Erasmus Medical Center, Netherlands
Title: Patients’and professionals’ barriers and facilitators to external cephalic version for breech presentation at term, a qualitative analysis in the Netherlands
AN Rosman has completed her graduation as a Midwife in 1987. Till 2000, she practiced midwifery in a private primary practice in Zwolle (The Netherlands). Thereafter, she started working as a Midwife in secondary and tertiary care and started her PhD in 2009 on External Cephalic Version which she succesfully completed in 2014. Presently, she is working at the University of Rotterdam (Erasmus MC) as Senior Researcher and Project Manager of pre and interconception care, work related risks and pregnancy.
Within the Netherlands there is a professional consensus that external cephalic version (ECV) should be offered to all eliglible women with a fetus in breech presentation, but only up to 70% of these women undergo an ECV attempt. The aim of this study was to identify barriers and facilitators for ECV among professionals advising on ECV and patients who decided on ECV. Semi-structured interviews were held with patients and midwives and obstetricians treating patients with a breech presentation. Based on National Guidelines and expert opinions, we developed topic lists to guide the interviews and discuss barriers and facilitators in order to decide on ECV (patients) or advice on ECV (midwives and obstetricians). Among patients the main barriers were fear, the preference to have a planned caesarean section (CS), incomplete information and having witnessed birth complications whitin the family or among friends. The main facilitators were the wish for a homebirth, the wish to deliver vaginally 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 (counseling 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 knowlegde should be taken into account in designing implementation strategies for ECV to improve the uptake of ECV by professionals and patients.