Undiagnosed breech: Towards a woman-centred approach

Walker, Shawn

doi:10.12968/bjom.2013.21.5.316

Cited by 11 publications

(14 citation statements)

References 32 publications

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“…Breech presentation at the end of pregnancy is a relatively common dilemma, as approximately 4% of babies will be breech at term . Historically, it has long been recognized that breech presentation poses a risk to the fetus and that some term breech babies are more safely delivered by cesarean .…”

Section: An Obstetrician's Perspective On the Mode Of Breech Deliverymentioning

confidence: 99%

Up against a wall: A patient and obstetrician’s perspective on the mode of breech delivery

Hipsher

Fineberg

2019

Birth

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Section: An Obstetrician's Perspective On the Mode Of Breech Deliverymentioning

confidence: 99%

Up against a wall: A patient and obstetrician’s perspective on the mode of breech delivery

Hipsher

Fineberg

2019

Birth

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“…thought to be cephalic -false negatives. As a result approximately 1:100 women go into labour with an undiagnosed breech presentation, and the false reassurance of having been assessed as head-down by their midwives (Vause et al 1998, Walker 2013.…”

Section: How Important Is Diagnostic Accuracy?mentioning

confidence: 99%

Assessment of fetal presentation: Exploring a woman-centred approach

Walker¹,

Sabrosa²

2014

British Journal of Midwifery

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Abstract:This article explores the core midwifery skill of fetal presentation assessment from the perspective of women's meanings and experiences, including the social and relational aspects of antenatal palpation. Brief background information is provided, explaining the clinical purpose of determining presentation antenatally, and the key debates surrounding the available interventions applied when babies present breech, eg. external cephalic version and caesarean section. In order to make the screening process transparent, women need to know the accuracy (or rather, inaccuracy) of abdominal palpation, and what her options will be if her baby is found to be presenting breech, either before or during labour. Specialist midwifery care may help meet women's increased needs for counselling and reassurance, and provide continuity throughout the breech care pathway, which for low-risk women begins with palpation.Keywords: breech, midwives, antenatal, palpation, woman-centred, specialist Key phrases:From 33 weeks, there is almost a 3:4 chance overall that a breech baby will remain breech, and many women will want to be considering their options by this point.The clinical value of detecting breech babies antenatally, in terms of improved outcomes, is highly dependent on whether ECV is offered, accepted and performed with a high degree of success, factors known to be highly variable. 3Antenatal detection of breech presentation is associated with a significant level of anxiety for women. However, provider's ways of speaking about breech influenced women's experiences, and a more supportive stance to all three options (ECV, VBB, CS) may result in less anxiety in the final weeks of a known breech pregnancy.The UK clinical collective has remained comfortable with a certain degree of uncertainty when it comes to diagnosing all breech presentations antenatally.Whether an individual woman will be comfortable with this uncertainty is likely to depend on her general approach to pregnancy and childbirth, as well as the approach of her providers.Women reveal themselves physically for each abdominal examination, and the emotional and psychological effects of this exposure and vulnerability should not be underestimated.In woman-centred care, the core midwifery skill of palpation is used mindfully and holistically, taking into consideration what knowing her baby's position will mean for this individual woman, and how this information can help her meet her needs, aspirations and expectations for this pregnancy. 4The assessment of fetal presentation by abdominal palpation is a fundamental antenatal care skill, in which the midwife (or doctor) uses her/his hands to gently feel the position of the baby through the mother's abdomen, in order to assess which way the baby is lying in the uterus. The clinical purpose of this activity is to enable appropriate interventions to be offered and care to be planned. In their 2008

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“…In fact, the management of the vaginal breech birth at term on the all‐fours maneuver proved to be a simple, safe, and effective strategy for the woman described in this case report. Breech presentation at term occurs in about 3–4% of pregnant women . It is estimated that 8% to 35% remain undetected until labor .…”

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confidence: 99%

“…However, the increased rates of cesarean section resulted in higher maternal mortality and morbidity with potential hazards for subsequent pregnancies . As the absolute risk of planned vaginal birth is low and cesarean section is not without maternal health hazards, individualized decision‐making on the route of delivery is a sensible and realistic approach in counseling selected women with fetal breech presentation at term . Pregnant women with a singleton breech presentation at term should be fully informed about the unusual fetal position, the associated intrapartum risks, and the obstetric management options, such as external cephalic version and route of delivery .…”

mentioning

confidence: 99%

“…However, apart from maternal preference for “natural” child birth , vaginal birth will be inevitable in certain circumstances, as is demonstrated by our case report. In such circumstances, the woman may not even have a choice or does not have time to make a well‐balanced decision about the mode of delivery . Several studies have shown that failure to diagnose a breech presentation before the onset of labor was associated with a lower probability of cesarean section when compared to women where breech presentation was timely diagnosed, while this had no adverse effect on short‐term neonatal outcome .…”

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