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02 July 2018
Clinical Practice
Volume 26 · Issue 7
ISSN (print): 0969-4900
ISSN (online): 2052-4307
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Abstract
In many countries, including the UK, Australia, China, and the USA, more than 80% of breech-presenting fetuses are born by caesarean section. However, it is important for midwives to note the options that are available to women desiring a vaginal birth. This article will investigate cephalic version methods available to women with a breech-presenting baby, including external cephalic version, moxibustion and acupuncture. The literature emphasises the need for further research into alternative methods of cephalic version, for clinicians to up-skill on vaginal breech birth techniques and, if not recommend, then advise women of alternative methods available if mainstream interventions are unacceptable or contraindicated.
The safest mode of birth for a breech-presenting fetus has been a topic for debate among researchers and clinicians for decades (Walker, 2012; Evans, 2013; Odent, 2013; Homer et al, 2015). Women with a cephalic fetus at term, in the absence of contraindications, are encouraged to have a vaginal birth, yet women with a breech-presenting fetus routinely undergo a caesarean section, even if their pregnancy has been otherwise uncomplicated (Banks, 1999).
The debate seemed to culminate with publication of the Term Breech Trial (Hannah et al, 2000), which concluded, after a randomised controlled trial, that caesarean section was the optimal mode of birth when compared to vaginal breech birth. This was suggested because of an increased risk of serious morbidity and mortality to infants born vaginally and, as a result, management of breech birth changed worldwide (Kotaska, 2011; Lawson, 2012; Odent, 2013; Sanders and Steele, 2014; Vlemmix et al, 2014).
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Cephalic version
Breech presentation
Moxibustion
Alternative methods
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