Mushka Kaye, Fanglong Dong PhD, Dayna Grundy, Megan Economidis MD, Hindi Stohl MD, JD

Introduction:

Breech presentation at term is an abnormal presentation of the fetus. While a breech fetus can be delivered via cesarean or corrected through an external cephalic version, a frank breech fetus may be delivered vaginally under appropriate circumstances. Providers trained in vaginal breech delivery can offer the service directly, while those unable to should counsel patients about their options. As future OB providers, medical students should be exposed to all delivery options and learn comprehensive patient counseling. However, variance remains in clinical approaches and exposures for students regarding frank breech delivery at term.

Methods:

This IRB-approved survey included 59 clinical preceptors in Oregon and California affiliated with WesternU, and 328 medical students who had completed their OB-GYN rotations. Three waves of invitations were sent for survey completion, focusing on perceptions of risks associated with term frank breech delivery.

Results:

The response rates were 17% for clinical faculty and 12% for students. None of the clinicians offered VBD, citing fetal risk as the primary reason, with 40% noting a lack of training and 10% citing medical-legal liabilities. In contrast, almost 15% of students considered recommending VBD at term. Less than half the students believed VBD posed significant fetal risk, while 18% thought VBD carried greater risk for the mother than cesarean delivery.

Conclusion:

We found hesitation among clinicians to offer planned VBD, while students showed more openness to varied options. Assessing perceptions of risks associated with term frank breech delivery in environments like UCLA-Ronald Reagan Medical Center, with its large number of faculty, residents, and students, allows for focused education and training. Understanding sources of resistance or openness to VBD among clinicians and students can inform targeted education, aligning clinical practice with evolving guidelines.