Attitudes towards breech management among a team of maternity clinicians in Australia undertaking breech training

Abstract

Background: Australian women seeking a vaginal breech birth report limited access to this option due to resistance from clinicians and strict medical criteria. Limited evidence exists to determine the attitudes, knowledge, experience and perceived confidence of Australian maternity clinicians towards the management of a breech presentation at term.

Aim: The aim of this study is to identify experience, knowledge and attitudes of birth suite clinicians' before and after training, toward term breech presentation and management practices.

Methods: A mixed methods research design was used that included a survey tool. A survey of 29 midwives and 11 medical professionals who attended an educational course in breech management ("BABE - Becoming a Breech Expert") was undertaken pre and post BABE training.

Results: While participants were experienced in providing maternity services, the results indicated most were inexperienced in facilitating a vaginal breech birth. Prior to training, most participants believed vaginal breech birth had a higher risk of neonatal morbidity and mortality compared to caesarean birth. The prospect of a woman choosing a breech birth outside of medical recommendations made many participants "nervous". Despite this, support to ensure there was informed decision-making and respect for a woman's choice was high. Following training, clinician knowledge of assessment of risks for breech birth and intention to discuss breech management options with women increased.

Conclusions: Participation in breech management training is beneficial to increasing clinician knowledge and assessment of risk and confidence towards discussing vaginal breech birth management, respect for women's choice and informed decision-making.

Keywords: Breech; Caesarean section; External cephalic version; Vaginal breech birth.