Comparison of birth positions for breech presentation at term: a retrospective study

Abstract Background Breech presentation accounts for 3.5 to 5.0% of all term births. The majority of term breech babies are delivered by caesarean section. When the criteria for a vaginal delivery are met and the choice is made to attempt a vaginal delivery, delivery remains a challenge. This retrospective study aimed to compare the maternal and neonatal outcomes of vaginal breech delivery in the upright positions (including all fours) and in the supine position. Results Among 146 women, 60 delivered in the upright position and 86 in the supine position. There was a significant difference in the use of obstetric manoeuvres, with fewer manoeuvres in the upright position group 16.1% compared to 44.6% in the supine position group (aOR 0.22; 95%CI 0.09–0.53). There was a significant difference in the use of episiotomy with 1.8% in the upright position group compared with 14.9% in the supine position group (aOR 0.06; 95%CI 0.01–0.51). There was a non-statistically significant trend towards fewer full dilation cesarean sections with 13.9% in the supine group compared to 6.7% in the upright position group (aOR 0.43; 95%CI 0.11–1.64). No statistically significant difference was shown in neonatal outcomes. Conclusion Vaginal breech birth in upright positions appears to offer a safe and reasonable alternative to the traditional supine position. The need for obstetric manoeuvres and the rate of episiotomy are lower without compromising neonatal outcomes. The options available for the delivery position should be discussed, including the possibility of giving birth in an upright position including on all-fours.