Choosing vaginal breech birth : discourses of breech birth in contemporary society

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[Aim] Most breech presenting babies are born by elective Caesarean section. Very few are born vaginally, with even fewer accounting for planned, rather than unplanned, vaginal birth. Despite maternity services in middle and high income countries offering limited support for planned vaginal breech birth, some women continue to seek this option for birth. Little is known about these women and how socio-cultural views impact on their decision-making for birth. The aims of this research were to understand how social discourse in contemporary society impact on women’s decisions for vaginal breech birth; explore how and why women make decisions for this birth option; and identify strategies for clinicians to support women considering vaginal breech birth. [Methods] A multi-methods study was undertaken in which four different approaches were employed to gather data for this project. The approaches were taken in four parts: 1) semi-structured interviews with 22 women who opted for a vaginal breech birth in Australia; 2) an international online survey of 204 women between April 2014 - January 2015 who sought a vaginal breech birth; 3) an analysis of internet forum discussions; and 4) a content analysis of online news media to explore how breech presentation and birth are portrayed. [Findings] Social discourse in contemporary society holds a strong belief that Caesarean section is the safe way to manage the birth of a breech baby. Planned vaginal breech birth has a limited profile in society and is seen as a high risk option. These views may be the result of limited clinical support for this birth option. Despite this resulting in anxiety for women when decision-making for this mode of birth, women seeking a vaginal breech birth feel strongly about bodily autonomy and their ability to give birth. They are able to transcend negative views of others and display a determination in finding supportive care for birth. These findings are presented in Chapters 4-8, which outline the results and conclusions arising from this study. [Conclusion and implications] Clinical recognition of vaginal breech birth as a legitimate option for women may address socio-cultural perceptions of risk relating to this birth option. Strategies to increase the profile of vaginal breech birth in clinical settings include the development of high level policy supporting this birth option, increasing availability of vaginal breech birth services and targeted training programs for clinicians. This in turn may normalise the option of vaginal breech birth in socio-cultural contexts and facilitate a more positive experience for women seeking this mode of birth.
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