Maternal and neonatal outcomes associated with breech presentation in
planned community births: a prospective observational cohort study
Abstract
Objective Investigate maternal and neonatal outcomes associated
with breech presentation in planned community births in the United
States Design Cohort analysis of a national perinatal data
registry Setting Homes and birth centres, United States
Sample Medical records of individuals with a term, singleton
gestation (N=71,943) planning community birth at labour onset
Methods Descriptive statistics to calculate associations
between types of breech presentation and perinatal outcomes Main
Outcome Measures Maternal: intrapartum/postpartum transfer,
hospitalization, caesarean, haemorrhage, severe perineal laceration,
duration of labour stages and membrane rupture Neonatal:
transfer, hospitalization, NICU admission, congenital anomalies,
umbilical cord prolapse, birth injury, intrapartum/neonatal death
Results One percent (n=695) of individuals experienced breech
birth, with most (57%) presenting frank breech (19% complete, 18%
incomplete, 5% unknown breech type). Among all breech labours, there
were high rates of intrapartum transfer and caesarean (OR 9.0, 95% CI
7.7-10.4 and OR 18.6, 95% CI 15.9-21.7, respectively), with no
substantive difference based on parity, planned site of birth, or level
of health system integration. Risk of nearly all assessed neonatal
outcomes was higher for all breech presentation types, including
hospital transfer, NICU admission, birth injury, and umbilical cord
prolapse. Breech presentation was also associated with increased risk of
intrapartum/neonatal death (OR 8.5, 95% CI 4.4-16.3), even after
excluding congenital anomalies. Conclusions All types of breech
presentation in community birth settings are associated with increased
risk of adverse neonatal outcomes. Findings contribute to informed
decision-making and reinforce the need for accessible, high-quality care
for planned vaginal breech birth in hospitals.