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

Abstract

INTRODUCTION Currently, caesarean section is the primary mode of birth for a breech presenting fetus, leading to a deskilling of clinicians and limitation of birth choices for women. The aim of this review is to present a synthesized summary of existing literature related to women’s experiences of breech birth mode decision-making. METHODS A systematic search of the literature was conducted in April 2021, utilizing five databases to identify and obtain peer-reviewed articles meeting the predetermined selection criteria. RESULTS Four major categories were synthesized from the integrated review: 1) Women who desire a vaginal birth may experience a range of negative emotions such as feelings of disempowerment, loss, uncertainty and a sense of isolation; 2) Women who experience a breech presentation at term experience significant pressures to conform to expectations of medical professionals and their families due to perceptions of risk related to breech birth; 3) Breech birth decision-making in a limiting system; and 4) Overall satisfaction with the decision to plan a vaginal breech birth. CONCLUSION Women with a breech presenting fetus at term experience a complex range of emotions and internal and external pressures due to perceptions of risk around breech birth. Midwives were seen as helpful throughout the breech experience. The reduced caesarean section rate for breech, observed in studies exploring specialized care pathways or dedicated services, could reduce the incidence of Severe Acute Maternal Morbidity.

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

“…They are also resonant with previous research on women's experiences. 26 The level of involvement of the OptiBreech PPI group and service user members of our research team have been significant and meaningful.…”

What are women’s experiences of seeking to plan a vaginal breech birth? A systematic review and qualitative meta-synthesis

“…Experiences of 'isolated constraint' also led to significant 'emotional turmoil.' Women felt strong negative emotions when receiving their breech diagnosis, including fear and anxiety 14,16,[18][19][20][21][22] , uncertainty 16,[23][24][25] , powerlessness 23,25 and grief: "I don't talk about it I guess but when I do I get quite upset. It has probably upset me more than I realise... it took me quite a while to get over it."…”

“…In addition to healthcare professionals, "pressure and judgement from family members" 14(p43) also influenced the decision-making process 16,[20][21][22][24][25][26][27][28] . Many felt "upset when family and friends accused them of being selfish and 'putting the birth before the baby.'"…”

“…Women "seeking a VBB highlight[ed] the lack of supportive/adequately experienced clinicians as a barrier to achieving the birth that they wanted." 26(p3129) Some women were forced to travel long distances [13][14][15]22,[24][25][26]28 , introducing a physical disconnect between them and their primary providers.…”

“…He just spoke to me like it was a done deal and made me feel so confident … I'm so relieved!" 27(pe99) Multiple papers described how women sought out clinicians, described as 'specialist[s]' 14,20,[24][25][26][27]30 , who presented them with unbiased information and encouraged them to be an active part of decision-making, even if this meant changing providers. Finding this person significantly alleviated many women's anxieties and boosted their personal feelings of self-efficacy in decision-making and birth.…”