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Women's perception of choice and support in making decisions regarding management of breech presentation

02 July 2021
18 min read
Volume 29 · Issue 7

Abstract

Background

Professional guidelines recommend midwives and obstetricians actively involve women in making decisions about their care. To date, breech research has focused mainly on assessing the effectiveness of different management options.

Aim

This research explores women's experience of breech presentation and their perception of choice and support in making decisions with regards to breech management.

Methods

This study uses a phenomenological research design. Semi-structured interviews took place in hospital or women's homes. A total of six postnatal women who were diagnosed with breech presentation after 36 weeks' gestation took part in the study. Data was analysed using Colaizzi's method.

Findings

A total of 84 significant statements were clustered into four main emerging themes. These include women's feelings, their healthcare expectations, their preferences and their values.

Results

Breech discussions mostly occurred between obstetricians and women. These primarily focused on external cephalic version, Elective Lower Segment Caesarean Section and Breech Vaginal Birth. These options did not always become choices available to women.

Breech presentation refers to the position of a fetus in the uterus where the buttocks or feet present first, as opposed to a cephalic presentation where fetal vertex constitutes the presenting part (Waites, 2003), with an incidence of 3%–4% of all term pregnancies (Impey et al, 2017a; 2017b).

Although vaginal breech delivery has traditionally been considered a common approach in the management of labour, the findings from the Term Breech Trial (TBT) (Hannah et al, 2000) suggested a reduction of neonatal mortality and morbidity amongst service users undergoing Elective Lower Segment Caesarean Section (EL-LSCS). Since its publication, the TBT has been subject to professional criticism (Whyte et al, 2004; Glezerman, 2006; Kotaska, 2007; Lawson, 2012), due to its limitations and biases (see Table 1). Maternal and fetal complications that may derive from undergoing EL-LSCS should not be underestimated either (see Table 2). Irrespective of this, the TBT was pioneer in leading a change in practice that would see a rise in the number of EL-LSCS for breech-presenting women at term and a decline in vaginal breech birth offer.

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