making sure we are sure. And even though it's uncomfortable for the woman, usually if we explain why it's really important for her safety that we actually find the flexion point. So so if you just want to demonstrate where that is, so the affection point is a present to me, it's along the eat such a two seater from the posterior front in L S O ensuring that you have this point is really important for successful Want to use delivery so you have the positive ones now here and then you follow along three centimeters down to find inflection point on the satchel suture. So I think that is what you say. Think of it like that. So if you imagine getting an egg into a neck up on, you know, having smallest diameter, then that ends our going to fit on. That sounds really simplistic, but I think it's a really good rule of thumb, because if the baby's head is not flex correctly, then it won't be the smallest I am until it to come through the birth canal on. But I think from too, he's probably got a very bad name because some of us we're not using it properly. And if you don't use it properly and don't get the election point, the complication rate goes from about full to 17 and above. I don't know whether any seeing, but this is what gave on twos about name. I think by people you're not using it, probably not using it right where no inflection point. Sorry for the glory pictures, but I think it's important just to make that point that if we do it properly, we can avoid those. And we have to. Especially as we're talking about introducing on Tuesday in areas where perhaps the uses less, we have to make sure that we're all skilled and probably trained to do it. So it's really important when we're looking at the cops election that we use a cup that's maneuverable on. But just ask. So feedings, though, had to show us Miami Those were having colds especially, for example, if the position was paid. You want to just yeah, so in a known Lee position, then often the flexion point is quite a long way back. And so it's really important that we use a cup, either. Manson court all this cup that's able to get really far back and then get on the actual election point one. But so I just looked at these five steps. I think it's worth spending a bit of time on these. This is described by on your back, and this is the way that we should all be using some twos. So, first of all, ready to locate the flexion point so so field of study. Well, it's so in three centimeters from the posterior from now. He used to be a so holding insert cut. And then we knew that cop towards the flexion point, which is what Sofia is, just a. The next thing we need to do is to create a vacuum, which is so hell demonstrate now so related that vacuum. We also need to make sure that there's no tissue so occasionally that can be vaginal to use. Also mixed. Trapped in Imagine on that back in. So it's really vital that we do whatever we come to make sure that there's no issues there on my number five, obviously which is the easiest one. Probably build up the vacuum pump, which so how is doing on? But I was saying to the last group I have talked midwives to do 12. I actually think that they're much better than we are, and because they only sound know physiology There patient, they wait for the baby to come down and they look at the way that the pelvic curve naturally works. Where is some of us sometimes over in patients, perhaps pool not unnecessary. The right direction. So I was in my junior go march. Mid wives doing births watch had exactly how the baby comes through because that's what we need to emulate. Are so hurt you just don't know. So the axis a traction is really important that we follow the pelvic curb promptly on that women new pair of shoes as we go, they're not calling home, and you just want to demonstrate what we do with that number being have. So it's important that we just died, and they're also has doing keeping a fun there on the bottom, too, so that were guiding it through. And it provides count pressure. Now someone was saying this morning, all that happened was one of them is not coming through, which is on the dilated or second state is that the normal mechanism is stalled. For whatever reason, you know the woman's scan. She's not analgesia all the baby's not relaxation. There are lots of reasons, but basically the normal mechanism is stalled on. We just need to encourage it by flexing the baby's head simple as that, and then it will also rotate. Okay, so one of the one of the biggest things that island is the flat from point is always in the midline, and that's, you know, if you are in your instance, I was. When you're learning to do one, too, is probably, you will think it must be somewhere electoral, but it isn't. It's always in the midline, so that's really important. So we're just going to finish off before anyone has to go. If you like to have a good on when you use so similar to four steps delivery for a long second stage, generally a little compromise as you know which one's being increasingly careful with our language. So we try not to use terms like fairly to progressed anymore. We're talking about progressively with about we try and avoid using those negative terms, but basically these are the reasons why. So prolong second stage, we try news rather than fairly to progress when not to use. So we have some discussion in the seaside meeting yesterday about whether HIV is a visa and which I'm speaking to some colleagues in South Africa, actually, because they do use from twos on. I think it depends in terms of HIV prevalence, when people have access to viral load estimations, which was obviously quite crucial with that scenario. I think useful for us to discuss further on whether the Celebrex is for the dilated. We say it should be, I think, with experience. If it's actually in a multiple, I think it's reasonable to do without. But that needs to be with caution. I think the last one is the most important. If you don't know the position that people had, we should not be able to the farm to zone. So finally, manual protection was really important. As with any delivery, we need to be protecting the peroneal if we possibly can. If you got a system, do it or otherwise. We need to do that at the time and just allow Arsu down. Told us today, sometimes you just can't allow it to turn. Left it to do in the last week, which is really nice. Okay, so we'll maybe just questions. Um, maybe one or two people want to have go. We won't. I'll stare at you. We will have discussion. Anybody wants to go and have a girl. Well, we're doing some talking about five minutes. So got the people don't have ago. So that was an opportunity from the way won't help. What? You know, You just bring the corner. If anyone else wants to do is well, yes, I think you know, I was just wondering if someone sees Yeah, definitely. Yeah, No reason at all. Why not? So if all the conditions from general after that I really know sets up and safe, then you can do not to use delivery, just as you can do, uh, allow things to happen spontaneously on. In fact, sometimes it is a way that we do to limit the second stage. If somebody has seen with previous and you might be slightly worried about a scar If they're in the second stage for a long time, it might be a good idea to use on to. So yes, we are commonly is this is a Really? Yeah. Absolutely. Absolutely. So any compressions? A vaginal birth esteem to be feasible after cesarean, Then a bunch of those separately Also reasonable. So if a vaginal birth was contraindicated so far, Yeah. Yes. What? Did they advice or really guidance? Your experience. How many times can I can I try for a few? Fails one time use it pops up. It was, But it is a question. Um, they also itchy. Kinda changed quite recently. We still say three calls. So three pulls is what the current house here to you guys didn't send us. They also now have it on. But if the heart is on the parent here, you can give another three gentle pools. I'm any contradiction or anything that would make you change the third time you put it, you know, compare with the first. Yeah, right across the. So they also have also added Now, just recently, a closet says if after two pools you're not seeing progress, you should be reassessing. So previous college students was three pulls yes or no, which was actually quite frustrating if you knew that you were nearly there. And similarly, with each pill, you don't get any for my stool. We should not be continuing. So yes, I think that's really pertinent. And those are the reasons why the osteo GI guidance changed recently. TOB flat that if our clinical opinion is that the woman is my progress, we're making progress. We should be continuing. If we're not, we should see casino personal. Is that opinion. Uh, this's but I think it's a really good part of it is something that we are trying to encourage all fixed stuff to be involved in. So, you know, there was some difficult cases where somebody might be calling on pulling because they're in the one at the baby, and sometimes it needs someone else to say, actually, shall we get someone else to help? Shall we consider, um, today, etcetera. So I think it's speak of culture in That's, well, it's really important. Just you. Yeah, well, I I wouldn't caution again. He's putting them on Tuesday. I don't know the position. I would say You shouldn't do it. I mean, there might be exceptional so himself. This house I have had if someone's been in labor with such a long time, the tissues are so swollen. Sometimes if the baby's had very low way, just have to try so the right things. But I think generally we should not be putting on a one to use awful steps or anything if we don't know the position. Yeah, sorry. Yeah, much. There is the missile evidence out a year now. The rate of success of the box on, but it may not just apply it, uh, vaginal birth on. But it's not about you try and look through it for about success of a John over. So, yeah, So we would we would, um, support women. Happy that anytime you end, I think what? It was much sometimes people think if that way past, If it's been 10 years ago, therefore the reason to risk. And I would say there was always a risk that what we search says there is always a risk there. Thank you very much. Not from online know. Toe will move on. Lucy will take this group on to your next workshop on online people, please log out of this session and then log into the one that you haven't attended yet. But I e o e Uh huh. Fine. Yeah. It was a, um Yeah. Okay. Yes. Yeah, it's Oh, right, yeah. Going way. Yeah. Okay. Well, I just I don't know why you No. So we we take a stomach, Katherine of people there in the room. Can everyone here. Good. Good to see what? I'm Alison, right? I'm here with Sophia. And so her I was going to talk a little bit about second stage in general. Just context your lives on Tues on. Then we'll small 1 to 2 every six. I know you've got four sets. Come here tomorrow. I have to look at this. I would recommend it, obviously, because I was an author and it's very difficult to get good. Later, you might tell me otherwise. We found quite a good date on second stage management when we tried to pull over what we could just have a look at ourselves and Fiego and also the mid wives. I see em to look up. What's the best evidence out there? I don't need to tell everyone here about level rise into there in September. I just remind everyone I still hear some people talking about the only way show 10 15% just to remind everyone in 2018 that target was removed. So we're looking that the best way to live every woman has. We're talking about these two days. I think it isn't well, isn't a look at what people say. And lots of calling and telling those a lot of schools in the system for China is one of the many reasons for right section right? Certainly it's more that we should be considering. Then. I don't know whether anyone knows Glen Model his medicine. He's a real champion of training in assisted vaginal birth. On similar. Andrea was saying about another one's actually similar area seeing We've been waiting for a long time for Cesarean, the had concerns about his Glenn's is that no one that has a bit of on Tuesday, and that's why women are waiting. So let is a real champion of assistive John Birth, and he's been too many places in the around the world. What I really miss that for is he stays in place, is so he stays in place is so it's sustainable change of support team there on. I think we've learned that that makes a big difference. If we go on teach, that's great. But then when we come away and then it's difficult for the people on the ground as a safe was all. So seven stage is probably the most dangerous. Time was, Dave was time for us all. This one was 80 going through all this canal. That's a nice area on. I think it's really important to remember that for the baby we got high pox it quicker than any of the time and labor for the mother. We need to worry about the pH out sepsis and, of course, obstruction. It's too little tissues and so on. So section states. It was really important. I'm not gonna draw the choice between the whole sepsis they review. It is quite a lot of them now. Odor people. Maybe only one way of saying is on the going trials. That commitment's what drug called smoking on be really interesting to see whether this takes on a popular, whether the advantages to what you already fetal had. I'm just going to mention something is really important that if we are training a learning in the vagina birth, that we also know what to do if we get into difficulty with Impacted. Beautiful Head was quite interesting is in the UK, although we have to make the incidence is only about 2 to 4% it's actually double that in terms of litigation. So we need to be aware. It seems to be an imposing, obstetric emergency that we all need to be familiar with and learn what to do very for ways which I'm not going to dwell on now. But just to say that I think what's really important is knowing the position of the baby's head before we do a Caesarean. Same way that we're going to talk about flexion is absolutely key. Moment of opportunity to every flexes of the head is really important with an impacted head. So if you know what position the baby's head is in, if you're going to do a difficult cesarean, it's gonna be easy, because you can flex it and break upwards in the same way that we flex, bring it down on cheese. So just on the basics that in stage what we need to do is to optimize, we need to know held them for reducing Caesareans, maybe in some settings if there's appropriate. But we need to go the optimizing all right, using Robson's So on TV with midwives, we got midways in the room. Well, I'm trying to do to wait a minute. Um, I was getting those. I've got to talk to leave on Tuesday. I think they're much better than we are because midwives understand the physiology of the second stage and I will say to my juniors, Watch the mid wives do a delivery before you do your own on Tuesday. I think it's really important. Um, I know we debate us, which was which is fascinating. Thank you, Andre trained together. So we train no, only in the techniques or from two's. But why I'm looking now around. It's a decision making around. It's really important. What's the contact do you have? Still, it is to do a cesarean If this is not successful, etcetera. So these the hands are workshops that we do for fee go in second stage skills on there. That's the last time we did labs on you, which was in Rio's. I'm glad it to, uh, to be replaced. That's exciting. So we're gonna focus on TV. Oh, so I thought that was for and say the flexion plane is really what it is in order to know that you are safe as a successful on delivery. So what you want to do is you want to find osteo, you know on and you follow the reasons to find affection, find and what you want is the center of the one point. So then, to get the to the decision for you. Pill. Okay, wait. Just want to use our sample, Unfortunately, which so we need t o. I like Nexium stick, but if you think of trying to get into you don't have the samples. I have to get that long, you know, physician anything and get that way. I make the small compulsively being on. I'm trying to be on, like the time that you do in the UK UK and complications. But if you get up in the right place, way up in the wrong place, probably seven total for about, just wait on that was still doing it. So it's really got to show. Yeah, so I might demonstrate 74 people in hello election. You really need to get right to join a gym. I think that's good. You can get, I think, if you do it so you're just going to probably way so that way, Way, usually around 11 between. It's not I don't have a fighting with Point is around the way. So wait til I joined that Trapped. So So how's doing now on then? Using. So that's what we'll use near the gym if it's getting into the red. That's too much pressure on you Sometimes because the clothes you wear, the baby's coming back to the subject. Sometimes we do that, but strict. Okay, so this is where most of it's well, well show with feeling. How's it do you have? And I was saying earlier, maybe stuck. It's usually a position on Always do It, said one of the picky substance Island Point is in the midline kind of counter intuitive you who like I did after trusted. It's in the midline measure where it is, but I just never so just before people have ago. If you want to have a go, indications are generally we using it stage on language, really trying, wasting more aggressive, so looking at look and eternal exhausted. And sometimes I might talk about VBAC. Somebody's sure now the country and control people with talking have access to five low, whether we should also be used to travel that moment on whether or not so strictly speaking, people start off matter use straight, but it's using in the standard situations. I think I'm the one is Head is really, really important. So always with the babies and of course, we finally make him in an ideal world. If you have something else to do that don't like talking about if we can let the woman without the final part way. Okay, wait. I, um please don't wait. So any questions? Anything else? I just asked him most of the cups. About six centimeters it on there were actually the central wants. Well, you're putting. It does needs that the posterior spontaneity is right at the edge. So I always tended to posterior Occidental put the cup the that point rather than going to the back, because I still have that easy. But you find people find it easier to defection points and then some house, I think. I think, 100. I think you I think a lot of people do do that, but I mean, that's well. The's difficulty is making its smaller then, which would be easier. Right? People, t function wise, are away is that it's more so that last. It's just changing. No, it's a it's a six. It's a six cent piece cup with juice things up up then, because three cents of the time it needs the problem. Flexion posterior Continetti, a society that we need to know where you're pointing, so long as you like the size. Yeah, yeah, I got it. Yeah, yes, yes. You be rooting or any assistance. Okay. Good question. I think I need guidelines now. 20 m gossip. Easy to make. My personal view is that we should have a crazy automotives default personally, because my weight very low threshold to pee off with an instrumental delivery even though from Tuesdays, know, increase the diameter in the way. It was slightly more having trauma to the power to shoes. So I was a general. We should do an appeal to me unless we see that the tissues are stretching really well. Current is to consider discussed. You still. So that's something I have to sit on my own after a hobby, living with living with HIV in this country, nearly all of detectable. So So we will just treat them just to say we would use for twos in just the same way I know. Speaking two colleagues yesterday was some concern about using the twos while if I will look little note and in my place is supposed to get our load. So I placed yesterday to ask that you may have You want that if you don't know the viral load and if would you feel comfortable using of, um, cheese? No. Yeah, I think most people probably say that. So unusual. There's no obvious contraindications in this country as far as I know. Yeah, So the car off. Yes, there's a coat brings about flexion or current is descent as long as it's on the fact that point. So I got used to say wrinkles now, after to hold. If you're not old is coming. Well, there any three. Consider because I almost, you know, just have a look, because we may have it in the wrong place, and that's why it's not coming out about it. So that's not changed anything. Well, everything in a good way for this because it gives you more flexibility. So if you have three normals in the heads on the perineum, guys could have another three genital calls, which I think is something is a good idea because sometimes we know we don't want people to be saying, Oh, three people's, that's it. So I think it's good, tough, some flexibility, but you know, caution and experiments. Have somebody that's on the Children is is in the hospital only if you bring from Aleppo natural or fire hose. And you consistently the village, like where you were is when you take them. Only that, but rejected. Not it's there. Yeah, so you need more. Okay, well, maybe so. Because now, because you have a relapse. If we have implements, we have a bunch of us. We have the masters, so you make it it. It's this knowledge, the people down to the ground because he's he's saying that it's what's in the money with this fancy that make the doctors really day that conflicts on the job role with the bachelor. Us good. Well, they look, I'm becoming understand you're not. You become those ones fighting from a friend. She that's good once a day. Thing is, is I, you know, lost. Your question, actually, was the cops designs for you. I put inside eights and then wash them in there. Yes, it's fine. It's fine. I don't know whether it's a script for that. I've told that we need a usable, so she's well aware. I told us the closer it is, but it is a reality that people are using. At times, I'm s so we need to be useful. Yeah, it's It's the It's the stent, which is the problem. Is that because the thing is the sponge, Well, your which gets incinerated with inside it. I don't know how long it but you also lost it for weight. Tell how long The last month. We just sort of you look at your position in a single buckets. Then you go pick it up for you. Weigh weigh way. Just have one more question that we need to wrap up. Patrons one. I think this is that he's, like, has got that shape. I think it's just me time. Yeah, Yeah. Is this plastic things? Right, Right. Like, bye. What? Oh, and no one? Yes. Yeah, way. Okay. Much born before it. Okay. Although she's being born before time. So maybe the stuff that looks way. Yeah, way. Yeah, yeah, yeah, yeah. Okay. Thank you. Okay. I have to wait. Okay. What? I think I don't Yeah, I way. Yeah. Way. You You on board like this? Yeah. You don't have anything? No. Oh, okay. Yeah. Uh huh. Okay.