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Nothelfer A, Friedl TWP, Dayan D, Beer F, Janni W, Reister F, Kraft K, Huener B. Trial and error - Outcome of breech presentation depending on birth mode and root cause analysis of severe adverse events. Eur J Obstet Gynecol Reprod Biol 2024; 299:309-316. [PMID: 38950454 DOI: 10.1016/j.ejogrb.2024.06.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 06/16/2024] [Accepted: 06/25/2024] [Indexed: 07/03/2024]
Abstract
OBJECTIVES The debate about the safest birth mode for breech presentation at term remains unresolved. The comparison of a vaginal breech birth (VBB) with an elective caesarean section (CS) regarding fetal outcomes favors the CS. However, the question of whether attempting a VBB is associated with poorer fetal outcomes is examined in this study. Additionally, the study evaluates factors contributing to a successful VBB and illustrates possible errors in VBB management. STUDY DESIGN We performed a retrospective analysis of term breech births over 15 years in a Perinatal Center Level I regarding fetal, maternal, and obstetric outcomes by comparing successful with unsuccessful VBB attempt and all attempted VBB vs. CS including a multivariate analysis of predictors for a successful VBB. A root cause analysis of severe adverse events (SAE) was conducted to evaluate factors leading to poorer fetal outcomes in VBB. RESULTS Of 863 breech cases, in 78 % a CS was performed and in 22 % a VBB was attempted, with 57 % succeeding. Comparing successful with unsuccessful VBB attempts, successful VBB showed significantly lower maternal blood loss (p < 0.001) but poorer umbilical arterial pH (UApH) (p < 0.001), while other fetal outcome parameters showed no significant differences. Predictive factors for a successful VBB attempt were a body mass index (BMI) below 30.0 kg/m2 (p = 0.010) and multiparity (p = 0.003). Comparing all attempted VBB to CS, maternal blood loss was significantly higher in CS (p < 0.001), while fetal outcomes were significantly worse in VBB attempts, included poorer Apgar scores (p < 0.001), poorer UApH values (p < 0.001), higher transfer rate to the Neonatal Intensive Care Unit (NICU) (p < 0.001) and higher rate of respiratory support in the first 24 h (p = 0.003). CONCLUSION The failed attempt of VBB indicates significantly worse UApH without lower Apgar scores or higher transfer rate to the NICU. The likelihood of a successful VBB is 9% lower with obesity and 2.5 times higher in multiparous women. Attempting a VBB should include detailed pre-labor counseling, regarding predictive success factors, an experienced team, and consistent management during birth.
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Affiliation(s)
- Anika Nothelfer
- University Hospital Ulm, Department of Gynecology and Obstetrics, Prittwitzstraße 43, 89075 Ulm, Germany.
| | - Thomas W P Friedl
- University Hospital Ulm, Department of Gynecology and Obstetrics, Prittwitzstraße 43, 89075 Ulm, Germany.
| | - Davut Dayan
- University Hospital Ulm, Department of Gynecology and Obstetrics, Prittwitzstraße 43, 89075 Ulm, Germany.
| | - Franziska Beer
- University Hospital Ulm, Department of Gynecology and Obstetrics, Prittwitzstraße 43, 89075 Ulm, Germany.
| | - Wolfgang Janni
- University Hospital Ulm, Department of Gynecology and Obstetrics, Prittwitzstraße 43, 89075 Ulm, Germany.
| | - Frank Reister
- University Hospital Ulm, Department of Gynecology and Obstetrics, Prittwitzstraße 43, 89075 Ulm, Germany.
| | - Katrina Kraft
- University Hospital Schleswig-Holstein, Department of Gynecology and Obstetrics, Campus Lübeck, Germany.
| | - Beate Huener
- University Hospital Ulm, Department of Gynecology and Obstetrics, Prittwitzstraße 43, 89075 Ulm, Germany.
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Walker S, Daelemans C, Gerhard-Nielsen K, Das S, Page L. Variations of cervical head entrapment in vaginal breech births: New insights on how to prevent, manage and resolve. Eur J Obstet Gynecol Reprod Biol 2024; 299:78-82. [PMID: 38843725 DOI: 10.1016/j.ejogrb.2024.05.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 05/26/2024] [Accepted: 05/31/2024] [Indexed: 07/20/2024]
Abstract
This paper presents a novel, systematic way to understand the causes of cervical head entrapment in vaginal breech births, and new insights into management. Three different types of cervical head entrapment are described, with detailed illustrations: unpredictable and potentially catastrophic, manageable, and preventable. The first affects preterm and growth-restricted fetuses. The second involves some degree of uterine prolapse. The third may result from prolonged head entrapment at the pelvic inlet, leaving time for cervical contraction or oedematous entrapment. Traditional and innovative strategies to resolve and prevent this complication are described and illustrated, with suggestions for further research.
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Affiliation(s)
- Shawn Walker
- King's College London, Department of Women & Children's Health, School of Life Course Sciences, Faculty of Life Sciences & Medicine, London, United Kingdom; Imperial College London, Clinical Academic Training Office, London, United Kingdom.
| | - Caroline Daelemans
- Obstetrics Division, Department of Woman, Child and Adolescent Medicine, Geneva University Hospitals, Geneva, Switzerland
| | | | - Sabrina Das
- Imperial College Healthcare NHS Trust, Queen Charlotte's and Chelsea Hospital, London, United Kingdom
| | - Louise Page
- Chelsea and Westminster Hospital NHS Foundation Trust, West Middlesex Hospital, London, United Kingdom
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Schafer R, Dietrich MS, Kennedy HP, Mulvaney S, Phillippi JC. "I had no choice": A mixed-methods study on access to care for vaginal breech birth. Birth 2024; 51:413-423. [PMID: 37968839 DOI: 10.1111/birt.12797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/26/2023] [Accepted: 10/16/2023] [Indexed: 11/17/2023]
Abstract
INTRODUCTION Although 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. METHODS We 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. RESULTS Of 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. CONCLUSION Some 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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Affiliation(s)
- Robyn Schafer
- Division of Advanced Nursing Practice, School of Nursing, Rutgers University, Newark, New Jersey, USA
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, USA
| | - Mary S Dietrich
- School of Nursing, Vanderbilt University, Nashville, Tennessee, USA
| | | | - Shelagh Mulvaney
- School of Nursing, Vanderbilt University, Nashville, Tennessee, USA
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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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Walker S, Spillane E, Stringer K, Meadowcroft A, Dasgupta T, Davies SM, Sandall J, Shennan A. The feasibility of team care for women seeking to plan a vaginal breech birth (OptiBreech 1): an observational implementation feasibility study in preparation for a pilot trial. Pilot Feasibility Stud 2023; 9:80. [PMID: 37173798 PMCID: PMC10175899 DOI: 10.1186/s40814-023-01299-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 04/10/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND OptiBreech Care is a care pathway for breech presentation at term, including where chosen, physiological breech birth attended by professionals with advanced training and/or proficiency. We aimed to assess the feasibility of implementing OptiBreech team care prior to proceeding with a planned pilot randomised controlled trial. METHODS Our design was an observational implementation feasibility assessment across England and Wales, January 2021-June 2022. Our objectives were to determine whether Trusts could provide attendants with advanced training (implementation feasibility), who deliver protocol-consistent care (fidelity), within existing resources (costs), while maintaining low neonatal admission rates (safety) and adequate recruitment rates (trial feasibility). Participants included women > 37 weeks pregnant with a breech-presenting foetus, requesting support for a vaginal breech birth following standard counselling, and staff involved in the study. No randomisation occurred in this first stage of feasibility work. RESULTS Thirteen National Health Service sites were recruited. A total of 82 women planned births in the study. Sites with a breech specialist midwife recruited at double the rate of sites without (0.90/month, 95% CI 0.64-1.16 vs 0.40, 95% CI 0.12-0.68). Referrals into the study came from midwives (46%), obstetricians (34%) and women themselves (20%). Vaginal births were attended by staff with OptiBreech training at 87.5% (35/40, 95% CI 0.732-0.958) and by staff who met additional proficiency criteria at 67.5% (27/40, 95% CI 0.509-0.814). Fidelity criteria were more consistently met by staff who also met proficiency criteria. There were four neonatal admissions (4.9%, 4/82), including one serious adverse outcome (1.2%, 1/82). CONCLUSIONS A prospective observational cohort of OptiBreech collaborative care, which could potentially support nested or cluster randomisation, appears feasible in sites willing to establish a dedicated clinic and strategically develop further proficient members of staff, with back-up plans for supporting rapidly progressing births. Randomisation procedures remain to be feasibility tested. It is funded by the NIHR (NIHR300582).
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Affiliation(s)
- Shawn Walker
- Department of Women & Children's Health, Faculty of Life Sciences & Medicine, School of Life Course and Population Sciences, King's College London, London, SE1 7EH, UK.
- Women's and Children's Services, Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Rd, London, SW10 9NH, UK.
| | - Emma Spillane
- Kingston Hospital NHS Foundation Trust, Galsworthy Road, Surrey, Kingston upon Thames, KT2 7QB, UK
| | - Kate Stringer
- Surrey and Sussex Healthcare NHS Trust, East Surrey Hospital, Canada Avenue, Redhill, RH1 5RH, UK
| | - Amy Meadowcroft
- Northern Care Alliance NHS Foundation Trust, Royal Oldham Hospital, Rochdale Road, Oldham, Greater Manchester, OL1 2JH, UK
| | - Tisha Dasgupta
- Department of Women & Children's Health, Faculty of Life Sciences & Medicine, School of Life Course and Population Sciences, King's College London, London, SE1 7EH, UK
| | - Siân M Davies
- Department of Women & Children's Health, Faculty of Life Sciences & Medicine, School of Life Course and Population Sciences, King's College London, London, SE1 7EH, UK
| | - Jane Sandall
- Department of Women & Children's Health, Faculty of Life Sciences & Medicine, School of Life Course and Population Sciences, King's College London, London, SE1 7EH, UK
| | - Andrew Shennan
- Department of Women & Children's Health, Faculty of Life Sciences & Medicine, School of Life Course and Population Sciences, King's College London, London, SE1 7EH, UK
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Roy R, Gray C, Prempeh-Bonsu CA, Walker S. What are women's experiences of seeking to plan a vaginal breech birth? A systematic review and qualitative meta-synthesis. NIHR OPEN RESEARCH 2023; 3:4. [PMID: 37881467 PMCID: PMC10593332 DOI: 10.3310/nihropenres.13329.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/04/2023] [Indexed: 10/27/2023]
Abstract
Background Guidelines for breech management at term emphasise choice and informed decision-making. Despite this, the choice of vaginal breech birth (VBB), is not always available or accessible. We aimed to describe the experiences of women seeking a VBB as reported in primary research and to offer strategies for improving this experience that are grounded in evidence. Methods We conducted a systematic review and qualitative meta-synthesis of the results, using grounded theory analysis methods (PROSPERO registration CRD42021262380), with literature published between January 2000 and February 2022. Seven databases were searched. Our review included literature about women with breech presentation, who sought a planned or unplanned VBB. Studies considering only experiences of alternative management (e.g. caesarean, external cephalic version), and those investigating healthcare workers' experiences were excluded. Covidence systematic review software was used for screening and quality assessment. Qualitative data were extracted using NVivo software (20.5.0). Data were analysed through an iterative process based on constant comparison methods, with an iterative and reflexive code generation process. Codes were then arranged into 'categories of experience', which gave rise to over-arching themes. Results Our review included 19 studies. We present one overarching theory: 'Women who wish to plan a vaginal breech birth seek connected autonomy'. Our schematic, depicting this theory, includes seven main categories of experience: paternalistic healthcare; emotional turmoil; judgement and self-doubt; mother vs society: refusing to conform; isolated but united by breech; welcomed direction; and supported self-determination and self-efficacy. Conclusions Women seeking to plan a VBB feel vulnerable and wish to connect with capable and confident healthcare providers. To meet their needs, services should be designed so that they can connect with clinicians who are willing and able to support their autonomy. Services should also seek to limit their exposure to disrespectful and judgemental interactions with healthcare providers.
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Affiliation(s)
- Ritika Roy
- School of Life Course Sciences, Faculty of Life Sciences & Medicine, King's College London, London, SE1 7EH, UK
| | - Cecilia Gray
- School of Life Course Sciences, Faculty of Life Sciences & Medicine, King's College London, London, SE1 7EH, UK
| | | | - Shawn Walker
- Women and Children's Health, King's College London, London, SE1 7EH, UK
- Women and Children's Services, Chelsea and Westminster Hospital NHS Foundation Trust, London, SW10 9NH, UK
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Farin A, Ceccaldi PF, Tapie L, Derisbourg S, Desseauve D, Daelemans C. Training for breech deliveries with the mother in an upright position: An innovative adaptation of a simulation model. Eur J Obstet Gynecol Reprod Biol 2023; 280:108-111. [PMID: 36446258 DOI: 10.1016/j.ejogrb.2022.11.015] [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: 09/16/2022] [Revised: 11/11/2022] [Accepted: 11/18/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Delivery of a breech baby with the mother in an upright position or on all fours has gained a renewed interest. In these positions, the obstetrician or midwife needs to learn new landmarks and maneuvers. A realistic simulation model would be a valuable adjunct for breech on all fours teaching programs. MATERIAL AND METHODS This article describes the simulation model and training program we have developed to train an interprofessional team to assist breech births when the mother is on all fours. A questionnaire was used to evaluate the realism of the adapted mannequin and the impact of training on the confidence level of the participants. RESULTS On a Likert scale of 1 to 5, 92% of participants agreed or strongly agreed that the adapted mannequin used was realistic for training obstetric maneuvers for complicated breech births. After training, their confidence level supporting a breech birth in an upright position rose from an average of 2.5 to 5.7 on a scale of 1 to 10. CONCLUSION Learning the skills for breech deliveries on all fours is made possible by targeted training with this adapted simulation model.
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Affiliation(s)
- Alexandre Farin
- Obstetrics Unit, Hôpital Riviera-Chablais, Rennaz, Switzerland
| | - Pierre-François Ceccaldi
- Department of Obstetrics, Gynecology, and Reproductive Medicine, Hôpital Foch, 92150 Suresnes, France; Innovative Materials and Interfaces Research Unit, (URB2i - EA 4462), Faculty of Health, University of Paris, University of Sorbonne Paris Nord, 93430 Villetaneuse, France; Center of Simulation iLumens, Paris, Diderot-Paris Nord, Faculty of Health, University of Paris, Paris, France
| | - Laurent Tapie
- Innovative Materials and Interfaces Research Unit, (URB2i - EA 4462), Faculty of Health, University of Paris, University of Sorbonne Paris Nord, 93430 Villetaneuse, France
| | - Sara Derisbourg
- Obstetrics Unit, Cliniques Universitaires de Bruxelles, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - David Desseauve
- Departement of Woman, Mother and Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Caroline Daelemans
- Department of Women, Children and Adolescents, Geneva University Hospitals, Geneva, Switzerland.
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Bevilacqua E, Jani JC, Meli F, Carlin A, Bonanni G, Rimbault M, Ruggiano I, Quenon C, Romanzi F, Lanzone A, Badr DA. Pregnancy outcomes in breech presentation at term: a comparison between 2 third level birth center protocols. AJOG GLOBAL REPORTS 2022; 2:100086. [DOI: 10.1016/j.xagr.2022.100086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
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Walker S, Reitter A. The structure of breech revolutions, a response to: "Upright breech birth: New video research risks reviving Friedman's curse". Birth 2022; 49:16-18. [PMID: 34931718 DOI: 10.1111/birt.12602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 10/11/2021] [Accepted: 10/26/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Shawn Walker
- Department of Women and Children's Health, Faculty of Life Sciences & Medicine, King's College London, London, UK.,Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Anke Reitter
- Obstetric and Prenatal Medicine Department, Hospital Sachsenhausen, Academic Teaching Hospital of the Goethe-University Frankfurt, Frankfurt, Germany
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10
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Morris SE, Sundin D, Geraghty S. Women’s experiences of breech birth decision making: An integrated review. Eur J Midwifery 2022; 6:2. [PMID: 35118350 PMCID: PMC8784975 DOI: 10.18332/ejm/143875] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 11/10/2021] [Accepted: 11/11/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Currently, caesarean section is the primary mode of birth for a breech presenting fetus, leading to a deskilling of clinicians and limitation of birth choices for women. The aim of this review is to present a synthesized summary of existing literature related to women’s experiences of breech birth mode decision-making. METHODS A systematic search of the literature was conducted in April 2021, utilizing five databases to identify and obtain peer-reviewed articles meeting the predetermined selection criteria. RESULTS Four major categories were synthesized from the integrated review: 1) Women who desire a vaginal birth may experience a range of negative emotions such as feelings of disempowerment, loss, uncertainty and a sense of isolation; 2) Women who experience a breech presentation at term experience significant pressures to conform to expectations of medical professionals and their families due to perceptions of risk related to breech birth; 3) Breech birth decision-making in a limiting system; and 4) Overall satisfaction with the decision to plan a vaginal breech birth. CONCLUSION Women with a breech presenting fetus at term experience a complex range of emotions and internal and external pressures due to perceptions of risk around breech birth. Midwives were seen as helpful throughout the breech experience. The reduced caesarean section rate for breech, observed in studies exploring specialized care pathways or dedicated services, could reduce the incidence of Severe Acute Maternal Morbidity.
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Affiliation(s)
- Sara E. Morris
- School of Nursing and Midwifery, Edith Cowan University, Perth, Australia
- King Edward Memorial Hospital, Perth, Australia
| | - Deborah Sundin
- School of Nursing and Midwifery, Edith Cowan University, Perth, Australia
| | - Sadie Geraghty
- School of Nursing and Midwifery, Edith Cowan University, Perth, Australia
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Robin A, Eyraud JL, Catalan C, Aubard Y, Coste Mazeau P. [Impact of a service protocol on the practice of vaginal delivery of breech presentations at term]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2022; 50:45-52. [PMID: 34530145 DOI: 10.1016/j.gofs.2021.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES The delivery of breech presentations remains controversial. Our study analysed the impact of a service protocol on the proportion of planned vaginal delivery and its success. Immediate neonatal morbidity and factors that may influence the success of vaginal delivery were studied. METHODS Retrospective study, between 2009 and 2020 at the CHRU of Limoges, type 3 maternity hospital, on patients with a breech foetus at term. The proportion of planned vaginal delivery and the rate of effective vaginal delivery were compared before/after 2015. Neonatal morbidity was compared for planned vaginal delivery and planned cesarean delivery groups. RESULTS We included 923 patients. The rate of planned vaginal delivery was significantly higher after 2015 from 5.2% to 19% (P<0.001), with a success rate increasing from 60% to 82.1% (P=0.06). The rate of vaginal breech deliveries significantly increased from 3.8% to 17% (P<0.001). We found significantly more newborns with moderate acidosis when a vaginal delivery was attempted (P<0.001). The success of vaginal delivery was correlated to the Magnin index (P=0.044), to gestational age (P=0.037), and to multiparity (OR 3.78 95% CI [1.42-10.03] P=0.006). CONCLUSION Our study demonstrates the benefits of setting up a service protocol for the practice of breech vaginal delivery.
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Affiliation(s)
- A Robin
- Service de gynécologie obstétrique, hôpital Mère-Enfant, CHRU de Limoges, 8, avenue Dominique-Larrey, 87000 Limoges, France
| | - J-L Eyraud
- Service de gynécologie obstétrique, hôpital Mère-Enfant, CHRU de Limoges, 8, avenue Dominique-Larrey, 87000 Limoges, France
| | - C Catalan
- Service de gynécologie obstétrique, hôpital Mère-Enfant, CHRU de Limoges, 8, avenue Dominique-Larrey, 87000 Limoges, France
| | - Y Aubard
- Service de gynécologie obstétrique, hôpital Mère-Enfant, CHRU de Limoges, 8, avenue Dominique-Larrey, 87000 Limoges, France
| | - P Coste Mazeau
- Service de gynécologie obstétrique, hôpital Mère-Enfant, CHRU de Limoges, 8, avenue Dominique-Larrey, 87000 Limoges, France; Inserm U1092, centre de biologie et de recherche en santé, université de Limoges, CHRU de Limoges, 2, rue du Pr Bernard Descottes, 87000 Limoges, France.
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Mattiolo S, Spillane E, Walker S. Physiological breech birth training: An evaluation of clinical practice changes after a one-day training program. Birth 2021; 48:558-565. [PMID: 34160107 DOI: 10.1111/birt.12562] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 05/22/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The "physiological breech birth" one-day training program is based on evidence about the physiology of breech births and how clinicians learn breech skills. Previous evaluations have demonstrated positive effects on confidence and knowledge, but the training's effect on clinical practice and outcomes is unknown. METHODS A mixed-methods evaluation was conducted in eight National Health Service hospitals in England and Northern Ireland. Changes in confidence and knowledge were assessed using pretraining and post-training surveys. Mode of birth and maternal birth positions were evaluated using audit data covering one year before the training and one year after, for all singleton vaginal breech births at term. FINDINGS A total of 263 participants completed the surveys. Confidence in managing breech births in both upright and supine positions significantly increased, as did participant knowledge. Audited data for 1402 women were collected. Overall vaginal birth rates remained similar in both periods. Among singleton vaginal breech births >37 weeks, the use of upright birthing positions increased significantly (P = .002). The study was not powered to detect differences in other outcomes, but pilot data were collected to inform the design of future studies. CONCLUSIONS Increase in use of upright birthing positions suggests that physiological breech birth training is likely to lead to clinical practice changes, which may help support maternal choice in line with current guidance. However, provision of a one-day training program did not change overall vaginal breech birth rates. Adequately powered research is needed to determine effects of clinical practice changes on clinical outcomes.
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Affiliation(s)
- Stella Mattiolo
- Women's and Children's Health, Epsom and St Helier University Hospitals, Epsom, UK
| | - Emma Spillane
- Kingston Hospital NHS Foundation Trust, Kingston, UK
| | - Shawn Walker
- Women and Children's Health, King's College London, London, UK.,Chelsea and Westminster Hospitals NHS Foundation Trust, London, UK
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Morris S, Geraghty S, Sundin D. Development of a Breech-Specific Integrated Care Pathway for Pregnant Women: Protocol for a Mixed Methods Study. JMIR Res Protoc 2021; 10:e23514. [PMID: 33620329 PMCID: PMC7943339 DOI: 10.2196/23514] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/29/2020] [Accepted: 01/19/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The development of an integrated care pathway with multidisciplinary input to standardize and streamline care for pregnant women experiencing breech presentation at 36 or more weeks of gestation poses several challenges because of the divisive and contentious nature of the phenomenon. Although many clinicians are interested in obtaining the skills required to safely support women desiring a vaginal breech birth, the primary trend in most health care facilities is to recommend a cesarean section. OBJECTIVE This paper aims to discuss the mixed methods approach used in a doctoral study conducted to generate new knowledge regarding women's experiences of breech birth in Western Australia and professional recommendations regarding the care of women experiencing breech presentation close to or at term. This study was designed to inform the development of an integrated care pathway for women experiencing a breech presentation. This mixed methods approach situated within the pragmatic paradigm was determined to be the optimal way for incorporating multidisciplinary recommendations with current clinical practice guidelines and consumer feedback. METHODS A mixed methods study utilizing semistructured interviews, an electronic Delphi (e-Delphi) study, and clinical practice guideline appraisal was conducted to generate new data. The interviews were designed to provide insights and understanding of the experiences of women in Western Australia who are diagnosed with a breech presentation. The e-Delphi study explored childbirth professionals' knowledge, opinions, and recommendations for the care of women experiencing breech presentation close to or at term. The clinical practice guideline appraisal will examine the current national and professional breech management and care guidelines. This study has the potential to highlight areas in practice that may need improvement and enable clinicians to better support women through what can be a difficult time. RESULTS Data collection for this study began in November 2018 and concluded in March 2020. Data analysis is currently taking place, and the results will be disseminated through publication when the analysis is complete. CONCLUSIONS The results of this study will guide the development of an integrated care pathway for women experiencing a breech presentation close to or at term, with the hope of moving toward standardized breech care for women in Western Australia. This study protocol has the potential to be used as a research framework for future studies of a similar nature. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/23514.
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Affiliation(s)
- Sara Morris
- King Edward Memorial Hospital, Subiaco, Australia.,Edith Cowan University, Joondalup, Australia
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