Evaluating Vaginal Breech Birth Outcomes

Date of Award

2025

Document Type

Project

College/School

College of Nursing

Degree Name

Doctor of Nursing Practice (DNP)

Project Mentor

Dr. Elizabeth Gabzdyl

Readers

Dr. Rixa Freeze

Abstract

Introduction: The publication of the Term Breech Trial (TBT) in 2000 concluded that cesarean delivery (CS) is the safest route for term breech pregnancies; as a result, current hospital standards in the United States (U.S.) require breech presentation fetuses to be delivered via CS and medical and nursing institutions have discontinued vaginal breech birth training. There is currently no large clinical outcome data available to compare clinical outcome data of providers trained in VBB. Identifying and publicizing VBB maternal and neonatal outcomes when attended by a provider who has completed VBB training can help to make VBB more accessible and safer.

Methods: This project utilized an online database called Kobo toolkit for data collection. A primary data analysis was conducted of 127 surveys submitted by self-selected participants in an international hybrid VBB training program from May 2021 to January 2025. This analysis serves as a summative quantitative data analysis of physiologic VBB clinical data outcomes.

Results: Across 127 survey responses, there were reports of 5 fetal mortalities and 0 maternal mortalities. 1 mother was reported to have experienced severe pre-eclampsia, no other potentially life-threating conditions were reported. Sixteen moderate to severe neonatal morbidities were reported. Of note, 57% of cases were found in a frank breech presentation, 18% of cases in a complete breech presentation without dropped feet, 6% of cases in a complete with two dropped feet presentation, 4% of cases in a complete presentation with 1 dropped foot, 4% of cases in a incomplete presentation with 1 dropped foot, 6% of cases in an incomplete presentation without any dropped feet, and 5% of cases in another breech presentation. Ninety six percent of surveys reported freedom of movement encouraged during labor, with an average time from rump to birth of 3.959 minutes. Labor was induced in 5.5% of cases and augmented in 12.6% of cases. Hands-on maneuvers to assist in the birth were reportedly used in 47% of surveys, the most common being shoulder press in 73.3% of these cases.

Discussion: This data collection provides context for findings related to VBB clinical outcomes. This will serve as the first study to look at clinical outcome data of a vaginal breech training program. Increasing the knowledge of the current outcome statistics for VBB when attended by a skilled and trained VBB provider will help support birth autonomy and guide future clinical practice decision making.

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