Alarab M, Regan C, O'Connell M, Keane DP, O'Herlihy C, Foley ME Singleton vaginal breech delivery at term: still a safe option. Obstet Gynecol. 2004; 103:(3)407-12

Birth Trauma Association. 2014.

London: Maternal and Child Health Consortium; 2000

Cheng M, Hannah M Breech delivery at term: a critical review of the literature. Obstet Gynecol. 1993; 82:(4)605-18

Cronk MNorfolk: Norwich University Trust; 2011

Dahlen H Undone by fear? Deluded by trust?. Midwifery. 2009; 26:156-62

Evans J The final piece of the breech jigsaw. Essentially Midirs. 2012; 3:(3)46-9

Fahy K Is breech birth really unsafe? Treatment validity in the Term Breech Trial. Essentially Midirs. 2011; 2:(10)17-21

Founds S Women's and providers' experiences of breech presentation in Jamaica: a qualitative study. Int J Nurs Stud. 2007; 44:(8)1391-9

Glezerman M Five years to the term breech trial: The rise and fall of the randomized control trial. Am J Obstet Gynecol. 2006; 194:(1)20-5

Goffinet F, Carayol M, Foidart J, Alexander S, Uzan S, Subtil D, Breart G Is planned vaginal delivery for breech presentation at term still an option? Results of an observational prospective survey in France and Belgium. Am J Obstet Gynecol. 2006; 194:(4)1002-11

Guttier M, Bonnet J, Jarabo G, Boulvain M, Irion O, Hudelson P Breech presentation and choice of mode of childbirth: A qualitative study of women's experiences. Midwifery. 2011; 27:208-13

Hannah ME, Hannah WJ, Hewson SA, Hodnett ED, Saigal S, Willan AR Planned caesarean section versus planned vaginal birth for breech presentation at term: A randomised multicentre trial. Lancet. 2000; 356:(9239)1375-83

Hickock DE, Gordon DC, Milberg JA, Williams MA, Daling JR The frequency of breech presentation by gestation at term. A large population based study. Am J Obstet Gynecol. 1992; 166:(3)851-2

Kirkham M, 2. : Palgrave Macmillan; 2010

Kotaska A Commentary: Routine cesarean section for breech: the unmeasured Cost. Birth. 2011; 38:(2)162-4

Klein M, Enkin M, Kotaska A, Shields S The patient-centered (r)evolution. Birth. 2007; 34:(3)264-6

Lawson G The Term Breech Trial Ten Years On: Primum Non Nocere?. Birth. 2012; 39:(1)3-9

London: NICE; 2004

National Institute for Health and Clinical Excellence. 2011.

National Health Service Institute for Innovation and Improvement (NHSIII). 2013.

London: NMC; 2008

London: NMC; 2012

London: RCOG; 2006

Royal College of Midwives. 2005.

Scott JR Solving the vaginal birth after caesarean dilemma. Obstet Gynecol. 2010; 115:(6)1112-3

Society of Obstetricians and Gynaecologists of Canada. 2009.

Toivonen E, Palomaki O, Huhtala H, Uotila J Selective vaginal breech delivery at term – still an option. Ada Obstetricia et Gynecological Scandinavica. 2012; 91:(10)1177-83

Vistad I, Cvancarova M, Hustad BL, Henriksen T Vaginal breech delivery: results of a prospective registration study. BMCPregnancy Childbirth. 2013; 13:(1)

Waites BLondon: Free Assocation Books; 2003

Whyte H, Hannah ME, Saigal S, Hannah WJ, Hewson S, Amankwah K, Cheng M, Gafni A, Guselle P, Helewa M, Hodnett ED, Hutton E, Kung R, McKay D, Ross S, Willan A Outcomes at 2 years after planned caesarean versus planned vaginal birth for breech presentation at term: the international randomized term breech trial. Am J Obstet Gynecol. 2004; 191:917-27

Re-engaging with vaginal breech birth: A philosophical discussion

02 May 2014
Volume 22 · Issue 5


The philosophical debate as to whether midwives are equipped to support women requesting vaginal breech birth continues, yet midwives are deemed able to conduct a vaginal breech birth in an ‘emergency’ scenario. The International Breech Birth Conference (2012) prompted the discussion of how midwives can revisit the facilitation of vaginal breech birth as a normal birth phenomenon in the post-Term Breech Trial era. The conference delegates concluded that vaginal breech birth is indeed a safe option with strict criteria and experienced practitioners in place. However, a cultural shift is required in the midwifery community to re-skill and reinvigorate vaginal breech practice.

In November 2012, over 200 birth professionals including midwives, obstetricians, alternative therapists and birth supporters gathered together in Washington, USA for the third International Breech Birth Conference. It is internationally acknowledged that the incidence of breech presentation at term (37 weeks onwards) stands between 3-4% (Hickok et al, 1996; Royal College of Obstetricians and Gynaecologists (RCOG), 2006), so why does such a seemingly niche midwifery area warrant such an international effort? The aim of the conference was to connect practitioners passionate about breech birth with a view of taking newly acquired and consolidated knowledge back to prospective places of work, reigniting the discussion and developing vaginal breech practice which has become a disappearing art form since the Term Breech Trial (TBT) (Hannah et al, 2000).

Fourteen years ago, the TBT (Hannah et al, 2000) was published in the Lancet, with its conclusions providing persuasive confirmation that vaginal breech birth was high risk, having adverse effects for both mother and fetus. The trial transformed breech birth practices across the world with startling immediacy (Lawson, 2012) the trial itself being stopped earlier than originally planned because ‘the lives of mothers and babies were at risk’ (Hannah et al, 2000: 219). Since then vaginal breech birth has been a topic of heightened debate within the community and has decreased in practice partly due to caesarean section becoming progressively safer and more widely used, and partly because of the indications of the TBT. The TBT has been widely criticised and the original findings have been disputed by a number of participants who were present at the Breech Birth Conference (Glezerman, 2006; Bisits, 2012) along with the original authors, who subsequently found in their 2-year follow up that there were no differences in outcome deriving from mode of delivery (Whyte et al, 2004) for either the mother or the baby. However, because it continues to inform current practice on an international level, it is important for midwives to fully understand the flaws of the TBT.

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