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Cesarean Delivery Prevention: The Vaginal Breech Initiative at the George Washington University Hospital [116]

INTRODUCTION: Reducing the cesarean delivery rate is a national priority and performing vaginal breech deliveries can be one component of a cesarean delivery reduction strategy. Scientific evidence, professional recommendations, and consumer demand have all shifted to support vaginal breech delivery as an option to routine cesarean delivery for breech presentations. However, health care provider comfort and skill in this area are limited. At the George Washington University Hospital, we have established a Vaginal Breech Initiative to increase access to, and training in, the process of vaginal breech delivery. The Vaginal Breech Team, a collaborative care team composed of physicians and nurse–midwives experienced in vaginal breech, leads the Vaginal Breech Initiative. Components of the Vaginal Breech Initiative are careful antenatal screening and diagnosis, strict inclusion and exclusion criteria, rigorous informed consent, established delivery guidelines, and regular simulation training. METHODS: This is an observational report and data analysis of the vaginal breech labors and deliveries managed by a Breech Vaginal Team from 2011 to 2014. RESULTS: Preliminary outcome data from our first 18 patients attempting a vaginal breech delivery in the context of the Vaginal Breech Initiative demonstrate an 89% vaginal breech rate. CONCLUSION: Improving access to, and training in, vaginal breech at the George Washington University Hospital has contributed to reducing our cesarean delivery rate, increased patient satisfaction, and provided critical training and skills for our health care providers. Through careful diagnosis, patient selection, counseling, and collaboration, breech vaginal deliveries performed in the context of a Breech Vaginal Initiative are feasible in an academic medical center.