Up against a wall: A patient and obstetrician’s perspective on the mode of breech delivery

Hipsher, Carissa; Fineberg, Annette

doi:10.1111/birt.12432

Cited by 4 publications

(5 citation statements)

References 16 publications

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“…Clinicians who provide VBB services to women have previously reported experiencing pressure from their hospital's administration to withdraw their support (Hipsher & Fineberg, 2019), but are viewed favourably by women (Homer et al, 2015). This may explain the abovementioned obstetrician making the distinction between her personal and professional opinion.…”

Section: Strategiesmentioning

confidence: 99%

Women’s experiences of breech birth and disciplinary power

Morris

Geraghty

Sundin

2021

Journal of Advanced Nursing

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Aims: To explore women's experiences of breech pregnancy and birth to identify areas in practice for improvement.Design: A descriptive exploratory study was conducted involving 20 women who had experienced a breech birth between 2013 and 2018.Methods: Semi-structured interviews were audio recorded and transcribed.Transcripts were examined using a free-form 'circling and parking' style of analysis.Foucault's concepts of power/knowledge were utilized to describe existing power relations.Results: Women experienced varying degrees of disciplinary power throughout their experiences. Knowledge was used as a means of enforcing disciplinary power by some

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Section: Strategiesmentioning

confidence: 99%

Women’s experiences of breech birth and disciplinary power

Morris

Geraghty

Sundin

2021

Journal of Advanced Nursing

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“…Community birth in the presence of high-risk conditions often indicates a failure of the medical system to meet patient’s needs for less interventive care and autonomy in decision-making [ 27 , 61 – 64 ]. Restrictive policies preventing hospital providers from offering care for planned vaginal breech birth to appropriate candidates should be eliminated as they impede patient autonomy and access to care and inadvertently push more medically complex births into community settings [ 24 , 26 , 57 , 59 , 65 , 66 ].…”

Section: Discussionmentioning

confidence: 99%

“…ACOG committee opinion now recommends that for a term, singleton fetus, planned vaginal breech birth “may be reasonable under hospital-specific protocol guidelines for eligibility and labor management” [ 22 ]. However, hospital-based care for planned vaginal breech birth in the US is very difficult to obtain, in part due to a lack of skilled providers and medicolegal concerns [ 22 – 24 ], leading some individuals to seek care in community-based settings (homes and birth centers) [ 25 – 27 ].…”

Section: Introductionmentioning

confidence: 99%

Maternal and neonatal outcomes associated with breech presentation in planned community (home and birth center) births in the United States: A prospective observational cohort study

Schafer,

Bovbjerg,

Cheyney

et al. 2024

PLoS ONE

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Objective Investigate maternal and neonatal outcomes associated with breech presentation in planned community births in the United States, including outcomes associated with types of breech presentation (i.e., frank, complete, footling/kneeling) Design Secondary analysis of prospective cohort data from a national perinatal data registry (MANA Stats) Setting Planned community birth (homes and birth centers), United States Sample Individuals with a term, singleton gestation (N = 71,943) planning community birth at labor onset Methods Descriptive statistics to calculate associations between types of breech presentation and maternal and neonatal outcomes Main outcome measures Maternal: intrapartum/postpartum transfer, hospitalization, cesarean, hemorrhage, severe perineal laceration, duration of labor stages and membrane rupture Neonatal: transfer, hospitalization, NICU admission, congenital anomalies, umbilical cord prolapse, birth injury, intrapartum/neonatal death Results One percent (n = 695) of individuals experienced breech birth (n = 401, 57.6% vaginally). Most fetuses presented frank breech (57%), with 19% complete, 18% footling/kneeling, and 5% unknown type of breech presentation. Among all breech labors, there were high rates of intrapartum transfer and cesarean birth compared to cephalic presentation (OR 9.0, 95% CI 7.7–10.4 and OR 18.6, 95% CI 15.9–21.7, respectively), with no substantive difference based on parity, planned site of birth, or level of care integration into the health system. For all types of breech presentations, there was increased risk for nearly all assessed neonatal outcomes including hospital transfer, NICU admission, birth injury, and umbilical cord prolapse. Breech presentation was also associated with increased risk of intrapartum/neonatal death (OR 8.5, 95% CI 4.4–16.3), even after congenital anomalies were excluded. Conclusions All types of breech presentations in community birth settings are associated with increased risk of adverse neonatal outcomes. These research findings contribute to informed decision-making and reinforce the need for breech training and research and an increase in accessible, high-quality care for planned vaginal breech birth in US hospitals.

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“…1 However, many pregnant and birthing people in the United States have reported difficulty accessing care for vaginal breech birth due to provider inexperience and institutional opposition. [11][12][13] Without access to vaginal breech birth in hospitals, some individuals choose to pursue breech birth at home. [14][15][16][17] ACOG is supportive of informed choice for intended site of birth but considers breech presentation an absolute contraindication to home birth based on an increased association with fetal and neonatal mortality (16.8/1000 adjusted odds ratio [aOR] 8.2 [95% CI 3.7-18.4]).…”

Section: Introductionmentioning

confidence: 99%

“…Mode of birth is an important decision with long‐term effects on health‐related quality of life, 8–10 and current ACOG guidelines support incorporating patient preferences and provider experience into decision‐making for mode of breech birth 1 . However, many pregnant and birthing people in the United States have reported difficulty accessing care for vaginal breech birth due to provider inexperience and institutional opposition 11–13 . Without access to vaginal breech birth in hospitals, some individuals choose to pursue breech birth at home 14–17 .…”

Section: Introductionmentioning

confidence: 99%

“I had no choice”: A mixed‐methods study on access to care for vaginal breech birth

Schafer,

Dietrich,

Kennedy

et al. 2023

Birth

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IntroductionAlthough current recommendations support vaginal breech birth as a reasonable option, access to breech birth in US hospitals is limited. This study explored the experiences of decision‐making and perceptions of access to care in people who transferred out of the hospital system to pursue home breech birth.MethodsWe conducted a mixed methods study of people with a singleton, term breech fetus who transferred out of the US hospital system to pursue home breech birth. Twenty‐five people completed an online demographic and psychosocial survey, and 23 (92%) participated in semi‐structured interviews. We used an interpretive description approach informed by situational analysis to analyze qualitative data about participants' experiences and perceived access to care.ResultsOf 25 individuals who left the hospital system to pursue a home breech birth, most felt denied informed choice (64%) and threatened or coerced into cesarean (68%). The majority reported low or very low autonomy in decision‐making (n = 20, 80%) and high decisional satisfaction using validated measures. Many participants felt safer in a hospital setting but were not able to access care for planned vaginal breech hospital birth, despite extensive efforts. Participants felt “backed into a corner” and “forced into homebirth,” perceiving a lack of access to safe and respectful care in the hospital system.ConclusionSome service users believe that home birth is their only option when they cannot access hospital‐based care for vaginal breech birth. Current barriers to care for breech birth limit birthing people's autonomy and may be placing them and their infants at increased risk.

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Up against a wall: A patient and obstetrician’s perspective on the mode of breech delivery

Cited by 4 publications

References 16 publications

Women’s experiences of breech birth and disciplinary power

Women’s experiences of breech birth and disciplinary power

Maternal and neonatal outcomes associated with breech presentation in planned community (home and birth center) births in the United States: A prospective observational cohort study

“I had no choice”: A mixed‐methods study on access to care for vaginal breech birth

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