In units with the available resources to perform a cesarean delivery, we suggest avoiding vaginal breech delivery in singleton gestations, or the initial twin. Vaginal delivery is an acceptable alternative for women who meet selection criteria for safe vaginal delivery and choose this option [1,2]. (See "Overview of breech presentation".)
Vaginal breech deliveries will continue to occur, even in institutions with a policy of routine cesarean deliveries for breech presentation, because of situations such as precipitous delivery, out of hospital delivery, severe fetal anomaly or fetal death, and mother's preference for vaginal birth. Therefore, it is essential for clinicians to maintain the skills of breech delivery.
In the absence of clinical experience, teaching aids such as videos and mannequins may be necessary . The following simulation video illustrates one clinician’s approach to vaginal breech delivery using Piper forceps to extract the aftercoming head (movie 1).
A free video demonstrating techniques of vaginal breech delivery is also available online at the World Health Organization’s (WHO) Reproductive Health Library (RHL) .
VAGINAL BREECH DELIVERY
Criteria for an optimal situation — Various criteria have been developed to minimize the risk of vaginal breech delivery. These criteria for patient selection are largely based upon clinical experience, and typically include [5-9]: