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John Hunter Hospital Breech Clinic

John Hunter Hospital
Project Added:
17 January 2013
Last updated:
21 October 2016

John Hunter Hospital Breech Clinic

Hunter New England Local Health District

Overview

John Hunter Hospital (JHH) has approximately 4,000 births per year and is considered one of the NSW centres of excellence for vaginal breech birth (VBB). Experience at JHH concurs with that of many European centres that vaginal breech birth is as safe as the alternative planned caesarean section for a select group of women with a breech presentation at term. This is in direct contrast to results from the Term Breech Trial (TBT) which was published in 2000 and has since been under intense professional critique.

Over recent years the outcomes given in the TBT had a significant impact on staff confidence and skill and ultimately caused considerable dilemma in counseling women about their options when diagnosed with a breech presentation at term. As a result of this as well as the Towards Normal Birth Policy Directive (TNB PD) JHH Maternity services decided to open a Breech clinic earlier this year. The primary aim of the clinic is to provide a pathway for referral for women who are diagnosed with a breech presentation from 36 weeks onwards.

Implementation

Staff

Integral to the ongoing success of this service is a commitment by most of the Obstetric staff specialists at JHH who have agreed to support women who have come through the clinic with their choice of planned VBB.

The breech clinic is run by Dr Matthew Holland and a dedicated team of midwives on a Wednesday afternoon. The team aim to be able to offer continuity of care for all women who plan to have a vaginal breech birth.

Communication

Since the initiation of the Breech clinic midwives and medical staff are encouraged to refer women to the breech clinic where they are all counselled individually but with consistent information regarding current evidence and options for care. They are reassured that JHH has a team of doctors and midwives who have the skills and experience to care for women in labour with breech presentation and that for a selected group of women with good labour management success rates here are nearly 60%.

Referrals

Referrals to the clinic are accepted for any women in the Hunter New England Local Health District who are diagnosed with a breech presentation at term.

Procedures

All women who are referred to the clinic are rescanned to confirm presentation and exclude fetal anomaly. They are all routinely informed that there is no evidence that the long term health of babies born by breech presentation is influenced by the mode of birth. Available options are discussed with each woman and her partner, these include, where appropriate: external cephalic version, vaginal breech birth or caesarean section.

Women are followed up on a weekly basis in the breech clinic and arrangements are put in place to try and facilitate continuity of care in the intrapartum setting, although this aspect is in its infancy and requires further development.

Management of women in labour with a vaginal breech birth is predominantly guided by recommendations from the Society of Obstetricians and Gynaecologists in Canada, Clinical Practice Guideline: Vaginal Breech Presentation. 

Both Dr Holland and the midwives on the team try to ensure that each of these women receives follow up in the postnatal period either in hospital or by a phone call at home and offer an opportunity to debrief about their birth experience.

Maternity: Management of Breech Presentation (PDF File pdf - 98 KB). Hunter New England Local Health District Clinical Guideline.

Contact


Clinical Midwife Consultant, Maternity Services
Conjoint Lecturer University of Newcastle
Division of Maternity and Gynaecology
John Hunter Hospital, Lookout Road, New Lambton, NSW
Phone: 02 4985 5469

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