Cuidados de la matrona en la versión cefálica externa / Midwife care in external cephalic version

La versión cefálica externa (VCE) es una maniobra obstétrica que intenta convertir una presentación fetal podálica o transversa en cefálica, más favorable de cara al parto. La matrona, como parte del equipo multidisciplinar, está presente durante el proceso de su realización, aplicando los cuidados necesarios para una atención integral de la mujer gestante. El objetivo de este artículo es presentar el caso clínico de una mujer embarazada durante el procedimiento de VCE. Se elabora el plan de cuidados enfermeros basado en las necesidades básicas de Virginia Henderson y guiado por la taxonomía NANDA-NIC-NOC, donde se identifican tres diagnósticos de Enfermería, que serán la base de la realización de este proceso enfermero: temor, dolor agudo y riesgo de alteración de la díada materno/fetal. La aplicación de este plan de cuidados supuso una mejora en la atención a la mujer y en la organización del trabajo

External cephalic version (ECV) is an obstetric manoeuvre intended to change a breech or transversal fetal presentation into cephalic, more favourable in terms of delivery. The midwife, as a member of the multidisciplinary team, will be present during this procedure, implementing any necessary measures for a comprehensive care of the pregnant woman. The objective of this article is to present the clinical case of a pregnant woman during the ECV procedure. The nursing care plan is prepared on the basis of Virginia Henderson’s basic needs, and guided by the NANDA-NIC-NOC taxonomy, where three nursing diagnoses will be identified as the basis for conducting this nursing process: fear, acute pain and risk of alteration of the maternal/fetal dyad. The application of this healthcare plan represented an improvement in women care and work organization

Physiological breech birth. Evaluation of a training programme for birth professionals.

This article evaluates the results of physiological breech birth (PBB) study days provided by breech Birth Network (BBN). An expanded version of this article, with further details including the statistics and additional information about the content of the training, is available on our website. This paper reports an evaluation of the BBN PBB training programme, which has been developed out of consensus research, with highly experienced health professionals. The training was delivered in four National Health Service trust hospitals in the north and south of England throughout the spring and summer of 2016. The evaluation involved pre- and post-training surverys containing a mixture of open-ended and multiple-choice questions, and rating scales. Data were analysed descriptively. The results indicated that the training addressed the concernsof the participants and was rated highly in expected usefulness for practice. Significant improvements in self-reported confidence and objectively assessed knowledge were observed. Participants found discussions and hands-on practice accompanying videos helpful, and reported concerns about lack of support and involvement of obstetric colleagues both before and after the training. The package is an effectively designed and replicable programme for introducing PBB practice to health care professionals.

1. Vaginal breech birth--the phoenix arising from the ashes.

Vaginal breech birth all but disappeared from UK maternity units after the publication of the Term Breech Trial (Hannah et al 2000). However, mounting evidence does not support caesarean section as the safest mode of birth for the baby or the mother when the baby is presenting breech. But the intervening years have depleted the attending professional's skills. We describe our personal journey to regaining them, learning better ones and introducing safe choice for women. This article is the first in a series which examines the practice and evidence base for the care of women and babies aspiring to experience a safe breech birth.

Facilitators and barriers to external cephalic version for breech presentation at term among health care providers in the Netherlands: a quantitative analysis.

OBJECTIVE: guidelines recommend that external cephalic version (ECV) should be offered to all women with a fetus in breech presentation at term. However, only 50-60% of the women receive an ECV attempt. We explored the determinants (barriers and facilitators) affecting the uptake of the guidelines among gynaecologists and midwives in the Netherlands. DESIGN: national online survey. SETTING: the Netherlands. PARTICIPANTS: gynaecologists and midwives. MEASUREMENTS: in the online survey, we identified the determinants that positively or negatively influenced the professionals׳ adherence to three key recommendations in the guidelines: (a) counselling, (b) advising for ECV, (c) arranging an ECV. Determinants were identified in a previously performed qualitative study and were categorised into five underlying constructs; attitude towards ECV, professional obligation, outcome expectations, self-efficacy and preconditions for successful ECV. We performed a multivariate analysis to assess the importance of the different constructs for adherence to the guideline. FINDINGS: 364 professionals responded to the survey. Adherence varied: 84% counselled, 73% advised, and 82% arranged an ECV for (almost) all their clients. Although 90% of respondents considered ECV to be an effective treatment for preventing caesarean childbirths, only 30% agreed that 'every client should undergo ECV'. Self-efficacy (perceived skills) was the most important determinant influencing adherence. KEY CONCLUSIONS: self-efficacy appears to be the most significant determinant for counselling, advising and arranging an ECV. IMPLICATIONS FOR PRACTICE: to improve adherence to the guidelines on ECV we must improve self-efficacy.

3. Undiagnosed breech--part of midwifery practice.

This article discusses the background to undiagnosed breech and what a midwife can do to support a woman who is giving birth to a baby in an undiagnosed breech presentation. There is no evidence to support the use of emergency caesarean section when a breech is diagnosed in labour and it is a requirement of the Nursing and Midwifery Council rules and standards that registered midwives should have been taught, pre-registration, how to assist an undiagnosed breech presenting baby to be born.

Patients' and professionals' barriers and facilitators to external cephalic version for breech presentation at term, a qualitative analysis in the Netherlands.

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. DESIGN: qualitative study with semi-structured interviews. SETTING: Dutch hospitals. PARTICIPANTS: pregnant women with a breech presentation who had decided on ECV, and midwives and gynaecologists treating women with a breech presentation. MEASUREMENTS: 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). FINDINGS: 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. CONCLUSION: 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.

Determinants of pain perception after external cephalic version in pregnant women.

OBJECTIVE: A considerable proportion of pregnant women with a fetus in breech position refuses external cephalic version (ECV), with fear of pain as important barrier. As a consequence, they are at high risk for caesarean section at term. The current study investigated determinants of pain perception during ECV, with special attention to maternal mental state such as depression and fear of ECV. DESIGN: Prospective study of 249 third-trimester pregnant women with breech position with a request for an ECV attempt. SETTING: Department of Obstetrics and Gynaecology in a large teaching hospital in the Netherlands. METHODS: Prior to the ECV attempts, obstetric factors were registered, participants fulfilled the Edinburgh Depression Scale (EDS) and reported fear of ECV on a 10-point visual analog scale. Perception of pain intensity was measured with a 10-point visual analog scale, immediately after ECV. FINDINGS: Multivariate linear regression analyses showed success of ECV to be the strongest predictor of pain perception. Furthermore, scores on the depression questionnaire and degree of fear of ECV independently explained pain perception, which was not the case for obstetrical or ECV related factors. CONCLUSION: Apart from ECV outcome, psychological factors like depression and fear of ECV were independently related to pain perception of an ECV attempt. IMPLICATION FOR PRACTICE: Maternal mood state should be taken into account when offering an ECV attempt to women with a fetus in breech position. Due to the painful experience and the importance of successful outcome, ECV should only be attempted in institutions with experienced practitioners and with careful attention to maternal mood and the way a woman is coping with the ECV attempt.