Implementation of a breech program in a Belgian obstetric team. Issue 2 (20th November 2021)

• Record Type: Journal Article
• Authors: Casteels, Martine; Podevyn, Kathleen; Vanoverschelde, Henk; Louwen, Frank
• Is Part Of: International journal of gynaecology and obstetrics. Volume 158:Issue 2(2022)
• Page Start: 432
• Page End: 438
• Publication Date: 2021-11-20
• Subjects: breech presentation -- counseling tool -- selection criteria -- training program -- upright position -- vaginal breech delivery; Gynecology -- Periodicals; Obstetrics -- Periodicals; Electronic journals; 618
• DOI: 10.1002/ijgo.14003
• Languages: English
• ISSNs: 0020-7292

Abstract

Abstract: Objective: To stimulate obstetric centers to start training in breech counseling and selection and performing vaginal breech deliveries. Methods: The different steps that were needed to roll out a breech program, are described: the "walking" epidural (PIEB protocol), the breech consultation with a structured counseling tool, and training of the whole team (gynecologists, midwives, anesthesiologists, and pediatricians). We describe below the results of 111 women who were counseled at the breech consultation, in the period May 2019 to August 2021. Results: In all, 86.5% of patients (n= 96) with a singleton term breech met the criteria for a vaginal breech delivery; 77% of this group (n= 74) accepted a planned vaginal breech delivery. Of this group, 54% (n=40) had a successful vaginal breech delivery, 27% (n=20) ended up in a secondary cesarean section, and 19% (n=14) had a planned cesarean section. Conclusion: We were able to roll out a successful breech program, including vaginal breech delivery, in a safe way. The breech consultation is the most essential part of the process. Training of the whole team is mandatory. The results of the first 2 years are encouraging to continue this program. Abstract : We present the results of a program for safe vaginal breech delivery, after careful counseling and selection of patients, in a trained team.