Undiagnosed Breech: towards a woman-centred approach

The unexpected diagnosis of breech presentation upon admission in labour affects approximately 1:100 women and presents an ethical dilemma for health professionals involved, particularly when this occurs in the context of midwifery-led care. This article critically examines current guidelines recommending caesarean section on the basis of available evidence, outlines factors which must be considered in order to provide safe care, makes recommendations for women-centred counselling, and explores the role of the midwife in this situation. Conflict of Interest None known Undiagnosed Breech: towards a woman-centred approach Background The prevalence of breech presentation is approximately 3-4% at term (3-4 women in 100 at 37 weeks) (Hickock et al 1992 and Albrechtsen et al 1998). Currently, standard care involves antenatal screening to identify babies who are presenting breech after 36 weeks, with subsequent referral for ultrasound confirmation and counselling regarding treatment options. However, this screening process is not highly effective, commonly resulting in a 25-33% rate of breech presentation diagnosed for the first time in labour (Nwosu et al, 1993, Jackson and Tuffnell, 1994, Nassar et al, 2006). Thus, the experience of an unexpected diagnosis of breech presentation in labour affects approximately 1 in 100 women.