Introduction: Approximately 3% to 4% of all pregnancies at term will have a fetus with a breech presentation. Studies have shown that the US has almost completely abandoned vaginal delivery for breech presentation through the influence of the "Term Breech Trial" (TBT) which concluded that a policy of planned caesarian section would reduce perinatal mortality, late neonatal mortality, and serious neonatal morbidity by approximately two-thirds for term fetuses. However, the recommendations are still being challenged by others.Objectives: The purpose of the study was to describe who in Virginia is having a vaginal delivery for a breech presentation and to determine if there is a difference in birth outcome based on mode of delivery for breech presentation of term infants.Methods: This population-based study used all birth records for term infants with breech presentation delivered between 1996 and 2005. Data were obtained from the Center for Health Statistics at the Virginia Department of Health. Descriptive statistics were done to characterize vaginal and caesarean section deliveries. These methods were compared using logistic regression for infant mortality and 5-minute Apgar scores as dependent variables.Results: In Virginia, over the last ten years, the prevalence of vaginal deliveries dropped from 13.1% to 6.6% for full term infants with a breech presentation, a decrease of almost 50%. Black women, younger mothers between the ages of 12 and 24, and women with less than or equal to a high school education had the highest occurrence of vaginal births. In the logistic models, the risk for infant death was highest for black women [OR = 1.93; (1.56, 2.38)], women with more than 13 prenatal visits [OR = 1.25; (1.02, 1.53) for 13-15 visits, OR = 2.33; (1 .82, 2.98) for >15 visits], infants who had a low birth weight [OR = 2.8 1 ; (2.08, 3.79)], and women who had a vaginal delivery [OR = 1.42; (1.10, 1.84)] The characteristics that were associated with a lower 5-minute Apgar score for breech infants delivered vaginally included the mother's method of payment, [Medicaid OR 1.75; (1.03, 2.97) and self pay OR 2.33; (1.13, 4.83)], low birth weight [OR = 2.54; (1.24, 5.22)], and delivery type [OR = 4.71; (2.95, 7.52)].Discussion/Conclusions: Our data showed that women who have a vaginal delivery for a term breech infant were more likely to be black, 12-24 years of age, no private insurance, and fewer prenatal visits and was associated with higher infant mortality and lower 5-minute Apgar scores. However, our results indicated that these infants had other significant problems, as indicated by the association with a high number of prenatal visits. Therefore, having physicians who are experienced in delivering breech infants vaginally, careful exclusion of risk factors and, educating the patient about the risks and complications of a vaginal delivery for breech fetuses could help decrease the potential risks for the mother and the infant.

Yes / This paper focuses on vaginal breech birth of singleton babies in New Zealand using a review of international literature to inform discussion on the care of women presenting at term with an uncomplicated breech presentation.

Bakgrund: I Sverige år 2022 förlöstes färre än ett av tio barn som låg i sätesbjudning genom vaginal sätesförlossning. Om denna siffra slås ut på antalet barnmorskor i Sverige blir det tydligt att vaginala sätesförlossningar är något som är svårt att få praktisk erfarenhet av som barnmorska. Barnmorskan förväntas ha kompetens att kunna handlägga en vaginal sätesförlossning. Det råder nationell enighet i att vaginala sätesförlossningar bör handläggas av barnmorskor och obstetriker med god erfarenhet. Att uppnå god erfarenhet av vaginala sätesförlossningar kan ses som ett problem när majoriteten av sätesfödslarna sker med kejsarsnitt. Syfte: Att beskriva barnmorskors erfarenheter av att handlägga vaginala sätesförlossningar Metod: Datainsamlingen utfördes genom tio enskilda intervjuer. Som analysmetod valdes en kvalitativ innehållsanalys med en induktiv ansats. Resultat: Insamlade data genererade tre kategorier, Ryggsäcken barnmorskan bär på, Handläggning vid vaginal sätesförlossning och Faktorer som påverkar trygghet vid vaginal sätesförlossning med totalt åtta underkategorier. Barnmorskors syn och inställning till vaginala sätesförlossningar påverkas av tidigare erfarenheter. Barnmorskorna påtalar vikten av en lugn miljö vid en vaginal sätesförlossning samt diskuterar val av förlossningsposition. Teamet har en betydande roll för barnmorskornas känsla av trygghet och det uttrycks ett behov av utökad träning kring vaginala sätesförlossningar. Slutsats: Samtliga barnmorskor i studien uttrycker en vilja att bistå fler sätesförlossningar men att de ser ett behov av ytterligare träning och kompetensutveckling. Genom utökad träning och kompetensutveckling inom detta område kan teamet stärkas vilket på sikt skulle kunna öka barnmorskans trygghet vid handläggningen av vaginala sätesförlossningar. / Background: In Sweden in 2022, fewer than one in ten babies who were breech were delivered by vaginal breech birth. If this figure is divided between the number of midwives in Sweden it is difficult to gain practical experience with vaginal breech births as a midwife. The midwife is expected to have the competence to handle a vaginal breech birth. There is national consensus that vaginal breech births should be managed by midwives and obstetricians with good experience. Achieving that good experience with vaginal breech births can be a problem when most breech births are by caesarean section. Aim: To describe midwives' experiences of handling vaginal breech births Method: The data collection was carried out through ten individual interviews. A qualitative content analysis with an inductive approach was chosen as the analysis method. Results: Collected data generated three categories, The backpack the midwife carries, Handling of vaginal breech birth and Factors affecting safety during vaginal breech birth with a total eight subcategories. Midwives' views and attitudes towards vaginal breech births are influenced by previous experiences. The midwives point out the importance of a calm environment during a vaginal breech birth and discuss the choice of birth position. The team has a significant role in the midwives' sense of security and there is a need for increased training around vaginal breech births. Conclusion: All midwives in the study expressed a desire to assist more breech births, but they are aware of the need for continiuous training and skill development.  Through increased training and competence development in this area, the team can be strengthened, which in the long run could increase the midwife's safety when handling vaginal breech births.