• Breech birth: Reviewing the evidence for external cephalic version and moxibustion

      Steen, Mary; Kingdon, Carol; University of Chester ; University of Central Lancashire (T G Scott, 2008-12-01)
      Background: Breech presentation, where a baby is buttocks or feet rather than head occurs in about 3 to 4% of singleton pregnancies at term. Worldwide, the majority of babies identified as breech are now delivered by planned caesarean section. Aim: This paper is the second of two that reviews evidence concerning breech presentation and birth mode. This review focuses specifically on women's preferences for birth mode, experiences of breech presentation and the use of external cephalic version (ECV) and moxibustion, which may be used in the third trimester of pregnancy to turn a breech baby to a cephalic presentation. Method: A structured literature review was undertaken using the Cochrane Library, CINAHL, EMBASE, MEDLINE, and AMED. Different permutations of 'breech' ('frank' or 'complete' or 'extended' or 'flexed') and 'alternative' or 'complementary therapies' or 'external cephalic version' or 'ECV' or 'moxibustion' and 'before term' and 'term' and 'singleton' in the title, key words or abstracts were used. Results: There is evidence that the majority of women would prefer a vaginal birth. There is substantial evidence that ECV can reduce the caesarean section rate by turning breech presentation to cephalic. Further research is needed to confirm or refute the clinical effectiveness and women's views of moxibustion therapy. Conclusions: As rates of caesarean section for breech presentation continue to rise, it is important that midwives and women have up-to-date evidence-based information about the alternative to proceeding straight to planned caesarean section when a breech presentation is identified.
    • Vaginal or caesarean delivery? How research has turned breech birth around

      Steen, Mary; Kingdon, Carol; RCM/UCLan ; UCLan (T G Scott, 2008-09)
      Background: Breech presentation, where a baby is buttocks or feet first rather than head occurs in about 3 to 4% of singleton pregnancies at term. Worldwide, the vast majority of babies identified as breech are now delivered by planned caesarean section. Aim: to identify relevant published research evidence relating to vaginal and caesarean breech birth and then to discuss the evidence, subsequent controversy and clinical implications that have influence an ongoing obstetrical debate. Method: A structured literature review was undertaken using the Cochrane Library, CINAHL, EMBASE and MEDLINE databases. Different permutations of 'breech' ('frank' or 'complete' or 'extended' or 'flexed') and 'vaginal' or 'caesarean' ('cesarean' or 'cesarian' or 'caesarean') and 'term' and 'singleton' in the title, key words or abstracts were the terms used. Results: Over the last 50 years, there has been an increasing trend toward the routine use of caesarean section as a preventive way of reducing the poor outcomes associated with breech presentation. Research evidence has also played a pivotal role in influencing the routine use of caesarean breech birth and, in particular, a single research trial, the Term Breech Trial (TBT) has substantially influenced current policy and practice. There is no other area of research that has such an impact upon clinical practice in such a short period of time. Conclusions: The speed and extent to which the recommendations of the TBT were implemented has given rise to new controversy surrounding the safety of breech birth, while raising important questions about how the findings of research are used in practice.