I think one of the issues it is that whatever people have experience in, will then be self-perpetuating...so, in the RCOG guidelines it gives the nod towards non-dorsal positions as an alternative, but then says that experience is in dorsal/lithotomy therefore....
Several authors have recommended use of upright postures to improve outcomes of vaginal breech birth. However, no studies documenting the effectiveness of this strategy have been found, to justify departure from conventional postures with which most practitioners are familiar. |
I do see why practitioners who are not persuaded by upright positions (on basis of 'no evidence, no experience') are reluctant to go with that. The only solution is really to have more education/training - and including medics - on upright positions for breech, and to have them properly audited too. (You would never get a research trial past the ethics committee, given that CS is recommended for breech currently...unless perhaps you randomized women who positively wanted vaginal breech, and then you might have difficulty recruiting sufficient numbers to really compare the two approaches.)