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Vaginal breech birth: can we move beyond the Term Breech Trial?
Journal of Midwifery & Women'S Health
|April 26, 2014
Summary
Planned cesarean birth is common for breech presentation, but evidence doesn't confirm it's safer than vaginal birth. Vaginal breech birth options and training are crucial for midwives and patients.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Midwifery Practice
Background:
- The Term Breech Trial (2000) shifted practice towards cesarean delivery for breech presentations.
- Subsequent evidence over 20 years has not definitively proven cesarean birth is superior to carefully selected vaginal breech birth.
- Obstetric organizations now support planned vaginal breech birth with strict criteria.
Purpose of the Study:
- To review the controversies in mode of birth following the Term Breech Trial.
- To summarize criteria for successful vaginal breech birth.
- To explore the role of simulation in training for vaginal breech birth and its implications for midwifery practice.
Main Methods:
- Literature review of evidence and guidelines regarding breech presentation birth.
- Analysis of the impact of the Term Breech Trial on clinical practice and training.
- Discussion of simulation as a training tool for vaginal breech birth skills.
Main Results:
- Cesarean delivery became the default for breech presentation post-Term Breech Trial.
- Evidence supporting cesarean as universally safer is inconclusive.
- Training opportunities for vaginal breech birth skills are diminishing for healthcare providers.
Conclusions:
- Women with term breech presentation face limited choices for labor and delivery.
- Vaginal breech birth remains a viable option under specific criteria.
- Simulation may offer a solution for maintaining essential skills in vaginal breech birth for future clinicians.
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