title: Patients' and professionals' barriers and facilitators to external cephalic version for breech presentation at term, a qualitative analysis in the Netherlands.
abstract: OBJECTIVE
  external cephalic version (ECV) is a relatively simple and safe manoeuvre and a proven effective approach in the reduction of breech presentation at term. There is professional consensus that ECV should be offered to all women with a fetus in breech presentation, but only up to 70% of women eligible for ECV undergo an ECV attempt. The aim of the study was to identify barriers and facilitators for ECV among professionals and women with a breech presentation at term.
  
  
  METHODS
  qualitative study with semi-structured interviews.
  
  
  METHODS
  Dutch hospitals.
  
  
  METHODS
  pregnant women with a breech presentation who had decided on ECV, and midwives and gynaecologists treating women with a breech presentation.
  
  
  METHODS
  on the basis of national guidelines and expert opinions, we developed topic lists to guide the interviews and discuss barriers and facilitators in order to decide on ECV (pregnant women) or advice on ECV (midwives and gynaecologists).
  
  
  RESULTS
  among pregnant women the main barriers were fear, the preference to have a planned caesarean section (CS), incomplete information and having witnessed birth complications within the family or among friends. The main facilitators were the wish for a home birth, the wish for a vaginal delivery 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 (counselling for) ECV within the region.
  
  
  CONCLUSIONS
  we identified several barriers and facilitators possibly explaining the suboptimal implementation of ECV for breech presentation in the Netherlands. This knowledge should be taken into account in designing implementation strategies for ECV to improve the uptake of ECV by professionals and patients.
authors.affiliation: Department of Obstetrics and Gynecology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: A N
authors.initials: AN
authors.lastname: Rosman
authors.affiliation: Department of Obstetrics and Gynecology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. Electronic address: f.vlemmix@amc.uva.nl.
authors.forename: F
authors.initials: F
authors.lastname: Vlemmix
authors.affiliation: TNO Department of Life Style, Leiden, the Netherlands.
authors.forename: M A H
authors.initials: MA
authors.lastname: Fleuren
authors.affiliation: TNO Department of Child Health, Leiden, the Netherlands.
authors.forename: M E
authors.initials: ME
authors.lastname: Rijnders
authors.affiliation: The Royal Dutch Organisation for Midwives, Utrecht, the Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Beuckens
authors.affiliation: Clinical Research Unit, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: B C
authors.initials: BC
authors.lastname: Opmeer
authors.affiliation: Department of Obstetrics and Gynecology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: B W J
authors.initials: BW
authors.lastname: Mol
authors.affiliation: Department of General practice/Medical Ethics, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: M C B
authors.initials: MC
authors.lastname: van Zwieten
authors.affiliation: Department of Obstetrics and Gynecology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Kok
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D001946:Breech Presentation / Q000451:nursing / Q000628:therapy*; D003144:Communication Barriers; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D009426:Netherlands; D057240:Patient Preference; D017410:Practice Guidelines as Topic; D057184:Practice Patterns, Nurses'; D011247:Pregnancy
keywords: Breech presentation; External cephalic version; Facilitators and barriers; Implementation