Vaginal breech birth

It is 02:40 and the multip in room 4 has been pushing for eight minutes. The midwife lifts the sheet and calls you: what is on the perineum is not a head. Two things now decide the next twenty years of this baby's life — whether you keep your hands off, and whether you know the sequence when you finally have to put them on. This topic is that sequence.^[1]

Overview and definition

Breech presentation means the fetal buttocks or feet occupy the lower pole of the uterus. The denominator is the sacrum, so positions are described as sacro-anterior, sacro-transverse or sacro-posterior. ^[1]

• Prevalence: 3 to 4% of singleton pregnancies beyond 37 weeks, and much higher preterm — the fetus spends the second trimester turning and settles head-down late.^[1]
• Practice reality in Australia and New Zealand: roughly 90% of term breech presentations are now delivered by caesarean section. That single number explains both the safety record and the skills crisis.^[1]
• The eligibility gap: in a NSW population linkage study of 10 133 term breech singletons, 51.3% met criteria for vaginal breech birth but only 6.8% intended it.^[10]

References17ShowHide

1. [1]Royal College of Obstetricians and Gynaecologists (RCOG) Management of Breech Presentation: Green-top Guideline No. 20b BJOG, 2017.PMID 28299904
2. [2]Hannah ME, Hannah WJ, Hewson SA, et al. Planned caesarean section versus planned vaginal birth for breech presentation at term: a randomised multicentre trial. Term Breech Trial Collaborative Group Lancet, 2000.PMID 11052579
3. [3]Whyte H, Hannah ME, Saigal S, et al. Outcomes of children at 2 years after planned cesarean birth versus planned vaginal birth for breech presentation at term: the International Randomized Term Breech Trial Am J Obstet Gynecol, 2004.PMID 15467555
4. [4]Hannah ME, Whyte H, Hannah WJ, et al. Maternal outcomes at 2 years after planned cesarean section versus planned vaginal birth for breech presentation at term: the international randomized Term Breech Trial Am J Obstet Gynecol, 2004.PMID 15467565
5. [5]Goffinet F, Carayol M, Foidart JM, et al. Is planned vaginal delivery for breech presentation at term still an option? Results of an observational prospective survey in France and Belgium Am J Obstet Gynecol, 2006.PMID 16580289
6. [6]Glezerman M Five years to the term breech trial: the rise and fall of a randomized controlled trial Am J Obstet Gynecol, 2006.PMID 16389006
7. [7]Berhan Y, Haileamlak A The risks of planned vaginal breech delivery versus planned caesarean section for term breech birth: a meta-analysis including observational studies BJOG, 2016.PMID 26234485
8. [8]Hofmeyr GJ, Hannah M, Lawrie TA Planned caesarean section for term breech delivery Cochrane Database Syst Rev, 2015.PMID 26196961
9. [9]Kotaska A, Menticoglou S No. 384-Management of Breech Presentation at Term J Obstet Gynaecol Can, 2019.PMID 31331608
10. [10]Bin YS, Roberts CL, Ford JB, Nicholl MC Outcomes of breech birth by mode of delivery: a population linkage study Aust N Z J Obstet Gynaecol, 2016.PMID 27339863
11. [11]Bin YS, Ford JB, Nicholl MC, Roberts CL Long-term childhood outcomes of breech presentation by intended mode of delivery: a population record linkage study Acta Obstet Gynecol Scand, 2017.PMID 28029180
12. [12]Royal College of Obstetricians and Gynaecologists (RCOG) External Cephalic Version and Reducing the Incidence of Term Breech Presentation: Green-top Guideline No. 20a BJOG, 2017.PMID 28299867
13. [13]Collins S, Ellaway P, Harrington D, et al. The complications of external cephalic version: results from 805 consecutive attempts BJOG, 2007.PMID 17355270
14. [14]Lambeek AF, De Hundt M, Vlemmix F, et al. Risk of developmental dysplasia of the hip in breech presentation: the effect of successful external cephalic version BJOG, 2013.PMID 23145903
15. [15]Touleimat S, Braund S, Delorme P, et al. Routine maneuvers in eutocic breech vaginal delivery at term: A prospective cohort study Int J Gynaecol Obstet, 2024.PMID 39033314
16. [16]Unger V, Gasparics A, Nagy Z, et al. Cesarean delivery is associated with lower neonatal mortality among breech pregnancies: a systematic review and meta-analysis of preterm deliveries ≤32 weeks of gestation Am J Obstet Gynecol, 2024.PMID 38908650
17. [17]Vlemmix F, Bergenhenegouwen L, Schaaf JM, et al. Term breech deliveries in the Netherlands: did the increased cesarean rate affect neonatal outcome? A population-based cohort study Acta Obstet Gynecol Scand, 2014.PMID 25113411