Should midwives learn to scan for presentation? Findings from a large survey of midwives in the UK
Undiagnosed breech presentation in labour is associated with fetal morbidity and mortality, and may cause significant maternal anxiety. With increasing availability of scan machines, ultrasound is now widely used in UK maternity settings. Bedside presentation scans are usually undertaken by junior doctors, often leading to delays and frustration among staff and patients.
To assess local practices and attitudes towards midwives scanning for presentation.
A nine-question anonymous online survey was first disseminated by email locally, and then via social media. It was open to all UK non-sonographer midwives and midwifery students. A total of 870 responses were received between January and April 2018.
The survey highlighted significant variation in practice across the UK. Of those who did not scan for presentation, 85.2% felt that being able to do so would improve their practice, with the majority of respondents highlighting improvements in patient safety and satisfaction as well as workflow.
This demonstrates that demand exists for a postgraduate or accredited short course to teach midwives how to safely and accurately scan to assess fetal presentation.
Fetal lie and presentation in the late third trimester have traditionally been determined by abdominal palpation using Leopold's manoeuvres or a similar technique. Although accuracy may be increased when this is undertaken by an experienced clinician (Lydon-Rochelle et al, 1993), correct diagnosis of non-cephalic presentation may prove difficult, especially in the context of increased maternal BMI or polyhydramnios. Several studies have found palpation alone to have low sensitivity (Thorp et al, 1991; Nassar et al, 2006). Unfortunately, in approximately 30% of women whose babies remain breech after 36 weeks' gestation, the diagnosis is made for the first time in labour (Walker, 2013; Hemelaar et al, 2015). As ‘high-risk’ women in the UK often receive a late third-trimester ultrasound as part of standard antenatal care, it is a reasonable assumption that many of these women diagnosed in labour with breech presentation would have been ‘low-risk’, and otherwise receiving midwife-led care.
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