Research on breech birth in an upright position

3999817908_2bbe5c20b3A new and groundbreaking research study has found that, “Upright vaginal breech delivery was associated with reductions in duration of the second stage of labor, maneuvers required, maternal/neonatal injuries, and cesarean rate when compared with vaginal delivery in the dorsal position.” (Louwen et al 2016)

The Frankfurt upright breech birth study compared the outcomes of women who gave birth to their breech babies while upright – which means that they were either on all fours, leaning over the back of the bed on their knees or (occasionally) standing – with women who were in a dorsal position (on their back) and with women who had planned caesareans. The results show that, “When upright position was used almost exclusively, the cesarean rate decreased. Serious fetal and neonatal morbidity potentially related to birth mode was low, and similar for upright vaginal deliveries compared with planned cesareans (OR 1.37, 95% CI 0.10–19.11).” (Louwen et al 2016)

This is such an important study, because practice – and the options for women whose babies are in a breech presentation – has changed in many areas of the world since the publication of the much-criticised Canadian term breech trial.  We have desperately needed good research into alternatives to caesarean section and dorsal vaginal breech delivery, and this study has provided just that. A huge thank you to its authors.

The full text of this study (in the form of the accepted author manuscript) is currently available for free.

Louwen F, Daviss B-A, Johnson KC and Reitter A (2016). Does breech delivery in an upright position instead of on the back improve outcomes and avoid cesareans? Int J Gynecol Obstet. Accepted Author Manuscript. doi:10.1002/ijgo.12033

The Research

Objective: To compare breech outcomes when mothers delivering vaginally are upright, on their back, or planning cesareans.

Methods: A retrospective cohort study was undertaken of all women who presented for singleton breech delivery at a center in Frankfurt, Germany, between January 2004 and June 2011.

Results: Of 750 women with term breech delivery, 315 (42.0%) planned and received a cesarean. Of 269 successful vaginal deliveries of neonates, 229 in the upright position were compared with 40 in the dorsal position. Upright deliveries were associated with significantly fewer delivery maneuvers (OR 0.45, 95% CI 0.31–0.68) and neonatal birth injuries (OR 0.08, 95% CI 0.01–0.58), second stages that were on average shorter (1 vs 1.75 hours), and nonsignificantly decreased serious perineal lacerations (OR 0.34, 95% CI 0.05–3.99). When upright position was used almost exclusively, the cesarean rate decreased. Serious fetal and neonatal morbidity potentially related to birth mode was low, and similar for upright vaginal deliveries compared with planned cesareans (OR 1.37, 95% CI 0.10–19.11). Three neonates died; all had lethal birth defects. Forceps were never required.

Conclusion: Upright vaginal breech delivery was associated with reductions in duration of the second stage of labor, maneuvers required, maternal/neonatal injuries, and cesarean rate when compared with vaginal delivery in the dorsal position.

photo credit: dogs & music Benjamin Franklin Canova via photopin (license)

1 comment for “Research on breech birth in an upright position

  1. December 2, 2016 at 1:20 pm

    Love, Love, Love the picture!

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