Since 2000, caesarean sections have been recommended as the safest mode of birth for breech position babies, and as a result less staff have the skills required to handle complications during a vaginal breech birth (VBB). In 2015, 87% of breech babies in Australia were born via caesarean section.
A systematic review of the experiences of women who’ve had a breech position baby has found that they feel significant pressure to accept advice to have a caesarean.
According to the lead author of the review, Dr Sara Morris of Edith Cowan University School of Nursing and Midwifery in Australia, it’s important that guidelines provided to health workers don’t overemphasise the safety of caesareans when a baby is in a breech position. This is because neurodevelopmental outcomes at the age of two do not appear to differ significantly in breech born children – regardless of their birth mode.
“Clinical practice guidelines, which focus on the risks of a VBB without also discussing the risks of a caesarean section have the potential to sway clinician attitudes and impact mothers’ decision-making,” says Morris.
The researchers undertook a systematic review of peer-reviewed articles which explored women’s experiences of breech presentation published between 2012 and 2021 and included a total of five qualitative studies, two cross-sectional descriptive studies and one case control study. The authors of this review were involved in one study included in the review.
They found that as well as women feeling significant external pressure for caesarean birth due to the perceptions of risk around breech birth, “women who desire a vaginal birth may also experience a range of negative emotions such as feelings of disempowerment, loss, uncertainty and a sense of isolation,” says Morris.
The review also found that women need to be made aware of all options available to them when faced with a breech-presenting baby, so that they can make informed decisions about what’s right for them.
“Maternity healthcare workers have a legal and ethical responsibility to provide unbiased and non-judgmental counselling regarding the risks and benefits of all breech birth modes,” adds Morris. “Without all relevant information being provided – including the right to refuse as well as alternative options available – the legal requirements for informed consent are not met.”
According to Morris, further research is needed on the safety and effectiveness of alternative breech birth methods such as upright birth position (standing, squatting, kneeling, or hand-and-knees), as well as counselling and training for health professionals in breech birth skills so that women can get the full picture when making decisions around breech births.