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Dasgupta T, Hunter S, Reid S, Sandall J, Shennan A, Davies SM, Walker S. Breech specialist midwives and clinics in the OptiBreech Trial feasibility study: An implementation process evaluation. Birth 2023; 50:596-605. [PMID: 36288483 DOI: 10.1111/birt.12685] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 08/03/2022] [Accepted: 10/06/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Attendance of skilled and experienced professionals at breech births has been associated with a reduction in adverse perinatal outcomes. We aimed to determine whether United Kingdom National Health Service (NHS) sites could reliably provide attendants with OptiBreech training and/or advanced proficiency (intervention feasibility) and consistent care (fidelity) that meets women's needs (acceptability), with low neonatal admission rates (safety) and recruitment adequate to support a clinical trial (trial feasibility). METHODS Mixed methods implementation evaluation was used. Settings were 13 services in England and Wales. Participants were 82 women requesting support for a vaginal breech birth (VBB) at term. Outcomes were descriptively analyzed. Twenty-one women were interviewed, and transcripts were analyzed using the Theoretical Framework of Acceptability. Iterative analysis informed subsequent interviews and the ongoing process of implementation across sites. RESULTS Although we initially suggested multidisciplinary teams, actively recruiting Trusts yielded services where VBB care was provided through a dedicated clinic, organized and delivered primarily by a lead midwife who functioned as a specialist. This model achieved 87.5% fidelity with the intervention's goal of ensuring the attendance of OptiBreech-trained professionals. Neonatal outcomes remained stable, with an admission rate of 5.5%. Women reported care from specialist midwives as highly acceptable, but the model is vulnerable without a strategic effort to develop additional proficient team members. CONCLUSIONS Dedicated clinics coordinated by specialist midwives appear to be an acceptable and feasible implementation strategy to test the safety and effectiveness of proficient team care for VBB in a clinical trial. Back-up arrangements should be maintained while additional members of the team develop proficiency.
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Affiliation(s)
- Tisha Dasgupta
- Department of Women & Children's Health, School of Life Course Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Sarah Hunter
- Department of Women & Children's Health, School of Life Course Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
- Independent Lay Members of the Research Team, Peterborough, UK
| | - Sharna Reid
- Department of Women & Children's Health, School of Life Course Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
- Independent Lay Members of the Research Team, London, UK
| | - Jane Sandall
- Department of Women & Children's Health, School of Life Course Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Andrew Shennan
- Department of Women & Children's Health, School of Life Course Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Siân M Davies
- Department of Women & Children's Health, School of Life Course Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Shawn Walker
- Department of Women & Children's Health, School of Life Course Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
- Chelsea and Westminster Hospital NHS Foundation Trust, Women's and Children's Services, London, UK
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2
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Attitudes towards breech management among a team of maternity clinicians in Australia undertaking breech training. Women Birth 2020; 33:e348-e356. [DOI: 10.1016/j.wombi.2019.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 08/05/2019] [Accepted: 08/05/2019] [Indexed: 11/21/2022]
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Breech deliveries in OLVG, the Netherlands: A retrospective cohort study of seven years. Eur J Obstet Gynecol Reprod Biol 2020; 248:37-43. [PMID: 32193024 DOI: 10.1016/j.ejogrb.2020.02.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 02/19/2020] [Accepted: 02/21/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND The clinical dilemma on the preferred mode of delivery for breech position still exists. Elective caesarean delivery (CD) could be safer for neonates, whereas vaginal breech delivery (VBD) remains a safe option when conducted by an experienced person. Besides successful VBD is beneficial for mothers and subsequent pregnancies. OBJECTIVES To evaluate breech deliveries on mode of delivery, maternal and neonatal outcomes. STUDY DESIGN A single center, retrospective, cohort study was performed of women who delivered a singleton fetus in breech position from 32 weeks' gestation onwards from January 2011 to December 2017. Primary outcome measure was mode of delivery defined as an elective CD and planned VBD. Secondary outcome measures were neonatal and maternal outcome. For neonatal outcome, we used neonatal mortality and a composite measure neonatal morbidity. Maternal outcome included maternal mortality and maternal morbidity divided in severe and non-severe complications. We subcategorized for preterm (32 weeks to 37 weeks of gestation) and term pregnancies (from 37 weeks of gestation onwards). RESULTS 1.774 women delivered a child in breech position, 73 % opted for an elective CD. Of the 484 women that had a planned VBD (preterm 38 % (n = 59), term 26 % (n = 425)) 71 % were successful. Neonatal mortality occurred twice in the VBD cohort. Preterm neonatal morbidity occurred in the elective CD and VBD cohort equally (both 66 %), at term significantly more in the VBD cohort (12 % v 4%, OR 3.2, 95 % CI 2.1-4.8). For the total cohort, severe maternal postpartum complications occurred more often in the elective CD compared to successful VBD (2% v 0.3 %, OR 6.0, 95 % CI 0.80-44.3). CONCLUSION A high rate of successful VBD after opting for a planned VBD was found in our center. Nevertheless, compromised neonatal outcome at term was more frequent in the planned VBD group compared to the elective CD group. Severe maternal postpartum complications were more frequent in the elective CD group compared to the VBD group. Future research should focus alternations in the management of breech presentation.
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Partridge B. Conceptual and ethical problems underpinning calls to abandon vaginal breech birth. Women Birth 2020; 34:e210-e215. [PMID: 31924567 DOI: 10.1016/j.wombi.2019.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 12/23/2019] [Accepted: 12/23/2019] [Indexed: 11/25/2022]
Abstract
The view that vaginal breech birth is unjustifiable due to neonatal safety concerns has resulted in continued calls for breech pregnancies to be managed via a policy of planned caesarean birth. Vaginal breech birth has of course always occurred, but women with term breech pregnancies who seek to have a vaginal birth often face coercive pressures to have a caesarean birth instead. In this paper I argue that even if there is population level evidence that vaginal birth is relatively riskier for the breech presenting fetus, implementing a policy of planned caesarean birth would essentially be an unjustified attempt at forced medical intervention upon women. Advocates of a policy of planned caesarean birth often conflate the acceptability of allocating participants to a treatment group (policy) within the context of a randomized controlled trial with the justifiability of doing that as part of individual health care. Calls for obstetricians to "abandon vaginal breech birth" mistakenly position vaginal breech birth itself as a form of medical intervention that can simply be removed as an option for women by obstetricians. In reality, abandoning vaginal breech birth would entail abandoning women by denying them access to healthcare options that are otherwise available to any woman having a vaginal birth.
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Affiliation(s)
- Bradley Partridge
- School of Clinical Medicine - TPCH Northside, The University of Queensland, Rode Road, Chermside, Queensland, 4032, Australia.
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Bjellmo S, Hjelle S, Krebs L, Magnussen E, Vik T. Adherence to guidelines and suboptimal practice in term breech delivery with perinatal death- a population-based case-control study in Norway. BMC Pregnancy Childbirth 2019; 19:330. [PMID: 31500581 PMCID: PMC6734432 DOI: 10.1186/s12884-019-2464-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 08/20/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND In a recent population-based study we reported excess risk of neonatal mortality associated with vaginal breech delivery. In this case-control study we examine whether deviations from Norwegian guidelines are more common in breech deliveries resulting in intrapartum or neonatal deaths than in breech deliveries where the offspring survives, and if these deaths are potentially avoidable. MATERIAL AND METHODS Case-control study completed as a perinatal audit including term breech deliveries of singleton without congenital anomalies in Norway from 1999 to 2015. Deliveries where the child died intrapartum or in the neonatal period were case deliveries. For each case, two control deliveries who survived were identified. All the included deliveries were reviewed by four obstetricians independently assessing if the deaths in the case group might have been avoided and if the management of the deviations from Norwegian guidelines were more common in case than in control deliveries. RESULTS Thirty-one case and 62 control deliveries were identified by the Medical Birth Registry of Norway. After exclusion of non-eligible deliveries, 22 case and 31 control deliveries were studied. Three case and two control deliveries were unplanned home deliveries, while all in-hospital deliveries were in line with national guidelines. Antenatal care and/or management of in-hospital deliveries was assessed as suboptimal in seven (37%) case and two (7%) control deliveries (p = 0.020). Three case deliveries were completed as planned caesarean delivery and 12 (75%) of the remaining 16 deaths were considered potentially avoidable had planned caesarean delivery been done. In seven of these 16 deliveries, death was associated with cord prolapse or difficult delivery of the head. CONCLUSION All in-hospital breech deliveries were in line with Norwegian guidelines. Seven of twelve potentially avoidable deaths were associated with birth complications related to breech presentation. However, suboptimal care was more common in case than control deliveries. Further improvement of intrapartum care may be obtained through continuous rigorous training and feedback from repeated perinatal audits.
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Affiliation(s)
- Solveig Bjellmo
- Department of Obstetrics and Gynecology, More and Romsdal Hospital Trust, Postbox 1600, 6026, Aalesund, Norway.
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
| | - Sissel Hjelle
- Department of Obstetrics and Gynecology, More and Romsdal Hospital Trust, Postbox 1600, 6026, Aalesund, Norway
| | - Lone Krebs
- Department of Gynecology and Obstetrics, University of Copenhagen Holbaek Hospital, Holbaek, Denmark
| | - Elisabeth Magnussen
- Department of Obstetrics and Gynecology, St Olav's University Hospital, Trondheim, Norway
| | - Torstein Vik
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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No. 384-Management of Breech Presentation at Term. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:1193-1205. [DOI: 10.1016/j.jogc.2018.12.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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No 384 - Prise en charge de la présentation du siège du fœtus à terme. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:1206-1220. [DOI: 10.1016/j.jogc.2019.03.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Montoya-Williams D, Lemas DJ, Spiryda L, Patel K, Neu J, Carson TL. What Are Optimal Cesarean Section Rates in the U.S. and How Do We Get There? A Review of Evidence-Based Recommendations and Interventions. J Womens Health (Larchmt) 2017; 26:1285-1291. [PMID: 28825512 DOI: 10.1089/jwh.2016.6188] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Cesarean sections (CSs) are the most commonly performed surgical procedures in the world today. Global epidemiological studies from the last decade suggest that the optimal CS rates in developed countries exist somewhere between 15% and 19%. Despite these findings, CS rates in the United States have remained stable at slightly over 32% over the past 10 years. Using primary and secondary literature published from 2010 to 2015, this review discusses how optimal CS rates were developed. In addition, we define a category of potentially avoidable CS (i.e., those conducted on nulliparous low-risk women who present with vertex infants at term) and explore how CS in this population appear to be one of the main drivers of high CS rates overall. The institutional, provider, and patient-related factors, which may be related to higher-than-recommended rates of CS, particularly those conducted in low-risk women, will be discussed. This review will then delve into clinician and patient-oriented interventions that have been shown to effectively reduce the rate of potentially avoidable CS. Our analysis showed that large-scale, multifaceted interventions that include audit and feedback cycles as well as peer review strategies were the most effective in decreasing rates of potentially avoidable CS. This review concludes with an agenda for future research into interventions that aim to achieve optimal CS rates.
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Affiliation(s)
- Diana Montoya-Williams
- 1 Division of Neonatology, Department of Pediatrics, University of Florida , Gainesville, Florida
| | - Dominick J Lemas
- 2 Department of Health Outcomes and Policy, University of Florida , Gainesville, Florida
| | - Lisa Spiryda
- 3 Department of Obstetrics and Gynecology, University of Florida , Gainesville, Florida
| | - Keval Patel
- 4 Department of Biology, College of Liberal Arts and Sciences, University of Florida, Gainesville, Florida
| | - Josef Neu
- 1 Division of Neonatology, Department of Pediatrics, University of Florida , Gainesville, Florida
| | - Tiffany L Carson
- 5 Division of Preventive Medicine, Department of Medicine, University of Alabama , Birmingham, Alabama
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Seeho SK, Nippita TA. Term breech delivery: Is recommending vaginal birth a breach of best practice? Aust N Z J Obstet Gynaecol 2017; 57:375-377. [DOI: 10.1111/ajo.12644] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Accepted: 04/17/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Sean K.M. Seeho
- Clinical and Population Perinatal Health Research; Kolling Institute; Sydney New South Wales Australia
- Sydney Medical School - Northern, University of Sydney; Sydney New South Wales Australia
- Department of Obstetrics and Gynaecology; Royal North Shore Hospital; Sydney New South Wales Australia
| | - Tanya A. Nippita
- Clinical and Population Perinatal Health Research; Kolling Institute; Sydney New South Wales Australia
- Sydney Medical School - Northern, University of Sydney; Sydney New South Wales Australia
- Department of Obstetrics and Gynaecology; Royal North Shore Hospital; Sydney New South Wales Australia
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Bisits A. There is a place in current obstetric practice for planned vaginal breech birth. Aust N Z J Obstet Gynaecol 2017; 57:372-374. [DOI: 10.1111/ajo.12643] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 04/17/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Andrew Bisits
- Department of Maternity; Royal Hospital for Women; Sydney New South Wales Australia
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11
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Bjellmo S, Andersen GL, Martinussen MP, Romundstad PR, Hjelle S, Moster D, Vik T. Is vaginal breech delivery associated with higher risk for perinatal death and cerebral palsy compared with vaginal cephalic birth? Registry-based cohort study in Norway. BMJ Open 2017; 7:e014979. [PMID: 28473516 PMCID: PMC5566597 DOI: 10.1136/bmjopen-2016-014979] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE This paper aims to study if vaginal breech delivery is associated with increased risk for neonatal mortality (NNM) or cerebral palsy (CP) in Norway where vaginal delivery accounts for 1/3 of all breech deliveries. DESIGN Cohort study using information from the national Medical BirthRegister and Cerebral Palsy Register. SETTING Births in Norway 1999-2009. PARTICIPANTS 520 047 term-born singletons without congenital malformations. MAIN OUTCOME MEASURES NNM, CP and a composite outcome of these and death during birth. RESULTS Compared with cephalic births, breech births had substantially increased risk for NNM but not for CP. Vaginal delivery was planned for 7917 of 16 700 fetuses in breech, while 5561 actually delivered vaginally. Among these, NNM was 0.9 per 1000 compared with 0.3 per 1000 in vaginal cephalic delivery, and 0.8 per 1000 in those actually born by caesarean delivery (CD) in breech. Compared with planned cephalic delivery, planned vaginal delivery was associated with excess risk for NNM (OR 2.4; 95% CI 1.2 to 4.9), while the OR associated with planned breech CD was 1.6 (95% CI 0.7 to 3.7). These risks were attenuated when NNM was substituted by the composite outcome. Vaginal breech delivery was not associated with excess risk for CP compared with vaginal cephalic delivery. CONCLUSION Vaginal breech delivery, regardless of whether planned or actual, and actual breech CD were associated with excess risk for NNM compared with vaginal cephalic delivery, but not with CP. The risk for NNM and CP in planned breech CD did not differ significantly from planned vaginal cephalic delivery. However, the absolute risk for these outcomes was low, and taking into consideration potential long-term adverse consequences of CD for the child and later deliveries, we therefore conclude that vaginal breech delivery may be recommended, provided competent obstetric care and strict criteria for selection to vaginal delivery.
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Affiliation(s)
- Solveig Bjellmo
- Department of Obstetrics and Gynecology, Helse More og Romsdal HF, Alesund, Norway
- The Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | - Guro L Andersen
- The Norwegian University of Science and Technology, NTNU, Trondheim, Norway
- The Cerebral Palsy Registry of Norway, Habilitation Center, Vestfold Hospital, Tønsberg, Norway
| | - Marit Petra Martinussen
- The Norwegian University of Science and Technology, NTNU, Trondheim, Norway
- Department of Laboratory Medicine, Children’s and Women’s Health, LBK, Trondheim, Norway
- Department of Obstetrics and Gynecology, St Olav`s Hospital, Trondheim, Norway
| | - Pål Richard Romundstad
- The Norwegian University of Science and Technology, NTNU, Trondheim, Norway
- Department of Public Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Sissel Hjelle
- Department of Obstetrics and Gynecology, Helse More og Romsdal HF, Alesund, Norway
| | - Dag Moster
- Institute of Global Public Health and Primary Care, UiB, Bergen, Norway
- Department of Paediatrics, Hauekland University Hospital, Bergen, Norway
| | - Torstein Vik
- The Norwegian University of Science and Technology, NTNU, Trondheim, Norway
- Department of Laboratory Medicine, Children’s and Women’s Health, LBK, Trondheim, Norway
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12
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Sloman R, Wanat M, Burns E, Smith L. Midwives’ views, experiences and feelings of confidence surrounding vaginal breech birth: A qualitative study. Midwifery 2016; 41:61-67. [DOI: 10.1016/j.midw.2016.07.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 07/18/2016] [Accepted: 07/31/2016] [Indexed: 10/21/2022]
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Simões R, Valadares Neto JDD, Bernardo WM, Salomão AJ, Baracat EC. Elective cesarean section for term breech delivery. Rev Assoc Med Bras (1992) 2015; 61:391-402. [PMID: 26602999 DOI: 10.1590/1806-9282.61.05.391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
| | - Ricardo Simões
- Federação Brasileira das Associações de Ginecologia e Obstetrícia, Brazil
| | | | | | - Antonio J Salomão
- Federação Brasileira das Associações de Ginecologia e Obstetrícia, Brazil
| | - Edmund C Baracat
- Federação Brasileira das Associações de Ginecologia e Obstetrícia, Brazil
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Homer CS, Watts NP, Petrovska K, Sjostedt CM, Bisits A. Women's experiences of planning a vaginal breech birth in Australia. BMC Pregnancy Childbirth 2015; 15:89. [PMID: 25885035 PMCID: PMC4396595 DOI: 10.1186/s12884-015-0521-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 03/30/2015] [Indexed: 11/10/2022] Open
Abstract
Background In many countries, planned vaginal breech birth (VBB) is a rare event. After the Term Breech Trial in 2000, VBB reduced and caesarean section for breech presentation increased. Despite this, women still request VBB. The objective of this study was to explore the experiences and decision-making processes of women who had sought a VBB. Methods A qualitative study using descriptive exploratory design was undertaken. Twenty-two (n = 22) women who planned a VBB, regardless of eventual mode of birth were recruited. The women had given birth at one of two maternity hospitals in Australia that supported VBB. In-depth, semi-structured interviews using an interview guide were conducted. Interviews were analysed thematically. Results Twenty two women were interviewed; three quarters were primiparous (n = 16; 73%). Nine (41%) were already attending a hospital that supported VBB with the remaining women moving hospitals. All women actively sought a vaginal breech birth because the baby remained breech after an external cephalic version – 12 had a vaginal birth (55%) and 10 (45%) a caesarean section after labour commenced. There were four main themes: Reacting to a loss of choice and control, Wanting information that was trustworthy, Fighting the system and seeking support for VBB and The importance of ‘having a go’ at VBB. Conclusions Women seeking a VBB value clear, consistent and relevant information in deciding about mode of birth. Women desire autonomy to choose vaginal breech birth and to be supported in their choice with high quality care.
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Affiliation(s)
- Caroline Se Homer
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Level 7, 235 Jones St, Ultimo NSW 2007, PO Box 123, Sydney, Australia.
| | - Nicole P Watts
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Level 7, 235 Jones St, Ultimo NSW 2007, PO Box 123, Sydney, Australia.
| | - Karolina Petrovska
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Level 7, 235 Jones St, Ultimo NSW 2007, PO Box 123, Sydney, Australia.
| | - Chauncey M Sjostedt
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Level 7, 235 Jones St, Ultimo NSW 2007, PO Box 123, Sydney, Australia.
| | - Andrew Bisits
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Level 7, 235 Jones St, Ultimo NSW 2007, PO Box 123, Sydney, Australia. .,Royal Hospital for Women, Barker St, Randwick, NSW 2031, Australia.
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15
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Mackay DF, Wood R, King A, Clark DN, Cooper SA, Smith GCS, Pell JP. Educational outcomes following breech delivery: a record-linkage study of 456947 children. Int J Epidemiol 2015; 44:209-17. [PMID: 25613426 PMCID: PMC4415090 DOI: 10.1093/ije/dyu270] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Obstetric management of term breech infants changed dramatically following the Term Breech Trial which suggested increased serious neonatal morbidity following trial of labour. Short-term morbidity is a poor proxy of long-term neurological sequelae. We determined whether vaginal breech delivery was associated with educational outcomes. METHODS We linked three Scotland-wide administrative databases at an individual level: the ScotXed school census; Scottish Qualifications Authority (SQA) examination results; and Scottish Morbidity Record (SMR02) maternity database. The linkage provided information on singleton children, born at term, attending Scottish schools between 2006 and 2011. RESULTS Of the 456 947 eligible children, 1574 (0.3%) had vaginal breech deliveries, 12 489 (2.7%) planned caesarean section for breech presentation and 442 090 (96.9%) vaginal cephalic deliveries. The percentage of term breech infants delivered vaginally fell from 23% to 7% among children who started school in 2006 and 2011, respectively. Of children born by vaginal breech delivery, 1.5% had a low 5-min Apgar score (≤3) compared with only 0.4% of those born by either breech caesarean section [adjusted odds ratio (OR) 6.16, 95% confidence interval (CI) 4.44-8.54, p<0.001] or cephalic vaginal delivery (adjusted OR 3.84, 95% CI 2.99-4.93, p<0.001). Children born by vaginal breech delivery had lower examination attainment than those born by either planned caesarean section for breech presentation (adjusted OR 1.16, 95% CI 1.02-1.32, p=0.020) or vaginal cephalic delivery (adjusted OR 1.14, 95% CI 1.01-1.28, p=0.029). CONCLUSIONS Vaginal delivery of term breech infants was associated with lower examination attainment, as well as poorer Apgar scores, suggesting that the adverse effects are not just short-term.
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Affiliation(s)
- Daniel F Mackay
- Institute of Health and Wellbeing, Glasgow University, Glasgow, UK, Information Services Division, NHS National Services Scotland, Edinburgh, UK, ScotXed Unit, Scottish Government, Edinburgh, UK and Obstetrics and Gynaecology Department, Cambridge University, Cambridge, UK
| | - Rachael Wood
- Institute of Health and Wellbeing, Glasgow University, Glasgow, UK, Information Services Division, NHS National Services Scotland, Edinburgh, UK, ScotXed Unit, Scottish Government, Edinburgh, UK and Obstetrics and Gynaecology Department, Cambridge University, Cambridge, UK
| | - Albert King
- Institute of Health and Wellbeing, Glasgow University, Glasgow, UK, Information Services Division, NHS National Services Scotland, Edinburgh, UK, ScotXed Unit, Scottish Government, Edinburgh, UK and Obstetrics and Gynaecology Department, Cambridge University, Cambridge, UK
| | - David N Clark
- Institute of Health and Wellbeing, Glasgow University, Glasgow, UK, Information Services Division, NHS National Services Scotland, Edinburgh, UK, ScotXed Unit, Scottish Government, Edinburgh, UK and Obstetrics and Gynaecology Department, Cambridge University, Cambridge, UK
| | - Sally-Ann Cooper
- Institute of Health and Wellbeing, Glasgow University, Glasgow, UK, Information Services Division, NHS National Services Scotland, Edinburgh, UK, ScotXed Unit, Scottish Government, Edinburgh, UK and Obstetrics and Gynaecology Department, Cambridge University, Cambridge, UK
| | - Gordon C S Smith
- Institute of Health and Wellbeing, Glasgow University, Glasgow, UK, Information Services Division, NHS National Services Scotland, Edinburgh, UK, ScotXed Unit, Scottish Government, Edinburgh, UK and Obstetrics and Gynaecology Department, Cambridge University, Cambridge, UK
| | - Jill P Pell
- Institute of Health and Wellbeing, Glasgow University, Glasgow, UK, Information Services Division, NHS National Services Scotland, Edinburgh, UK, ScotXed Unit, Scottish Government, Edinburgh, UK and Obstetrics and Gynaecology Department, Cambridge University, Cambridge, UK
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Abstract
Since the concept of "evidence-based medicine" was first launched 20 years ago as a new method of teaching the practice of medicine, it has had an enormous impact on practice in many fields of health care. From the very start, professionals in pregnancy and perinatal care were at the forefront of attempts to collect good evidence systematically on the benefits and harms of health care interventions during pregnancy and in and around childbirth. Perinatal practice has largely benefitted from that endeavor. However, it has also suffered from the ill-effects of the narrow view that evidence, to be good evidence, needs to be randomized evidence. Twenty years on, it may be time to reflect on what is meant by evidence and how to use it, not as a doctrine or dogma, but as a valuable tool and a tremendous asset to improve outcomes for mothers and babies.
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Affiliation(s)
- Marc J N C Keirse
- Obstetrics, Flinders University, Adelaide, South Australia, Australia
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17
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TOIVONEN ELLI, PALOMÄKI OUTI, HUHTALA HEINI, UOTILA JUKKA. Selective vaginal breech delivery at term - still an option. Acta Obstet Gynecol Scand 2012; 91:1177-83. [DOI: 10.1111/j.1600-0412.2012.01488.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Abstract
In 2000, the Term Breech Trial was published, and its authors recommended cesarean section as the safest mode of delivery for breech-presenting babies. Criticisms of the trial were raised at the time, which the authors dismissed. Since then, maternal deaths have been recorded among women undergoing cesarean sections for breech presentations. Accordingly, those initial criticisms deserve to be revisited.
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Affiliation(s)
- Gerald W Lawson
- Gerald W. Lawson is a former Consultant in Obstetrics and Gynaecology at John Hunter Hospital, Newcastle, New South Wales, Australia
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Affiliation(s)
- Marc J N C Keirse
- Flinders University, Flinders Medical Centre, Adelaide, South Australia, Australia
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Evolving Evidence Since the Term Breech Trial: Canadian Response, European Dissent, and Potential Solutions. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2010; 32:217-24. [DOI: 10.1016/s1701-2163(16)34447-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Kotaska A, Menticoglou S, Gagnon R, Gagnon R, Farine D, Basso M, Bos H, Delisle MF, Grabowska K, Hudon L, Menticoglou S, Mundle W, Murphy-Kaulbeck L, Ouellet A, Pressey T, Roggensack A. Accouchement du siège par voie vaginale. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2009. [DOI: 10.1016/s1701-2163(16)34222-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Kotaska A, Menticoglou S, Gagnon R, Gagnon R, Farine D, Basso M, Bos H, Delisle MF, Grabowska K, Hudon L, Menticoglou S, Mundle W, Murphy-Kaulbeck L, Ouellet A, Pressey T, Roggensack A. Vaginal Delivery of Breech Presentation. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2009; 31:557-566. [DOI: 10.1016/s1701-2163(16)34221-9] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Kotaska A. In the literature: combating coercion: breech birth, parturient choice, and the evolution of evidence-based maternity care. Birth 2007; 34:176-80. [PMID: 17542823 DOI: 10.1111/j.1523-536x.2007.00165.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Andrew Kotaska
- Department of Obstetrics and Gynecology, Stanton Territorial Hospital, Yellowknife, Northwest Territories and University of Manitoba, Winnipeg, Manitoba, Canada
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Glezerman M. Five years to the term breech trial: the rise and fall of a randomized controlled trial. Am J Obstet Gynecol 2006; 194:20-5. [PMID: 16389006 DOI: 10.1016/j.ajog.2005.08.039] [Citation(s) in RCA: 157] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2005] [Revised: 07/18/2005] [Accepted: 08/18/2005] [Indexed: 11/19/2022]
Abstract
OBJECTIVE On the basis of the end points of neonatal morbidity and death, the authors of the term breech trial concluded unequivocally that cesarean delivery was safer for breech babies. STUDY DESIGN Analysis of the original and new data gives rise to serious concerns as far as study design, methods, and conclusions are concerned. In a substantial number of cases, there was a lack of adherence to the inclusion criteria. There was a large interinstitutional variation of standard of care; inadequate methods of antepartum and intrapartum fetal assessment were used, and a large proportion of women were recruited during active labor. In many instances of planned vaginal delivery, there was no attendance of a clinician with adequate expertise. RESULTS Most cases of neonatal death and morbidity in the term breech trial cannot be attributed to the mode of delivery. Moreover, analysis of outcome after 2 years has shown no difference between vaginal and abdominal deliveries of breech babies. CONCLUSION The original term breech trial recommendations should be withdrawn.
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Affiliation(s)
- Marek Glezerman
- Department of Obstetrics and Gynecology, Wolfson Medical Center, The Helen Schneider Hospital for Women, Holon, Israel
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Abstract
As randomised trials continue to ascend in the evolution of evidence based medicine, we must recognise and respect their limitations when examining complex phenomena in heterogeneous populations
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Affiliation(s)
- Andrew Kotaska
- Department of Obstetrics and Gynaecology, University of British Columbia, BC Women's Hospital, Vancouver, BC, V6H 3V5 Canada.
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Raynes-Greenow CH, Roberts CL, Barratt A, Brodrick B, Peat B. Pregnant women's preferences and knowledge of term breech management, in an Australian setting. Midwifery 2004; 20:181-7. [PMID: 15177862 DOI: 10.1016/j.midw.2003.10.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2003] [Revised: 05/29/2003] [Accepted: 09/24/2003] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To assess women's familiarity with breech presentation and external cephalic version (ECV), and to identify women's preferences and attitudes regarding breech management. DESIGN Cross-sectional survey. SETTING King George V (KGV) Memorial Hospital for Mothers and Babies, Sydney, Australia, a major metropolitan teaching hospital. POPULATION 174 pregnant women (20-38 weeks gestation) attending KGV for antenatal care in 2001. METHODS Data were obtained from a self-administered questionnaire that was distributed through the antenatal clinics. MAIN OUTCOME MEASURES Women's familiarity of breech presentation and ECV, women's attitude towards ECV, decision to attempt ECV, and with whom participants would like to make a decision regarding ECV. FINDINGS Of the 174 respondents, 85% could correctly identify breech presentation, and 66% had heard of ECV. For 87% this information was from books, and family/friends, and not their midwife/doctor. Equal numbers of women responded that they would or would not choose ECV (39%), and the remaining 22% were uncertain. Factors influencing their decision included concerns about the safety for the baby, ECV not guaranteeing vaginal birth despite successful version, and ECV not being effective enough. Seventy-two per cent wanted to make the decision to attempt ECV together with their doctor. CONCLUSION Although the majority of the women had a preference for vaginal birth, their knowledge of ECV appeared insufficient to enable them to make informed decisions about attempting ECV. These findings suggest that care-providers should offer women information on ECV, in a shared-decision-making environment.
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Affiliation(s)
- Camille H Raynes-Greenow
- Centre for Perinatal Health Services Research, Screening and Test Evaluation Program, School of Public Health, University of Sydney, Australia.
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Grimes DA, Schulz KF. Clinical research in obstetrics and gynecology: a Baedeker for busy clinicians. Obstet Gynecol Surv 2002; 57:S35-53. [PMID: 12479352 DOI: 10.1097/00006254-200209003-00001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- David A Grimes
- Family Health International, Research Triangle Park, North Carolina 27709, USA.
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