Professional Preferences Towards Vaginal Breech Delivery at Term: An International Discrete Choice Experiment

To assess healthcare professionals' preferences for antepartum counseling on the mode of delivery for patients with term breech presentation and their preferences for intrapartum management of vaginal breech delivery (VBD).

A web-based international survey and Discrete Choice Experiment (DCE) were conducted among gynecologists and midwives. In the DCE for antepartum counseling, participants were presented with scenarios for antepartum counseling and asked to choose between VBD and elective cesarean delivery (CD). The scenarios differed in four attributes: maternal age, BMI, parity, and estimated fetal weight. Intrapartum management of VBD was evaluated through a questionnaire involving four distinct clinical scenarios.

In antepartum counseling, the likelihood of being advised for a VBD was 43.9%. The strongest factors to opt for a CD compared to a VBD were a history of vaginal birth (OR 0.25, 95% CI 0.19-0.32) and a large estimated fetal weight (OR 5.89, 95% CI 4.07-8.54). Intrapartum management during breech deliveries did not differ among professionals and their annual number of self-reported VBD.

The key factors driving professionals to recommend CD are a history of vaginal birth and average estimated fetal weight. Intrapartum management approaches during breech deliveries were consistent across professionals. Those with more experience managing VBDs were more likely to counsel patients towards VBD antepartum and proceed with VBD intrapartum.