Facilitators and barriers to external cephalic version for breech presentation at term among health care providers in the Netherlands: a quantitative analysis
Related Experiment Video
Updated: May 3, 2026
External Cephalic Version: Is it an Effective and Safe Procedure?
Published on: June 6, 2020
Ageeth N Rosman1, Floortje Vlemmix1, Antje Beuckens2
1Department of Obstetrics and Gynecology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Objective:
guidelines recommend that external cephalic version (ECV) should be offered to all women with a fetus in breech presentation at term. However, only 50-60% of the women receive an ECV attempt. We explored the determinants (barriers and facilitators) affecting the uptake of the guidelines among gynaecologists and midwives in the Netherlands.
Design:
national online survey.
Setting:
the Netherlands.
Participants:
gynaecologists and midwives.
Measurements:
in the online survey, we identified the determinants that positively or negatively influenced the professionals׳ adherence to three key recommendations in the guidelines: (a) counselling, (b) advising for ECV, (c) arranging an ECV. Determinants were identified in a previously performed qualitative study and were categorised into five underlying constructs; attitude towards ECV, professional obligation, outcome expectations, self-efficacy and preconditions for successful ECV. We performed a multivariate analysis to assess the importance of the different constructs for adherence to the guideline.
Findings:
364 professionals responded to the survey. Adherence varied: 84% counselled, 73% advised, and 82% arranged an ECV for (almost) all their clients. Although 90% of respondents considered ECV to be an effective treatment for preventing caesarean childbirths, only 30% agreed that 'every client should undergo ECV'. Self-efficacy (perceived skills) was the most important determinant influencing adherence.
Key Conclusions:
self-efficacy appears to be the most significant determinant for counselling, advising and arranging an ECV.
Implications For Practice:
to improve adherence to the guidelines on ECV we must improve self-efficacy.
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