Breech deliveries, where a baby is born bottom first instead of head first, present unique challenges and risks in the realm of obstetrics.

While constituting a small percentage of all births, these deliveries demand significant attention due to the higher potential for complications that can affect both the newborn and the mother.

From a medico-legal standpoint, understanding the implications of managing breech presentations is crucial for healthcare professionals to mitigate risks and uphold the standard of care.

Breech presentations occur in approximately 3-4% of all full-term pregnancies. There are several types of breech presentations, including frank breech (bottom first with legs up), complete breech (bottom first with legs crossed), and footling breech (one or both feet come first). The type of breech can influence the delivery method and associated risks.

The management of breech delivery has evolved significantly, with a notable shift towards caesarean sections (C-sections) following the Term Breech Trial (2000). This trial suggested that planned C-sections could reduce neonatal morbidity and mortality compared to vaginal delivery for breech presentations. However, subsequent analysis and critique have prompted a re-evaluation of these findings, highlighting the importance of individualized decision-making based on the specific circumstances of each case.

Informed consent is paramount in managing breech presentations. Obstetricians must provide expectant mothers with comprehensive information about the risks and benefits of vaginal delivery versus C-section. This conversation should cover potential outcomes, the possibility of emergency C-section, and the availability of expertise for vaginal breech delivery. Effective communication ensures that parents can make informed decisions that align with their values and preferences.

The standard of care for managing breech presentations involves assessing each case’s unique risks and benefits, considering the mother’s and baby’s health and the healthcare provider’s expertise. Training and competence in vaginal breech delivery have become more of a concern as the prevalence of caesarean deliveries for breech presentations has risen. Maintaining skills in vaginal breech delivery is essential for offering safe choices to women and requires ongoing training and support for healthcare professionals.

Healthcare providers face medico-legal challenges in managing breech deliveries, particularly around the issues of consent, choice of delivery method, and adverse outcomes. Documentation of discussions about delivery options, the rationale for chosen methods, and the management plan is crucial in demonstrating adherence to the standard of care.

Cases of litigation often revolve around allegations of inadequate informed consent, poor decision-making leading to avoidable complications, and perceived failures in executing the chosen delivery method competently. Defending such claims typically involves demonstrating that the healthcare provider acted in accordance with accepted medical practices and made decisions that considered the patient’s best interests based on the information available at the time.

Breech deliveries represent a complex intersection of obstetric practice and medico-legal considerations. Navigating these challenges requires a combination of clinical expertise, effective communication, and a commitment to patient-centred care. By fostering an environment where informed consent, continuous learning, and adherence to best practices are prioritized, healthcare professionals can navigate the medico-legal complexities of breech delivery with confidence, ensuring the best possible outcomes for mothers and babies alike

Mr. Timothy Hookway is a Consultant Obstetrician and Gynaecologist at Derriford Hospital, Plymouth.

He trained in London, before moving to Wessex to complete advanced training in complex laparoscopic (keyhole) surgery, working in both Winchester and Southampton.

He was appointed to a consultant post in Plymouth in 2016 to support general obstetrics and gynaecology, along with developing a specialist endometriosis centre.

He has a keen interest in treating endometriosis and pelvic pain, along with menstrual disorders such as heavy or irregular periods.

To request his CV or for any medico-legal matters he can be reached at timhookway@inneg.co.uk.