Does vaginal breech delivery have a future despite low volumes for training? Results of a questionnaire

Post, Wilke M.; Vlemmix, Floortje; Hundt, Marcella de; Rheenen, Leonie E. van

doi:10.1016/j.ejogrb.2018.08.020

Cited by 13 publications

(10 citation statements)

References 4 publications

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“…Finally, in Dpt.C, 82.5% women underwent cesarean delivery, of which 59.6% were elective procedures. Since publication of the term breech trial, the number of breech vaginal births is decreasing worldwide, thereby reducing the pool of doctors with sufficient skills to manage such cases. This trend was reflected in results of this study …”

Section: Discussionmentioning

confidence: 99%

Evaluation of cesarean delivery rates at three university hospital labor units using the Robson classification system

Záhumenský

Pšenková

Némethová

et al. 2019

Intl J Gynecology & Obste

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Objective To analyze the frequency of cesarean delivery using the Robson 10‐group classification. Methods A multicenter retrospective cohort study was conducted at three university hospital labor units in the Slovak Republic. The medical records of all women who gave birth at these centers from January 1 to December 31, 2017, were assessed. Results In all, 1437 of 3361 (42.8%), 729 of 2795 (26.1%), and 303 of 2080 (14.6%) births recorded at the three centers during the current study period were by cesarean delivery. Among the nulliparous term singleton vertex deliveries (Robson group 1 and 2), the frequency of cesarean delivery at the three centers was 613 of 1653 (37.1%), 278 of 1389 (20.0%), and 91 of 898 (10.1%). Among term multiparas with one fetus in a cephalic position and at least one previous cesarean delivery (Robson group 5), the frequency of cesarean delivery at the three centers was 405 of 418 (96.9%), 261 of 343 (76.1%), and 55 of 115 (47.8%). Conclusion Analysis of the frequency of cesarean delivery by Robson classification could help to identify possibilities for safely decreasing cesarean delivery rates in the clinic. Robson groups 1, 2, and 5 were the most modifiable groups.

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Section: Discussionmentioning

confidence: 99%

Evaluation of cesarean delivery rates at three university hospital labor units using the Robson classification system

Záhumenský

Pšenková

Némethová

et al. 2019

Intl J Gynecology & Obste

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“…A recent study in the Netherlands also shows that more than half of residents consider the exposure to vaginal breech deliveries insufficient. 18 A survey of 1284 RANZCOG obstetricians showed that 72% of them offered vaginal breech delivery before the Term Breech Trial, but only 20% would do so after the findings were published. 19 F I G U R E 1 Feeling of sufficient experience in performing vaginal twin deliveries or vaginal breech deliveries among trainees and Fellows.…”

Section: Discussionmentioning

confidence: 99%

Experience and confidence in vaginal breech and twin deliveries among obstetric trainees and new specialists in Australia and New Zealand

Yeoh

Rolnik

Regan

et al. 2018

Aust NZ J Obst Gynaeco

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Background: The number of vaginal breech and twin deliveries may be insufficient for adequate training. Objective: To determine whether advanced trainees and new Fellows in obstetrics are gaining adequate experience and confidence in vaginal breech and twin deliveries. Methods: An online survey was emailed to registered Royal Australia and New Zealand College of Obstetrics and Gynaecology (RANZCOG) advanced trainees and new Fellows (Years 1-5). This survey asked about their experience, confidence and whether they intend to perform vaginal breech and twin deliveries as specialists. Results: The survey was sent to 703 advanced trainees (162) and Fellows (541) and answered by 217 (31.7%). Experience and confidence in vaginal breech and twin deliveries increased with the number of procedures performed (P < 0.001) in both groups and were significantly higher among Fellows. Despite the level of experience, 100% of respondents felt confident in managing vaginal twin deliveries with or without supervision, whereas 14.9% of respondents did not feel confident in managing vaginal breech deliveries. Intention to offer these procedures in their practice depended on confidence levels, and there was a significant difference between twins and breech. Overall, 87.3% of respondents intended to offer vaginal twin deliveries in their practice, while only 32.7% intended to offer vaginal breech deliveries. Conclusion: Confidence in complex vaginal deliveries increases with increasing number of procedures performed and a significant proportion of trainees and Fellows consider they do not have sufficient experience. The association between confidence and intention to offer these procedures is stronger in twins than in breech deliveries.

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“…First, research suggests that cesarean births are frequently used in instances when physicians are not confident in their ability to deliver a breech pregnancy 34,61 . Few physicians receive comprehensive training in vaginal breech delivery, 33,34 and twins have a greater probability of presenting breech 20,21 . As such, lack of practitioner training in methods promoting vaginal delivery (eg, manual breech extraction) might contribute to heightened cesarean rates among twins 33,34 .…”

Section: Discussionmentioning

confidence: 99%

“…Few physicians receive comprehensive training in vaginal breech delivery, 33,34 and twins have a greater probability of presenting breech 20,21 . As such, lack of practitioner training in methods promoting vaginal delivery (eg, manual breech extraction) might contribute to heightened cesarean rates among twins 33,34 . Since ACOG guidelines suggest external cephalic version for twins 55,62 and vaginal delivery when first twin is cephalic, even if second twin is breech, 2 increased physician training in breech delivery methods could help to decrease the cesarean rate among twins.…”

Section: Discussionmentioning

confidence: 99%

“…Fear of negative birth outcomes above and beyond identified risk may then influence maternal request for cesarean birth among twin births at higher rates than for singleton births. Other nonmedical factors potentially driving deviations from recommended delivery methods unequally across comparable twin and singleton births include factors such as physician concern over litigation 30,32 and physician training (eg, limited training in breech vaginal deliveries) 33,34 …”

Section: Introductionmentioning

confidence: 99%

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Protocol versus practice: Deviations from guidelines in low‐risk twin deliveries in the United States

Morris

Bertotti

2021

Birth

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Background Medical guidelines recommend vaginal delivery for low‐risk twin pregnancies because cesareans increase the probability of maternal morbidity and mortality. Yet, vaginal delivery rates for twins are considerably lower than for comparable singletons. One explanation for this disparity argues that greater risk associated with twins warrants increased surgical intervention. An alternative explanation is that twin deliveries are more likely to deviate from protocols that advise vaginal birth. Methods Using the 2017 Natality Detail File (N = 3,197,401), we measured alignment of vaginal birth and trial of labor (TOL) with the American College of Obstetricians and Gynecologists’ guidelines for twin and singleton no‐indicated‐risk births. We calculated predicted probabilities for the population and by maternal race/ethnicity to assess whether low rates of vaginal births among twins are explained by associated risk factors, or by deviations from recommended delivery methods. Results Overall, 31.2% of twins were born vaginally compared with 79.4% of singletons. Controlling for indicated risks, the predicted probability of vaginal birth for twins was 0.49 and 0.85 for singletons. The predicted probability of TOL for twins was 0.18 and 0.47 for singletons. Maternal race/ethnicity was only weakly associated with mode of delivery. These findings indicate that no‐indicated‐risk twin pregnancies, across maternal racial/ethnic categories, have lower probabilities of vaginal birth and TOL than would be expected with widespread adherence to current guidelines. Conclusions Given the life‐threatening consequences that may result from unnecessary surgical procedures, our findings highlight the need for further research to illuminate medical and nonmedical mechanisms driving nonadherence to clinical guidelines for twin births.

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Does vaginal breech delivery have a future despite low volumes for training? Results of a questionnaire

Cited by 13 publications

References 4 publications

Evaluation of cesarean delivery rates at three university hospital labor units using the Robson classification system

Evaluation of cesarean delivery rates at three university hospital labor units using the Robson classification system

Experience and confidence in vaginal breech and twin deliveries among obstetric trainees and new specialists in Australia and New Zealand

Protocol versus practice: Deviations from guidelines in low‐risk twin deliveries in the United States

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