Planned vaginal breech delivery: current status and the need to reconsider

Glezerman, Marek

doi:10.1586/eog.12.2

Cited by 18 publications

(41 citation statements)

References 39 publications

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“…However, the response of the academic and organizational leaders of our specialty has been ill-directed and not led to a commensurate level of improved outcomes. Technology and specialty consultation have seen an increase while training in the skill set that make obstetricians unique has all but disappeared [17]. The process of growing a human fetus and laboring is not a disease.…”

Section: Discussionmentioning

confidence: 99%

“Home Birth” with an Obstetrician: A Series of 135 Out of Hospital Births

Fischbein¹

2015

OGIJ

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Section: Discussionmentioning

confidence: 99%

“Home Birth” with an Obstetrician: A Series of 135 Out of Hospital Births

Fischbein¹

2015

OGIJ

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“…Hannah et al (2000) found reduced short-term morbidity and mortality for babies who were born by CS than those who were born vaginally. While this trial informs many national guidelines, the results are far from universally accepted and the consequences have been the subject of much criticism and debate since its publication (Kotaska 2004, Glezerman 2012. In addition, the long-term outcomes for the TBT showed no difference at two years of age between those babies born after planned vaginal birth and those who planned a CS (Whyte et al 2004).…”

Section: Introductionmentioning

confidence: 90%

Assessment of fetal presentation: Exploring a woman-centred approach

Walker¹,

Sabrosa²

2014

British Journal of Midwifery

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Abstract:This article explores the core midwifery skill of fetal presentation assessment from the perspective of women's meanings and experiences, including the social and relational aspects of antenatal palpation. Brief background information is provided, explaining the clinical purpose of determining presentation antenatally, and the key debates surrounding the available interventions applied when babies present breech, eg. external cephalic version and caesarean section. In order to make the screening process transparent, women need to know the accuracy (or rather, inaccuracy) of abdominal palpation, and what her options will be if her baby is found to be presenting breech, either before or during labour. Specialist midwifery care may help meet women's increased needs for counselling and reassurance, and provide continuity throughout the breech care pathway, which for low-risk women begins with palpation.Keywords: breech, midwives, antenatal, palpation, woman-centred, specialist Key phrases:From 33 weeks, there is almost a 3:4 chance overall that a breech baby will remain breech, and many women will want to be considering their options by this point.The clinical value of detecting breech babies antenatally, in terms of improved outcomes, is highly dependent on whether ECV is offered, accepted and performed with a high degree of success, factors known to be highly variable. 3Antenatal detection of breech presentation is associated with a significant level of anxiety for women. However, provider's ways of speaking about breech influenced women's experiences, and a more supportive stance to all three options (ECV, VBB, CS) may result in less anxiety in the final weeks of a known breech pregnancy.The UK clinical collective has remained comfortable with a certain degree of uncertainty when it comes to diagnosing all breech presentations antenatally.Whether an individual woman will be comfortable with this uncertainty is likely to depend on her general approach to pregnancy and childbirth, as well as the approach of her providers.Women reveal themselves physically for each abdominal examination, and the emotional and psychological effects of this exposure and vulnerability should not be underestimated.In woman-centred care, the core midwifery skill of palpation is used mindfully and holistically, taking into consideration what knowing her baby's position will mean for this individual woman, and how this information can help her meet her needs, aspirations and expectations for this pregnancy. 4The assessment of fetal presentation by abdominal palpation is a fundamental antenatal care skill, in which the midwife (or doctor) uses her/his hands to gently feel the position of the baby through the mother's abdomen, in order to assess which way the baby is lying in the uterus. The clinical purpose of this activity is to enable appropriate interventions to be offered and care to be planned. In their 2008

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“…Although the exact etiology is unknown, breech presentation is associated with an increased risk of fetal anomalies such as hydrocephaly or aneuploidy . Another concern is whether there is an underlying maternal or fetal condition that might have caused the malpresentation.…”

Section: Management Of Breech Presentationsmentioning

confidence: 99%

“…Since healthy active fetuses are thought to adopt a best fit position in the maternal pelvis, it seems reasonable that a breech presentation may in fact indicate a fetal or maternal problem. Contributing factors such as multiple gestation, placenta previa, uterine fibroids, or amniotic fluid abnormalities may be found in up to 20% of women with a fetus in a breech presentation . A summary of these factors can be found in Table .…”

Section: Management Of Breech Presentationsmentioning

confidence: 99%

“…Because fewer than 10% of fetuses who are breech at term revert spontaneously to a vertex presentation, vigilant appraisal of the presenting part should take place by 35 weeks’ to 36 weeks’ gestation . Although abdominal palpation (Leopold's maneuvers) of the fetal lie and presenting part is an excellent first‐line assessment technique, any suspicion that the fetus is in a breech presentation must be confirmed via a formal ultrasound.…”

Section: Management Of Breech Presentationsmentioning

confidence: 99%

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Vaginal Breech Birth: Can We Move Beyond the Term Breech Trial?

Hunter¹

2014

J Midwife Womens Health

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Since the publication of the Term Breech Trial in 2000, planned cesarean has become the preferred mode of birth for women whose fetus is in a breech presentation. Over the past 20 years, however, subsequent evidence has not shown conclusively that cesarean birth is safer than vaginal birth for a fetus in a breech presentation when certain criteria are met. Many obstetric organizations support the option of planned vaginal birth for women with a breech presentation under strict prelabor selection criteria and intrapartum management guidelines. The growing trend toward cesarean unfortunately has left midwives and other intrapartum care providers in training with dwindling opportunities to competently master skills for vaginal breech birth. Although simulation training offers opportunities to practice infrequently encountered skills such as vaginal breech birth, it is unknown if this alternative will provide sufficient experience for future generations of clinicians. As a result, women with a breech presentation at term who desire a trial of labor often have limited choices. This article reviews the controversies surrounding the ideal mode of birth created by the Term Breech Trial. Criteria for vaginal breech birth are summarized and the role of simulation explored. Implications for midwifery practice when a breech presentation is diagnosed are also included.

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Planned vaginal breech delivery: current status and the need to reconsider

Cited by 18 publications

References 39 publications

“Home Birth” with an Obstetrician: A Series of 135 Out of Hospital Births

“Home Birth” with an Obstetrician: A Series of 135 Out of Hospital Births

Assessment of fetal presentation: Exploring a woman-centred approach

Vaginal Breech Birth: Can We Move Beyond the Term Breech Trial?

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