Breech birth at home: outcomes of 60 breech and 109 cephalic planned home and birth center births
Abstract Background Research on outcomes of out-of-hospital breech birth is scarce. This study evaluates the outcomes of singleton term breech and cephalic births in a home or birth center setting. Methods This is a retrospective observational cohort study of 60 breech and 109 cephalic planned out-o...
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| Format: | Article |
| Language: | English |
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BMC
2018-10-01
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| Series: | BMC Pregnancy and Childbirth |
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| Online Access: | http://link.springer.com/article/10.1186/s12884-018-2033-5 |
| _version_ | 1818315603253919744 |
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| author | Stuart James Fischbein Rixa Freeze |
| author_facet | Stuart James Fischbein Rixa Freeze |
| author_sort | Stuart James Fischbein |
| collection | DOAJ |
| description | Abstract Background Research on outcomes of out-of-hospital breech birth is scarce. This study evaluates the outcomes of singleton term breech and cephalic births in a home or birth center setting. Methods This is a retrospective observational cohort study of 60 breech and 109 cephalic planned out-of-hospital term singleton births during a 6 year period with a single obstetrician. Outcomes measured included mode of delivery; birth weights; 1 & 5-min Apgar scores; ante-, intra-, and post-partum transports; perineal integrity; and other maternal and neonatal morbidity. Results 50 breech and 102 cephalic presentations were still in the obstetrician’s care at the onset of labor; of those, 10 breech and 11 cephalic mothers required transport during labor. 76% of breech and 92.2% of cephalic births were planned to occur at home, with the remainder at a freestanding birth center. When compared to the cephalic group, the breech group had a higher rate of antepartum and in-labor transfer of care and cesarean section. Among completed out-of-hospital births, the breech group had a significantly higher rate of 1-min Apgar scores < 7 but no significant difference at 5 min. Rates of vaginal birth for both groups were high, with 84% of breech and 97.1% of cephalic mothers giving birth vaginally in this series. Compared to primiparas, multiparas in both groups had less perineal trauma and higher rates of out-of-hospital birth, vaginal birth, and spontaneous vaginal birth. No breech infant or mother required postpartum hospital transport, while one cephalic infant and one cephalic mother required postpartum transport. Of the babies born out-of-hospital, there was one short-term and one longer-term birth injury among the breech group and one short-term brachial plexus injury in the cephalic group. Conclusions A home or birth center setting leads to high rates of vaginal birth and good maternal outcomes for both breech and cephalic term singleton presentations. Out-of-hospital vaginal breech birth under specific protocol guidelines and with a skilled provider may be a reasonable choice for women wishing to avoid a cesarean section—especially when there is no option of a hospital breech birth. However, this study is underpowered to calculate uncommon adverse neonatal outcomes. |
| first_indexed | 2024-12-13T09:08:09Z |
| format | Article |
| id | doaj.art-664c4c4d34ed4d01b43eddc971ce4389 |
| institution | Directory Open Access Journal |
| issn | 1471-2393 |
| language | English |
| last_indexed | 2024-12-13T09:08:09Z |
| publishDate | 2018-10-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pregnancy and Childbirth |
| spelling | doaj.art-664c4c4d34ed4d01b43eddc971ce43892022-12-21T23:53:01ZengBMCBMC Pregnancy and Childbirth1471-23932018-10-0118111210.1186/s12884-018-2033-5Breech birth at home: outcomes of 60 breech and 109 cephalic planned home and birth center birthsStuart James Fischbein0Rixa Freeze1Birthing Instincts, Inc.Wabash CollegeAbstract Background Research on outcomes of out-of-hospital breech birth is scarce. This study evaluates the outcomes of singleton term breech and cephalic births in a home or birth center setting. Methods This is a retrospective observational cohort study of 60 breech and 109 cephalic planned out-of-hospital term singleton births during a 6 year period with a single obstetrician. Outcomes measured included mode of delivery; birth weights; 1 & 5-min Apgar scores; ante-, intra-, and post-partum transports; perineal integrity; and other maternal and neonatal morbidity. Results 50 breech and 102 cephalic presentations were still in the obstetrician’s care at the onset of labor; of those, 10 breech and 11 cephalic mothers required transport during labor. 76% of breech and 92.2% of cephalic births were planned to occur at home, with the remainder at a freestanding birth center. When compared to the cephalic group, the breech group had a higher rate of antepartum and in-labor transfer of care and cesarean section. Among completed out-of-hospital births, the breech group had a significantly higher rate of 1-min Apgar scores < 7 but no significant difference at 5 min. Rates of vaginal birth for both groups were high, with 84% of breech and 97.1% of cephalic mothers giving birth vaginally in this series. Compared to primiparas, multiparas in both groups had less perineal trauma and higher rates of out-of-hospital birth, vaginal birth, and spontaneous vaginal birth. No breech infant or mother required postpartum hospital transport, while one cephalic infant and one cephalic mother required postpartum transport. Of the babies born out-of-hospital, there was one short-term and one longer-term birth injury among the breech group and one short-term brachial plexus injury in the cephalic group. Conclusions A home or birth center setting leads to high rates of vaginal birth and good maternal outcomes for both breech and cephalic term singleton presentations. Out-of-hospital vaginal breech birth under specific protocol guidelines and with a skilled provider may be a reasonable choice for women wishing to avoid a cesarean section—especially when there is no option of a hospital breech birth. However, this study is underpowered to calculate uncommon adverse neonatal outcomes.http://link.springer.com/article/10.1186/s12884-018-2033-5BreechVaginal breech deliveryDelivery modeHome birthBirth centerOut-of-hospital birth |
| spellingShingle | Stuart James Fischbein Rixa Freeze Breech birth at home: outcomes of 60 breech and 109 cephalic planned home and birth center births BMC Pregnancy and Childbirth Breech Vaginal breech delivery Delivery mode Home birth Birth center Out-of-hospital birth |
| title | Breech birth at home: outcomes of 60 breech and 109 cephalic planned home and birth center births |
| title_full | Breech birth at home: outcomes of 60 breech and 109 cephalic planned home and birth center births |
| title_fullStr | Breech birth at home: outcomes of 60 breech and 109 cephalic planned home and birth center births |
| title_full_unstemmed | Breech birth at home: outcomes of 60 breech and 109 cephalic planned home and birth center births |
| title_short | Breech birth at home: outcomes of 60 breech and 109 cephalic planned home and birth center births |
| title_sort | breech birth at home outcomes of 60 breech and 109 cephalic planned home and birth center births |
| topic | Breech Vaginal breech delivery Delivery mode Home birth Birth center Out-of-hospital birth |
| url | http://link.springer.com/article/10.1186/s12884-018-2033-5 |
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