Sunday, September 26, 2010
Title: Risk Factors for Breech Presentation: Eastern and Western Paradigms Compared and Contrasted
Caroline Peterson, DC, CPM, PhD, MPH
,
Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR
Discipline: Childbearing (CB)
Learning Objectives:
- Critically appraise the literature on risk factors for breech presentation.
- Describe the range of possibilities for effectively managing breech presentation in pregnancy.
- Weigh the risk attributable to Eastern and Western risk factors for breech presentation for an individual.
Submission Description:
Breech presentation occurs in 2-4% of all pregnancies and is associated with increased neonate morbidity and mortality. While the incidence of breech presentation appears to be similar cross-culturally, the West and East have strikingly different explanatory models for its occurrence. The West posits breech presentation is due to a mechanical problem on the part of the mother or the baby. The East posits breech presentation is due to impaired psycho-social-cultural relationships. In this presentation the published evidence for each paradigm is reviewed and original data from The Breech Baby Study are presented followed by evidence for clinical intervention.The Breech Baby Study was a mixed-methodology case-control study. The quantitative component compared mothers of breech babies with mothers of cephalic presentation babies using five years of Florida birth certificate and Medicaid/WIC eligibility linked data. The data were evaluated with logistic regression to determine the explanatory power of the risk factors associated with the Western model of risk. The model was poorly fit and accounted for less than five percent of the total variance.The qualitative component of the study included 114 women who had a baby in the past year. These women completed a socio-demographic survey. Seventy-five (52 mothers of cephalic presentation babies and 23 mothers of breech presentation babies) of these women also completed a two hour in-depth semi-structured interview about experiences from early childhood, peri-conception, pregnancy, birth, and the post-partum. While mothers of breech babies loved their baby no less and experienced no more stress than did mothers of cephalic presentation babies, personality characteristics and coping styles were different for the two groups of mothers. Mothers of breech presentation babies were idealistic and tended to be highly analytical, very busy, and fearful of pregnancy outcomes or parenting. They also tended to lack the coping mechanisms of flexibility and pragmatism. These findings supported the Eastern model of breech presentation. In the final stage of qualitative data analysis, findings from the study were compared with attachment theory. Parenting characteristics of mothers of breech presentation babies were found to be similar to those exhibited in ambivalent attachment.In the final section of the presentation Western, Eastern, and syncretic models for turning breech babies are presented and the level of evidence for their effectiveness is discussed. These approaches include external cephalic version, moxibustion, Webster’s technique, neuro-emotional technique, homeopathy, and positional guidelines.
