Patients' and professionals' barriers and facilitators to external cephalic version for breech presentation at term, a qualitative analysis in the Netherlands

external cephalic version (ECV) is a relatively simple and safe manoeuvre and a proven effective approach in the reduction of breech presentation at term. There is professional consensus that ECV should be offered to all women with a fetus in breech presentation, but only up to 70% of women eligible...

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Bibliographic Details
Published in:Midwifery 2014-03, Vol.30 (3), p.324-330
Main Authors: Rosman, A.N. (Ageeth), Vlemmix, F. (Floortje), Fleuren, M.A.H. (Margot), Rijnders, M.E. (Marlies), Beuckens, A. (Antje), Opmeer, B.C. (Brent), Mol, B.W.J. (Ben Willem), van Zwieten, M.C.B. (Myra), Kok, M. (Marjolein)
Format: Article
Language:English
Subjects:
Adult
Attitude of Health Personnel
Attitude to Health
Breech position
Breech presentation
Breech Presentation - nursing
Breech Presentation - therapy
Childbirth
Communication Barriers
External cephalic version
Facilitators
Facilitators and barriers
Female
Humans
Implementation
Interviews as Topic
Male
Netherlands
Nursing
Patient Preference
Practice Guidelines as Topic
Practice Patterns, Nurses
Pregnancy
Pregnant women
Women
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Summary:external cephalic version (ECV) is a relatively simple and safe manoeuvre and a proven effective approach in the reduction of breech presentation at term. There is professional consensus that ECV should be offered to all women with a fetus in breech presentation, but only up to 70% of women eligible for ECV undergo an ECV attempt. The aim of the study was to identify barriers and facilitators for ECV among professionals and women with a breech presentation at term. qualitative study with semi-structured interviews. Dutch hospitals. pregnant women with a breech presentation who had decided on ECV, and midwives and gynaecologists treating women with a breech presentation. on the basis of national guidelines and expert opinions, we developed topic lists to guide the interviews and discuss barriers and facilitators in order to decide on ECV (pregnant women) or advice on ECV (midwives and gynaecologists). among pregnant women the main barriers were fear, the preference to have a planned caesarean section (CS), incomplete information and having witnessed birth complications within the family or among friends. The main facilitators were the wish for a home birth, the wish for a vaginal delivery and confidence of the safety of ECV. Among professionals the main barriers were a lack of knowledge to fully inform and counsel patients on ECV, and the inability to counsel women who preferred a primary CS. The main facilitator was an unambiguous policy on (counselling for) ECV within the region. we identified several barriers and facilitators possibly explaining the suboptimal implementation of ECV for breech presentation in the Netherlands. This knowledge should be taken into account in designing implementation strategies for ECV to improve the uptake of ECV by professionals and patients.
ISSN:0266-6138
1532-3099
DOI:10.1016/j.midw.2013.03.013