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Implementation of a breech program in a Belgian obstetric team.

Martine Casteels1, Kathleen Podevyn1, Henk Vanoverschelde2

  • 1Department of Gynecology and Obstetrics, AZ Maria Middelares, Ghent, Belgium.

International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics
|November 4, 2021
PubMed
Summary

Implementing a vaginal breech delivery program, including team training and structured counseling, resulted in a successful vaginal breech delivery rate of 54% among eligible patients. This approach is safe and effective for obstetric centers.

Keywords:
breech presentationcounseling toolselection criteriatraining programupright positionvaginal breech delivery

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Area of Science:

  • Obstetrics and Gynecology
  • Maternal-Fetal Medicine
  • Surgical Procedures

Background:

  • Vaginal breech delivery is a complex obstetric procedure requiring specialized training and protocols.
  • Many obstetric centers have ceased offering vaginal breech delivery due to perceived risks and lack of expertise.

Purpose of the Study:

  • To describe the implementation of a comprehensive breech program, including counseling and vaginal breech delivery.
  • To evaluate the safety and success rates of planned vaginal breech deliveries within this program.

Main Methods:

  • A structured breech consultation process using a counseling tool was established.
  • Multidisciplinary team training (obstetricians, midwives, anesthesiologists, pediatricians) was conducted.
  • The program included the "walking" epidural (PIEB protocol) for pain management.

Main Results:

  • 86.5% of women with singleton term breech presentation met criteria for vaginal delivery.
  • 77% of eligible women accepted a planned vaginal breech delivery.
  • Successful vaginal breech delivery was achieved in 54% of planned cases; 27% resulted in secondary cesarean section.

Conclusions:

  • A successful and safe breech program, incorporating vaginal breech delivery, can be implemented in obstetric centers.
  • The breech consultation and comprehensive team training are critical components for program success.
  • The initial results are encouraging, supporting the continuation of the breech program.