Survey of Canadian Obstetricians Regarding the Management of Term Breech Presentation

Objective: the objective of this study was to determine current attitudes and practices of obstetricians in Canada regarding the management of breech presentation at term. Methods: a survey was sent to 307 obstetricians across Canada to determine their views on trial of labour for frank and non-frank breech presentation at term, use of external cephalic version, acquisition of skills by residents, influence of the medico-legal climate, and participation in a randomized controlled trial of Caesarean section versus planned vaginal delivery for breech presentation at term. Results: most obstetricians surveyed were from teaching hospitals and from hospitals in Ontario or the Western provinces. The response rate was 65 percent. Almost all of the respondents (96%) were supportive of a trial of labour for the frank breech, and many were supportive of a trial of labour for the non-frank breech presentation. Most (68%) performed external cephalic version, although 52 percent considered their success rate to be less than 50 percent. Most of the respondents (69%) did not feel that residents were acquiring the necessary skills to manage a trial of labour and vaginal delivery for the frank breech presentation at term. Many (46%) indicated that the medico-legal climate had a major influence on clinical decision making. Most respondents (58%) were willing to ask patients to be entered into a randomized controlled trial of Caesarean section versus planned vaginal delivery, and most (78%) indicated that they would be prepared to change their practice based on the results of such a trial. Conclusions: most obstetricians surveyed would support a trial of labour in selected pregnancies.