About 3 to 4% of fetuses are in a breech presentation at the end of pregnancy. In addition to that, in twin pregnancies, a breech presentation of the second twin is not uncommon.

In Portugal, until less than a decade ago, these births were frequently vaginal. Nowadays however, this practice varies among different hospitals and in almost all of them women are not given this option, and a caesarean section is booked.

Even when institutions have a policy of scheduling caesarean sections in cases where the fetus is presenting breech, unexpected situations cannot be ruled out and the opportunity and experience for professionals in attending these births should not disappear.

Both the American College of Obstetricians and Gynecologists – ACOG (‘Mode of Term Singleton Breech Delivery’, published in 2006 and reaffirmed in 2016), and the Royal College of Obstetricians and Gynecologists – RCOG (‘Management of Breech Presentation’; published in 2017 ) consider that a planned breech vaginal delivery is a valid option within appropriate clinical criteria and that the decision regarding the breech option should take into account the informed consent of the pregnant woman and the experience of the health professional.

A review on this subject was also published recently in the Portuguese Obstetrical and Gynecological Act, which concluded that, in the absence of contraindications for a vaginal breech delivery, the pregnant womanshould be informed of the risks and benefits of the two possible modes of delivery, and consent must be obtained (Ferreira A, Ayres-de- Campos D. ‘Pelvic vaginal delivery – a clinical option at the present time?’. Acta Obstet Ginecol Port 2016;10(2):142-147).

Thus, the essential components of a planned vaginal breech delivery are the appropriate selection of cases, their management according to a rigorous protocol and the availability of qualified professionals.

In addition to situations of planned vaginal breech deliveries, it´s worth noting that this knowledge is also necessary for assisting a woman that may arrive in hospital in an advanced laboring stage with a baby presenting breech. International societies are consensual: all maternity care institutions should be able to provide specialized assistance for a vaginal breech birth when a woman is admitted to hospital in an advanced laboring stage.

In regards to twin pregnancies, assistance in the case of a breech presentation may also be required. It is not recommended that a caesarean section be performed when the second twin is not in cephalic position. Thus, after the birth of a first cephalic infant, assistance in a vaginal breech delivery (ACOG, October / 2016) may be required.

The Gynecology / Obstetrics Specialty College considers the breech vaginal delivery is an important technical skill for the professional performance of the specialty, and its training program in Gynecology and Obstetrics dictates that all students must perform at least 5 breech deliveries during their training.

Since vaginal breech birth is currently a rare occurrence, it is important to train with biomedical simulators.

Thus, we conclude that training in breech deliveries are paramount to the improvement of care in Portuguese maternity services, especially in situations of hospital admission during the second stage of labour, informed refusal of the pregnant woman to undergo caesarean section or second-stage breech delivery of a second twin.



By the end of this training delegates should be able to:

  • Know the history of the breech vaginal delivery and the reasons for its near disappearance
  • Understand the theory of the breech foetal position
  • Know the selection criteria for a safe vaginal breech delivery
  • Understand the physiology of a breech delivery and positions to optimize labour and birth
  • Recognize possible complications of a breech delivery and learn maneuvers for its resolution



Dr. Stuart J. Fischbein is an obstetrician /gynecologist in Los Angeles, fellow of the American College of Obstetricians and Gynecologists and author of ‘Fearless Pregnancy, Wisdom & Reassurance from a Doctor, A Midwife and a Mom’; With more than 30 years of professional experience, his main field of work has been the care of women in vaginal breech, vaginal twin and vaginal birth after caesarean deliveries.



  • Obstetrician-gynecologist specialists / students
  • Nurse Midwives / Student Midwives



May 18th 2018

Hospital Garcia de Orta

Class A – 9:00 am to 12:30 pm

Class B – 2:00 pm to 5:30 pm


May 21st 2018

Centro Hospitalar Póvoa de Varzim – Vila do Conde

Class A – 9:00 am to 12:30 pm

Class B – 2:00 pm to 5:30 pm


::: Training in English. Maximum 15 delegates per group, to ensure that everyone undergoes the hands-on module. Register to guarantee your place :::



18th May – Hospital Garcia de Orta (HGO)

  • Workers from HGO: 75€
  • Workers from other institutions: 100€

Register here: (please copy and paste the url of the new on to a new browser window)


21st May – Centro Hospitalar Póvoa de Varzim – Vila do Conde (CHPVVC)

  • Workers from CHPVVC: 75€
  • Workers from other institutions: 100€

Fill in this form to register: (please copy and paste the url of the new on to a new browser window)