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

Abstract

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.

Vaginale Beckenendlagegeburt – immer noch eine Option?

“…Vaginale Geburt bei Beckenendlageeine Diskussion so alt wie die Geburtshilfe selbst. Der optimale Geburtsmodus bei BEL am Termin wird seit beinahe einem halben Jahrhundert von Forschenden untersucht [10], obwohl die vaginale BEL-Geburt über viele Jahrhunderte der geburtshilfliche Standard war [18]. Retrospektive Studien kamen in der Mitte des 20.…”

“…Obgleich Jahre später die Ergebnisse aufgrund methodischer Mängel relativiert wurden und neuen Evidenzen prädominieren, ist die Sectiorate bei betroffenen Schwangeren noch erschreckend hoch [13]. Obwohl diverse Studienergebnisse aufzeigen, dass eine Schnittentbindung im Vergleich zur Vaginalgeburt bei BEL keine sicherere Variante darstellt [10], wird eine I°Sectio Primiparae grundsätzlich empfohlen, um das fetale geburtshilfliche Risiko zu verringern [17]. Der daraus resultierende Verlust von Fachexpertise, mangels klinischer Erfahrung, manueller Fähigkeiten und Fertigkeiten einer vaginalen BEL-Entbindung stellt bei unerwarteten BEL und Gemini-Geburten eine Notfallsituation dar [15].…”

The incidence and perinatal outcomes of singleton vaginal breech deliveries in a low-resource setting, mpilo central hospital, Bulawayo, Zimbabwe

“…Over the last years subsequent evidence has not shown conclusively that that caesarean birth is safer than vaginal birth for a fetus in a breech presentation when certain criteria are met. 3 The best way to deliver a preterm breech still remains unresolved. There has been erosion of clinical skills and confidence.…”

“…There has been erosion of clinical skills and confidence. 3,4 Simulation-based training could never be the substitute for the real clinical experience. Future clinicians would have less skill and confidence in dealing with vaginal breech deliveries.…”

Getting the ‘Comfortable’ to listen: a mixed methods study of refusal of recommended maternity care

“…Likewise for women who decline routine vaginal examinations in labour, which is not an evidence-based practice (see Downe et al, 2013). In other areas, such as breech vaginal birth, homebirth and water birth, the evidence is contested (see Hunter, 2014;Roome et al, 2015;Young & Kruske, 2012b, respectively). The timing of a woman's refusal may also vary: some may arise throughout antenatal care if women and care providers disagree over prenatal testing or 'maternal lifestyle issues' such as alcohol or tobacco use, while others may not be addressed until birth is imminent (Oberman, 2000, p. 451).…”