• Vaginal breech birth or Caesarean?

      Steen, Mary; Kingdon, Carol; Royal College of Midwives/University of Central Lancashire (2007-11-08)
      This presentation will firstly explore the evidence in supporting the phenomenal shift in clinical practice from vaginal breech birth to routine caesarean breech birth, in particular the impact of a single research trial, the Term Breech Trial (TBT) on current worldwide policy and practice. Secondly, will explore the best available evidence for the use of External Cephalic Version (ECV)and moxibustion to turn a breech baby to a cephalic presentation as this may reduce a woman’s risk of having a caesarean section.
    • 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.