title: Does breech delivery in an upright position instead of on the back improve outcomes and avoid cesareans?
abstract: OBJECTIVE
  To compare breech outcomes when mothers delivering vaginally are upright, on their back, or planning cesareans.
  
  
  METHODS
  A retrospective cohort study was undertaken of all women who presented for singleton breech delivery at a center in Frankfurt, Germany, between January 2004 and June 2011.
  
  
  RESULTS
  Of 750 women with term breech delivery, 315 (42.0%) planned and received a cesarean. Of 269 successful vaginal deliveries of neonates, 229 in the upright position were compared with 40 in the dorsal position. Upright deliveries were associated with significantly fewer delivery maneuvers (OR 0.45, 95% CI 0.31-0.68) and neonatal birth injuries (OR 0.08, 95% CI 0.01-0.58), second stages that were 42% shorter on average (1.02 vs 1.77 hours), and nonsignificantly decreased serious perineal lacerations (OR 0.34, 95% CI 0.05-3.99). When upright position was used almost exclusively, the cesarean rate decreased. Serious fetal and neonatal morbidity potentially related to birth mode was low, and similar for upright vaginal deliveries compared with planned cesareans (OR 1.37, 95% CI 0.10-19.11). Three neonates died; all had lethal birth defects. Forceps were never required.
  
  
  CONCLUSIONS
  Upright vaginal breech delivery was associated with reductions in duration of the second stage of labor, maneuvers required, maternal/neonatal injuries, and cesarean rate when compared with vaginal delivery in the dorsal position.
authors.affiliation: Department of Obstetrics and Gynaecology, Johann Goethe-University Klinikum, Frankfurt, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Louwen
authors.affiliation: Department of Obstetrics and Gynaecology, The Montfort Hospital and The Ottawa Hospital, Ottawa, ON, Canada.
authors.forename: Betty-Anne
authors.initials: BA
authors.lastname: Daviss
authors.affiliation: School of Epidemiology, Public Health and Preventive Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
authors.forename: Kenneth C
authors.initials: KC
authors.lastname: Johnson
authors.affiliation: Department of Obstetrics and Gynaecology, Johann Goethe-University Klinikum, Frankfurt, Germany.
authors.forename: Anke
authors.initials: A
authors.lastname: Reitter
mesh_terms: D000328:Adult; D001720:Birth Injuries / Q000453:epidemiology*; D001946:Breech Presentation / Q000145:classification / Q000453:epidemiology*; D002585:Cesarean Section / Q000706:statistics & numerical data*; D016208:Databases, Factual; D005260:Female; D005858:Germany; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D007748:Labor Stage, Second; D007744:Obstetric Labor Complications / Q000453:epidemiology*; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D047929:Term Birth
keywords: Breech delivery; Cesarean delivery; Delivery mode; Second stage of labor; Vaginal breech delivery; Vaginal delivery