Optimal management of breech deliveries

In Germany in 2021, around 3.9% of all singleton pregnancies at term were registered as breech presentations. In comparison between vaginal delivery and primary cesarean section in breech position, the short-term neonatal outcome seems somewhat worse in cases of vaginal delivery, whereas long-term outcomes are comparable. In contrast, maternal morbidity is increased in cesarean section compared to vaginal delivery of breech babies. A proportional fetal thorax-to-head ratio represents a favorable condition for vaginal breech delivery. Contraindications are fetal intrauterine growth retardation, pathological cardiotocography (CTG), or an abnormality of the maternal pelvis, but not a previous cesarean section. Induction of labor, epidural anesthesia, and oxytocin infusion are all possible in breech deliveries, but the indication should be set strictly. The pregnant woman should be offered a choice of birthing position, either lithotomy position or on all fours, as long as delivery shows progress. To be able to carry out vaginal breech deliveries at a hospital, regular training of the whole interdisciplinary team as well as appropriate clinical structures are prerequisite.