Does breech delivery in an upright position instead of on the back improve outcomes and avoid cesareans?

Abstract

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Expertise in physiological breech birth: A mixed‐methods study

“…The opposing belief among a portion of participants that identification of specialists would limit, rather than expand, availability of breech births requires careful consideration in any setting intending to trial a breech team. A further limitation is that the participants in the research were all oriented to physiological breech birth, involving upright maternal positioning . Although many of the participants developed experience within settings where this practice was not normative, the social clinical roles may not function in the same way in maternity care contexts where women and/or their attendants are not able to use upright birthing positions.…”

Atención del parto con feto en presentación pelviana: revisión de la semiología, el mecanismo y la atención del parto

“…En ausencia de estudios conclusivos, la posición materna puede ser de litotomía o vertical (5,6,26) y, dado que no existe evidencia suficiente, el refuerzo del trabajo de parto con oxitocina (5,6) puede ser una alternativa por considerar cuando la dinámica uterina no es apropiada (1,5,18,25). El Maternal Fetal Medicine Committee (MFMC) recomienda evitar la amniorrexis, ofrecer una alternativa para el manejo del dolor, efectuar vigilancia del bienestar fetal (25), así como de la adecuada progresión del parto (5,24).…”

FIGO Statement: Restrictive use rather than routine use of episiotomy

“…An upright position during the second stage of labor also decreases the episiotomy rate but appears to increase 2nd degree lacerations and postpartum hemorrhage . For vaginal breech delivery, the upright position also seems to be associated with a significant reduction in the episiotomy rate when compared with vaginal delivery in the dorsal position …”

“…24 For vaginal breech delivery, the upright position also seems to be associated with a significant reduction in the episiotomy rate when compared with vaginal delivery in the dorsal position. 25 Given all available evidence, FIGO supports the restrictive use of episiotomy, where the procedure is limited to situations in which perineal laceration has already begun or there is an imminent threat of perineal tear or when there is urgency in delivering the fetus. Further research is needed to identify strategies that result in the reduction of episiotomies, as well as 3rd and 4th degree lacerations.…”