Consensus-based recommendations for the care of women with a breech presenting fetus

Footling Breech Delivery in an Emergency Department Without Obstetrical Services: A Case Report

“…This increases the potential for significant morbidity and mortality to both the mother and fetus [1]. Since the Term Breech Trial publication in 2004, the cesarean section has been the safest means of delivery for breech presentations [3]. Physicians now counsel women and recommend a cesarean section for the increased safety of both mother and baby in the event of a breech delivery [4].…”

“…Physicians now counsel women and recommend a cesarean section for the increased safety of both mother and baby in the event of a breech delivery [4]. This has consequently led to fewer vaginal breech deliveries and reduced instruction for this type of delivery [3,5]. With the emphasis on cesarean section, safe and effective methods, and care pathways have been poorly established in the obstetrical arena, making it even more challenging for the ED physician who rarely encounters deliveries, especially precipitous labor and high-risk cases [3].…”

“…This has consequently led to fewer vaginal breech deliveries and reduced instruction for this type of delivery [3,5]. With the emphasis on cesarean section, safe and effective methods, and care pathways have been poorly established in the obstetrical arena, making it even more challenging for the ED physician who rarely encounters deliveries, especially precipitous labor and high-risk cases [3]. Physicians who are in ED settings without formal obstetrical services, and where a cesarean section may not be feasible, may face an increased risk of adverse outcomes in patients with a complicated breech presentation [1].…”

“…There can be substantial time after graduation from residency before an ED physician encounters a difficult delivery. Furthermore, the new evidence-based practice dictates the need for updated training and simulation to ensure providers have up-to-date training [3].…”