Abstract
BackgroundWomen who have a breech presentation at term have to decide whether to attempt external cephalic version (ECV) and how they want to give birth if the baby remains breech, either by planned caesarean section (CS) or vaginal breech birth. The aim of this study was to explore the attitudes of women with a breech presentation and health professionals who manage breech presentation to ECV.MethodsWe carried out semi-structured interviews with pregnant women with a breech presentation (n=11) and health professionals who manage breech presentation (n=11) recruited from two hospitals in North East England. We used purposive sampling to include women who chose ECV and women who chose planned CS. We analysed data using thematic analysis, comparing between individuals and seeking out disconfirming cases.ResultsFour main themes emerged from the data collected during interviews with pregnant women with a breech presentation: ECV as a means of enabling natural birth; concerns about ECV; lay and professional accounts of ECV; and breech presentation as a means of choosing planned CS. Some women’s attitudes to ECV were affected by their preferences for how to give birth. Other women chose CS because ECV was not acceptable to them. Two main themes emerged from the interview data about health professionals’ attitudes towards ECV: directive counselling and attitudes towards lay beliefs about ECV and breech presentation.ConclusionsWomen had a range of attitudes to ECV informed by their preferences for how to give birth; the acceptability of ECV to them; and lay accounts of ECV, which were frequently negative. Most professionals described having a preference for ECV and reported directively counselling women to choose it. Some professionals were dismissive of lay beliefs about ECV. Some key challenges for shared decision making about breech presentation were identified: health professionals counselling women directively about ECV and the differences between evidence-based information about ECV and lay beliefs. To address these challenges a number of approaches will be required.
Highlights
Women who have a breech presentation at term have to decide whether to attempt external cephalic version (ECV) and how they want to give birth if the baby remains breech, either by planned caesarean section (CS) or vaginal breech birth
shared decision making (SDM) has become widely advocated as the ideal model of decision-making in many clinical situations, when there is no overall best choice, but it may be challenging for some clinicians [7,8]
In contrast to the negative lay accounts of ECV women in this study described, they reported that health professionals had been positive about ECV
Summary
Women who have a breech presentation at term have to decide whether to attempt external cephalic version (ECV) and how they want to give birth if the baby remains breech, either by planned caesarean section (CS) or vaginal breech birth. Women who have a breech presentation have two key decisions to make: whether to attempt external cephalic version (ECV) and how they want to give birth if their baby remains breech, either by planned caesarean section (CS) or attempted vaginal breech breech delivery, but there was an increased risk of shortterm complications for mothers, and insufficient evidence to evaluate the implications of planned CS for future pregnancies [5]. SDM is a process in which patients and clinicians collaborate together to make decisions about health care. SDM has become widely advocated as the ideal model of decision-making in many clinical situations, when there is no overall best choice, but it may be challenging for some clinicians [7,8]
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