Pregnant women facing a breech birth feel pressured by medical professionals into having a caesarean, a Perth researcher has claimed.
Dr Sara Morris from Edith Cowan University’s school of nursing and midwifery said many women with a breech-presenting baby were not told of other options and faced “significant pressure” to conform to expectations of medical professionals.
She cited the traditional Chinese medicinal practice of moxibustion – or burning mugwort – as an alternative.
A series of studies led by Dr Morris looked at the experiences of women who had faced a breech birth and reviewed the clinical guidelines in practice throughout health systems across the world.
She said that since 2000, caesarean sections had been recommended as the safest mode of birth for breech presenting babies, which has resulted in less staff with the skills needed to handle complications during a vaginal breech birth.
The loss of breech birth skills and the litigious nature of modern maternity care meant negative outcomes associated with childbirth complications could lead to costly legal proceedings against health services.
She said this had contributed to 87% of breech babies in Australia being born via caesarean.
Dr Morris said it was important guidelines provided to health workers did not over-emphasise the safety of caesareans when a baby was in a breech position, as neurodevelopmental outcomes did not appear to differ significantly in breech-born children by two years of age, regardless of their birth mode.
“Clinical practice guidelines which focus on the risks of a VBB without also discussing the risks of a caesarean section have the potential to sway clinician attitudes and impact mothers’ decision-making,” she said.
Less choice, more pressure
Dr Morris said maternity health care workers had a legal and ethical responsibility to provide unbiased and non-judgmental counselling regarding the risks and benefits of all breech birth modes.
“Without all relevant information being provided, including the right to refuse as well as alternative options available, the legal requirements for informed consent are not met,” she said.
More research was needed on the safety and effectiveness of alternative breech birth methods such as upright birth positions.
Dr Morris said there were alternative techniques for changing baby’s position other than external cephalic version which could help promote a head-down position.
“For example, moxibustion is a traditional Chinese medicinal practice that has been used for approximately 1300 years and entails burning moxa (mugwort) close to certain points of the body,” she said.
“Alternative methods such as this are acceptable to women and most practitioners as they are considered gentle and relatively low-risk.”
The way forward
Dr Morris said counselling and training health professionals in breech birth skills was the key to women gaining the full picture when making decisions around breech births.
“This means upskilling or reskilling workers to improve the safety of VBBs, and also making sure they are aware of alternative methods of encouraging a head down position so they can let women know all of their options.”
Dr Morris said access to skilled clinicians and greater birth options for women with a breech-presenting baby could be improved by creating breech-specific clinics or services.
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