Options for Deliveries: Vaginal Breech Deliveries - Essay Example

As a result, without sufficient training and experience for obstetricians and midwives in managing vaginal breech births, the skills of these practitioners have been reduced. Based on this critical assessment of studies on vaginal breech births, it has been established that there are various factors affecting the incidence of vaginal breech births, lack of experience among birth attendants at the top of the list. Also, the fear of litigation is impacting the conduct of vaginal breech births. These practitioners are also unwilling to risk the life of the infant by attempting to deliver these infants vaginally. However, as was mentioned, studies have not definitively indicated that cesarean deliveries are actually improving survival rates for breech infants. More studies in line with this research are needed in order to provide specific and definitive results which can be applied in the practice.

This dissertation examines the decreasing use of vaginal breech deliveries, in the context of choice available to women, the experience and expertise of the responsible midwives, and the trends toward preferential delivery by cesarean section. This dissertation will be based on the author’s perspective, available evidence, and current practice and will further evaluate if the women’s choices with regards to the delivery of the breach are significantly impacted by the deskilling of midwives or by the actual risks of the procedure itself. Current practice, as supported by the NICE and RCOG Guidelines recommends the counseling of women on their possible options for delivery, emphasizing the risks involved in vaginal and cesarean births (Royal College of Obstetricians and Gynaecologists, 2006). Many obstetricians and midwives however have only ever experienced vaginal breech deliveries in a simulated environment, often making vaginal breech births riskier options for women (ROCG, 2006). Since practice is now dominated by the opinion that the safest option for these babies is a cesarean section and the opportunities to gain experience in safe vaginal breech deliveries are limited, the dominance of cesarean section is reinforced. This paper aims to evaluate the evidence that has underpinned practice since the Term Breech Trial (TBT) in 2002 as well as in the emerging evidence that is the basis for continued interest in improving vaginal breech delivery rates

A breech presentation occurs when the fetus lies in a longitudinal position, with either the buttocks or the feet presenting at the cervical area during delivery, and occurs in about 3-4% of all term deliveries (Fischer, 2012). A breech presentation may be attributed to prematurity, uterine malformations, placenta praevia, multiple births, and sometimes fetal abnormalities (Fischer, 2012). Breech presentation is classified into frank, complete, and footling. Frank breech is observed with hips flexed, knees extended; complete is seen with hips flexed and knees flexed; and footling or incomplete with one of both hips extended and foot presenting (Fischer, 2012).