Preferences and perspectives on vaginal breech delivery in Ghana. Issue 2 (5th December 2020)

• Record Type: Journal Article
• Authors: Lawrence, Emma R.; Appiah‐Kubi, Adu; Konney, Thomas O.; Bell, Sarah G.; Tawiah, Augustine; Compton, Sarah D.
• Is Part Of: International journal of gynaecology and obstetrics. Volume 153:Issue 2(2021)
• Page Start: 307
• Page End: 314
• Publication Date: 2020-12-05
• Subjects: Breech delivery -- Ghana -- Low‐ and middle‐income countries -- Obstetric training -- Vaginal breech delivery; Gynecology -- Periodicals; Obstetrics -- Periodicals; Electronic journals; 618
• DOI: 10.1002/ijgo.13478
• Languages: English
• ISSNs: 0020-7292

Abstract

Abstract: Objective: To evaluate obstetrician/gynecologist and midwife perspectives and experiences with vaginal breech deliveries in Ghana. Methods: Respondents completed a survey on their experiences, training, comfort levels, and decision making about vaginal breech deliveries. Comparisons were made across obstetricians/gynecologists and midwives. Multiple logistic regression explored predictors of comfort performing vaginal breech deliveries. Results: Respondents comprised 93 (36.5%) obstetricians/gynecologists and 162 (63.5%) midwives. Most believed that some breech fetuses should be delivered vaginally, with higher agreement from obstetricians/gynecologists than from midwives (n = 86, 97.7% versus n = 207, 80.8%, P = 0.001). Midwives were more likely to strongly agree that training was adequate for obstetricians/gynecologists (n = 65, 55.6% versus n = 8, 9.8%, P < 0.001) and midwives (n = 60, 49.6% versus n = 6, 7.4%, P < 0.001). Most (n = 192, 94%) respondents wanted more experience and/or training. Despite most providers performing only one ot five breech vaginal deliveries yearly, 77.4% (n = 199) were comfortable performing them and 79.5% (n = 202) were comfortable supervising them. Significant predictors of comfort performing vaginal breech delivery were perceived adequacy of training (odds ratio 8.74, 95% CI 3.39–22.52) and belief that vaginal breech deliveries should be performed (odds ratio 4.28, 95% CI 1.33–13.72). Conclusion: Respondents were more likely to feel comfortable performing breech vaginal deliveries if they felt that their training was adequate. Vaginal breech deliveries can only be offered as safe alternatives to cesarean delivery if training and experience are maintained in low‐resource settings. Synopsis: A survey of obstetricians/gynecologists and midwives in Ghana demonstrates that comfort performing vaginal breech deliveries is dependent on perceived adequacy of training.