Facilitators and barriers to external cephalic version for breech presentation at term among health care providers in the Netherlands: A quantitative analysis

Ageeth N. Rosman, Floortje Vlemmix, Antje Beuckens, Marlies E. Rijnders, Brent C. Opmeer, Ben Willem J. Mol, Marjolein Kok, Margot A.H. Fleuren

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Objective: guidelines recommend that external cephalic version (ECV) should be offered to all women with a fetus in breech presentation at term. However, only 50-60% of the women receive an ECV attempt. We explored the determinants (barriers and facilitators) affecting the uptake of the guidelines among gynaecologists and midwives in the Netherlands. Design: national online survey. Setting: the Netherlands. Participants: gynaecologists and midwives. Measurements: in the online survey, we identified the determinants that positively or negatively influenced the professionals[U+05F3] adherence to three key recommendations in the guidelines: (a) counselling, (b) advising for ECV, (c) arranging an ECV. Determinants were identified in a previously performed qualitative study and were categorised into five underlying constructs; attitude towards ECV, professional obligation, outcome expectations, self-efficacy and preconditions for successful ECV. We performed a multivariate analysis to assess the importance of the different constructs for adherence to the guideline. Findings: 364 professionals responded to the survey. Adherence varied: 84% counselled, 73% advised, and 82% arranged an ECV for (almost) all their clients. Although 90% of respondents considered ECV to be an effective treatment for preventing caesarean childbirths, only 30% agreed that 'every client should undergo ECV'. Self-efficacy (perceived skills) was the most important determinant influencing adherence. Key conclusions: self-efficacy appears to be the most significant determinant for counselling, advising and arranging an ECV. Implications for practice: to improve adherence to the guidelines on ECV we must improve self-efficacy.

Original languageEnglish
Pages (from-to)e145-e150
Issue number3
Publication statusPublished - 1 Jan 2014
Externally publishedYes


  • Determinants
  • External cephalic version
  • Guidelines
  • Implementation

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