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\begin{document}

\title{Maternal and neonatal outcomes associated with breech presentation in
planned community births: a prospective observational cohort study}



\author[1]{Robyn Schafer}%
\author[2]{Marit Bovbjerg}%
\author[3]{Melissa Cheyney}%
\author[4]{Julia C. Phillippi}%
\affil[1]{Rutgers School of Nursing}%
\affil[2]{Oregon State University College of Health and Human Sciences}%
\affil[3]{Oregon State University}%
\affil[4]{Vanderbilt University School of Nursing}%


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  \date{May 23, 2024}


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\begin{abstract}
\textbf{Objective} Investigate maternal and neonatal outcomes associated
with breech presentation in planned community births in the United
States \textbf{Design} Cohort analysis of a national perinatal data
registry \textbf{Setting} Homes and birth centres, United States
\textbf{Sample} Medical records of individuals with a term, singleton
gestation (N=71,943) planning community birth at labour onset
\textbf{Methods} Descriptive statistics to calculate associations
between types of breech presentation and perinatal outcomes \textbf{Main
Outcome Measures} \emph{Maternal}: intrapartum/postpartum transfer,
hospitalization, caesarean, haemorrhage, severe perineal laceration,
duration of labour stages and membrane rupture \emph{Neonatal}:
transfer, hospitalization, NICU admission, congenital anomalies,
umbilical cord prolapse, birth injury, intrapartum/neonatal death
\textbf{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. \textbf{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.%
\end{abstract}%



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