Impact of implementation of a breech clinic in a tertiary hospital

Abstract

Background: The incidence of breech presentation in single pregnancies at term is between three to 5 %. In order to support eligible women in their choice of mode of delivery, a dedicated breech clinic with a care pathway was developed in December 2015 in a tertiary referral centre in Brussels. The primary objective of this study was to evaluate the vaginal birth rate before and after the introduction of a dedicated breech clinic. The secondary objective was to compare the early neonatal outcomes before and after the breech clinic was introduced. Methods: This was a single centre retrospective and prospective study. The inclusion criteria were term (from 37 weeks), singleton fetus and breech presentation at delivery. The exclusion criteria were suspected intrauterine growth restriction, severe fetal malformations and intrauterine fetal demise. We used a composite outcome as an indicator of neonatal morbidity and mortality. Results: After the introduction of the breech clinic, we observed a significant increase in planned vaginal delivery from 7.4% (12/162) to 53.0% (61/115) (OR: 13.5; 95% CI: 6.7-27.0). The effective vaginal breech delivery rate (planned and unexpected) significantly increased from 4.3% (7/162) pre-implementation of breech clinic to 43.5% (50/115) post-implementation (OR: 17.0; 95% CI: 7.3-39.6). Neonatal outcomes were not statistically different between the before and after periods. Conclusion: The introduction of a dedicated breech clinic has led to an increase in vaginal deliveries for breech babies without adversely affecting neonatal outcomes.

Women’s experiences of breech birth decision making: An integrated review

“…Midwives were at times responsible for initial discussions with women around breech presentation and basic assessments. They were also involved in birth counselling 52 , 53 , mostly in regard to labor and birth positions and available pain-relief options 51 . Australian research reports, that in a service which employs a multidisciplinary breech team, midwives and obstetricians are equally responsible for facilitating breech birth 54 .…”

“…Specialized or dedicated breech services offer non-biased birth mode counselling, ECV and support for women’s birth mode choices under a multidisciplinary team 3 , 4 . They have been shown to improve the uptake and success of ECV and increase the number of women choosing the option of a VBB, therefore reducing the CS rate for breech presentation when certain criteria are met 51 , 53 . A reduction in the rate of CS for breech has the potential to reduce the incidence of Severe Acute Maternal Morbidity (SAMM) 1 .…”

“…Research related to existing breech services or teams, indicates that midwives are involved in the counselling and care of women with a breech presentation [51][52][53] . Midwives were at times responsible for initial discussions with women around breech presentation and basic assessments.…”

Breech specialist midwives and clinics in the OptiBreech Trial feasibility study: An implementation process evaluation

“…Our findings are heavily influenced by context, including the continuing impacts of the COVID-19 pandemic on staffing levels within the NHS and low overall breech experience levels in these settings after decades of erosion. Successful breech services involving midwives have been reported internationally, 27,28 but other models have been reported in other contexts. 29,30 We have focused on interviews with women in this analysis.…”

Pregnancy outcomes in breech presentation at term: a comparison between 2 third level birth center protocols

“…However, the methodology, organization, and peer review process of the TBT have been heavily criticized in the following years. 4 , 5 , 6 , 7 , 8 One of the main criticisms concerns the inappropriateness of data extrapolation. An analysis of trends in perinatal mortality after the TBT demonstrates that increasing CD rates may account for only 16% of the observed decline in birth-related perinatal deaths, 9 suggesting that the mode of delivery is a relatively minor contributing factor and that the whole management protocol has probably more influence on pregnancy outcomes.…”