Objective: To estimate common determinants of breech presentation at parturition.
Study design: A population-based cohort study (between 1/1/2001 and 31/12/2010) was conducted
among all women who delivered a singleton baby in breech presentation from 22 completed weeks of
gestation. A binary logistic regression was used to determine independent feto–maternal characteristics
of breech presentation at birth, adjusted odds ratios and 95% confidence intervals. Variables were:
gestational age, birth weight, maternal age, parity and gender of the baby, presence or absence of a
history of cesarean section, gestational diabetes, gestational hypertension, pregnancy after assisted
reproduction technology and congenital malformations.
Results: From a population of 611,021 women; 28,059 were delivered in breech presentation (4.59%).
Independent determinants of breech presentation at delivery were: gestational age and birth weight (the
lower, the higher the incidence of breech at birth), parity (the frequency of breech decreased with
increasing parity) and maternal age (the older the mother, the higher the odds for breech presentation).
Women who had a scarred uterus, due to a previous cesarean section, women who gave birth to a female
offspring and women whose baby showed a congenital malformation, were more prone to be delivered in
breech presentation.
Conclusion: Low gestational age and birth weight, advanced maternal age, a scarred uterus, a female baby
and a baby with a congenital malformation increased the odds for singleton breech presentation at
parturition. The latter gradually decreased with increasing parity.
A B S T R A C T
Background: Since the Term Breech Trial in 2000, few Australian clinicians have been able to maintain
their skills to facilitate vaginal breech births. The overwhelming majority of women with a breech
presentation have been given one birth option, that is, caesarean section. The aim of this study was to
explore clinician’s experiences of caring for women when facilitating a vaginal breech birth.
Methods: A descriptive exploratory design was undertaken. Nine clinicians (obstetricians and midwives)
from two tertiary hospitals in Australia who regularly facilitate vaginal breech birth were interviewed.
The interviews were analysed thematically.
Results: Participants were five obstetricians and four midwives. There were two overarching themes that
arose from the data: Facilitation of and Barriers to vaginal breech birth. A number of sub-themes are
described in the paper.
Conclusions: In order to facilitate vaginal breech birth and ensure it is given as an option to women, it is
necessary to educate, upskill and support colleagues to increase their confidence and abilities, carefully
counsel and select suitable women, and approach the option in a calm, collaborative way.
2015 Australian College of Midwives. Published by Elsevier Australia (a division of Reed International