{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T17:34:16Z","timestamp":1790789656320,"version":"4.1.0"},"reference-count":68,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2024,7,22]],"date-time":"2024-07-22T00:00:00Z","timestamp":1721606400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000071","name":"National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["R03HD096094"],"award-info":[{"award-number":["R03HD096094"]}],"id":[{"id":"10.13039\/100000071","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000071","name":"National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["R03HD096094"],"award-info":[{"award-number":["R03HD096094"]}],"id":[{"id":"10.13039\/100000071","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Objective<\/jats:title>\n<jats:p>Investigate maternal and neonatal outcomes associated with breech presentation in planned community births in the United States, including outcomes associated with types of breech presentation (i.e., frank, complete, footling\/kneeling)<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Design<\/jats:title>\n<jats:p>Secondary analysis of prospective cohort data from a national perinatal data registry (MANA Stats)<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Setting<\/jats:title>\n<jats:p>Planned community birth (homes and birth centers), United States<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Sample<\/jats:title>\n<jats:p>Individuals with a term, singleton gestation (N = 71,943) planning community birth at labor onset<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec005\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Descriptive statistics to calculate associations between types of breech presentation and maternal and neonatal outcomes<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec006\">\n<jats:title>Main outcome measures<\/jats:title>\n<jats:p><jats:italic>Maternal<\/jats:italic>: intrapartum\/postpartum transfer, hospitalization, cesarean, hemorrhage, severe perineal laceration, duration of labor stages and membrane rupture<\/jats:p>\n<jats:p><jats:italic>Neonatal<\/jats:italic>: transfer, hospitalization, NICU admission, congenital anomalies, umbilical cord prolapse, birth injury, intrapartum\/neonatal death<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec007\">\n<jats:title>Results<\/jats:title>\n<jats:p>One percent (n = 695) of individuals experienced breech birth (n = 401, 57.6% vaginally). Most fetuses presented frank breech (57%), with 19% complete, 18% footling\/kneeling, and 5% unknown type of breech presentation. Among all breech labors, there were high rates of intrapartum transfer and cesarean birth compared to cephalic presentation (OR 9.0, 95% CI 7.7\u201310.4 and OR 18.6, 95% CI 15.9\u201321.7, respectively), with no substantive difference based on parity, planned site of birth, or level of care integration into the health system. For all types of breech presentations, there was increased risk for nearly all assessed neonatal outcomes including hospital transfer, NICU admission, birth injury, and umbilical cord prolapse. Breech presentation was also associated with increased risk of intrapartum\/neonatal death (OR 8.5, 95% CI 4.4\u201316.3), even after congenital anomalies were excluded.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec008\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>All types of breech presentations in community birth settings are associated with increased risk of adverse neonatal outcomes. These research findings contribute to informed decision-making and reinforce the need for breech training and research and an increase in accessible, high-quality care for planned vaginal breech birth in US hospitals.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0305587","type":"journal-article","created":{"date-parts":[[2024,7,22]],"date-time":"2024-07-22T17:31:45Z","timestamp":1721669505000},"page":"e0305587","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":6,"title":["Maternal and neonatal outcomes associated with breech presentation in planned community (home and birth center) births in the United States: A prospective observational cohort study"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0938-7726","authenticated-orcid":true,"given":"Robyn","family":"Schafer","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marit L.","family":"Bovbjerg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa","family":"Cheyney","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6549-094X","authenticated-orcid":true,"given":"Julia C.","family":"Phillippi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,7,22]]},"reference":[{"key":"pone.0305587.ref001","volume-title":"National Vital Statistics System, Natality on CDC WONDER Online Database.","author":"Centers for Disease Control and Prevention, National Center for Health Statistics","year":"2023"},{"issue":"3","key":"pone.0305587.ref002","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1111\/birt.12288","article-title":"Perspectives on risk: assessment of risk profiles and outcomes among women planning community birth in the United States.","volume":"44","author":"ML Bovbjerg","year":"2017","journal-title":"Birth."},{"key":"pone.0305587.ref003","first-page":"779","volume-title":"Committee opinion no.","author":"ACOG Committee on Obstetric Practice","year":"2017"},{"issue":"1","key":"pone.0305587.ref004","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1111\/jmwh.12431","article-title":"Midwifery provision of home birth services.","volume":"61","author":"American College of Nurse-Midwives","year":"2016","journal-title":"J Midwifery Womens Health."},{"issue":"9239","key":"pone.0305587.ref005","doi-asserted-by":"crossref","first-page":"1375","DOI":"10.1016\/S0140-6736(00)02840-3","article-title":"(Term Breech Trial Collaborative Group). 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