How should I counsel a patient with a breech presentation regarding the risks and benefits of vaginal delivery versus cesarean section?

When counselling a patient with a breech presentation about the risks and benefits of vaginal delivery compared to cesarean section, first discuss all available options, including external cephalic version, planned vaginal breech birth, and elective caesarean birth, explaining their benefits, risks, and implications ¹.

Explain that vaginal breech birth carries certain risks such as potential for fetal injury or complications during labour, but may be preferred by some women depending on their circumstances and preferences ¹,².

Elective caesarean section generally reduces the risk of complications related to breech vaginal birth, such as birth trauma, but it also carries surgical risks including infection, bleeding, thromboembolism, and implications for future pregnancies like placental adherence problems ².

Inform the woman that external cephalic version is an option to attempt to turn the baby to a head-down position after 36+0 weeks, which may reduce the need for caesarean section ¹,².

Use clear, individualised, and evidence-based information tailored to the woman’s needs and preferences, ensuring she understands the risks and benefits and has the opportunity to ask questions and make an informed decision ¹,².

Respect the woman’s decision, even if it differs from the healthcare professional’s view, and provide ongoing support throughout her care ¹.