Women's Selection of Mode of Birth for their Breech Presentation

Many studies since the Term Breech Trial have demonstrated the safety of vaginal breech birth (VBB), and today it is an option for breech presentation at term. However, women with breech presentation often face a difficult decision regarding mode of birth, especially when planned cesarean was the standard of care in the not-so-distant past. We aim to clarify the decision-making process and barriers women face when making this decision. Between January and April 2016, women who delivered with breech presentation were approached during their postpartum hospital stay to obtain consent for the study. The follow-up, semi-structured interview probed the woman's acquisition of knowledge and supports and barriers to her choices leading up to delivery. The responses were recorded and transcribed for analysis, and themes were identified for reporting. Of the 95 women who completed the interview, 21 preferred VBB but only 1 had a VBB. Most unplanned cesarean deliveries were performed for obstetrical indications, but 5 women expressed a lack of support for VBB or did not recall being provided options. Themes were identified with respect to the influences the women experienced, including passive external, provider-based, evidence-based, and internal. Despite the availability of options for breech pregnancy, the majority of women continue to have planned cesarean deliveries. The retrospective process reveals that women did not fully understand the eligibility criteria for VBB and all available options (including external cephalic version). Shared decision-making and continuity of care should remain a priority during the counselling process and delivery of care. Nombre d’études depuis l'essai clinique Term Breech Trial ont indiqué l'innocuité de l'accouchement du siège par voie vaginale (ASVV), qui représente aujourd'hui une option en cas de présentation du siège à terme. Par contre, les femmes dont le fœtus est en présentation du siège doivent souvent faire face à une décision difficile relativement au mode d'accouchement, en particulier si l'on tient compte du fait qu'il n'y a pas si longtemps, la césarienne planifiée était la norme de soins. Nous visons à clarifier le processus décisionnel et les obstacles auxquels font face les femmes au moment de faire ce choix. Entre janvier et avril 2016, des femmes ayant accouché d'un fœtus en présentation du siège ont été approchées pendant leur séjour post-partum pour obtenir leur consentement à participer à l’étude. L'entretie