Patient’s willingness to opt for external cephalic version

Abstract

Objective: External cephalic version (ECV) is a relatively simple and safe maneuver that reduces the cesarean section (CS) rate for breech presentation. There is professional consensus that ECV should be offered to all women, but only up to 70% of patients opt for this treatment. To improve counseling, we investigated the value patients place on various aspects of ECV.

Methods: We studied patient preferences by means of a vignette study. Varying levels of treatment characteristics were investigated in 16 scenarios, all including the “opt out” alternative of an elective CS. The probability that women preferred ECV was estimated using a logistic regression approach.

Results: Forty seven women participated in the study. Pain was the most important factor negatively influencing the willingness to opt for ECV (OR 0.11 (95% confidence interval (CI) 0.05–0.23) for a pain score of 8–10 compared to 1–2 on a visual analog scale of 0–10). Higher success rates of vaginal delivery after successful ECV increased women’s willingness (OR 3.42 (95% CI 2.04–5.74), if chance of vaginal delivery after successful ECV increased from 24% to 52%). The risk of an emergency CS during ECV did not influence the willingness to opt for ECV (OR 0.83 (95% CI 0.59–1.18) of chance increased from 0% to 1%).

Conclusions: We conclude that expected pain during treatment and the success rate are the most important factors influencing the willingness to undergo ECV. Taking this information into account when counseling for ECV and reassuring women that unbearable pain is always a reason to stop ECV, and that the vast majority of women reported that the experienced pain is bearable, might improve the uptake of ECV and decrease the number of CS due to breech presentation.

• Breech presentation
• external cephalic version
• patients’ preference
• vignette study

Acknowledgements

We would like to thank all gynecologists, midwives and patients in the contributing hospitals for their participation in this study.

Current knowledge on this subject

• ECV is the only treatment for women to achieve the safest route of delivery: cephalic vaginal delivery. A substantial proportion (up to 30%) of women rejects ECV. During counseling it is essential to first explore patient’s fears in order to get the message of the importance of a treatment across.

What this study adds

• This study provides information about the most important factors of ECV on which women decide to undergo or reject ECV. This information can be used during counseling in order to tailor information better according to a patient’s needs. This can improve the number of women willing to undergo ECV and therefore reduce the number of CSs due to breech position.