From the Research
Breech presentation does not always require a cesarean section, but planned cesarean delivery is generally recommended for term singleton breech presentations in most developed countries. While vaginal breech delivery may be appropriate in certain circumstances, such as preterm deliveries or cases where the second twin is in breech position, it should only be considered when specific criteria are met. These criteria include adequate maternal pelvis, estimated fetal weight between 2500-3800g, frank or complete breech presentation, flexed fetal head, and availability of experienced providers skilled in breech delivery techniques 1.
The decision to attempt vaginal breech delivery should involve informed consent discussions about the small but increased risk of complications with vaginal breech birth compared to planned cesarean section. The provider must be experienced in maneuvers such as Mauriceau-Smellie-Veit or delivery of the aftercoming head. External cephalic version at 36-38 weeks gestation should be offered to eligible women with breech presentations to avoid both cesarean delivery and the risks of vaginal breech birth when possible 2.
Some key points to consider when deciding on the mode of delivery for a breech presentation include:
- The risks of perinatal mortality and morbidity are higher with planned vaginal breech delivery compared to planned cesarean section 1, 3
- The use of epidural anesthesia in vaginal breech delivery does not increase neonatal or maternal morbidity and mortality, but may be associated with a longer birth duration and manually assisted delivery 4
- The availability of experienced providers skilled in breech delivery techniques is crucial for a safe vaginal breech delivery
- Informed consent discussions should include the risks and benefits of both planned cesarean section and vaginal breech delivery.
Overall, the decision on the mode of delivery for a breech presentation should be individualized and based on the specific circumstances of each case, taking into account the risks and benefits of both planned cesarean section and vaginal breech delivery.