Non-clinical determinants of planned cesarean delivery in cases of term breech presentation in France

Background. To explore non-clinical maternal and institutional factors associated with the decision for planned cesarean in cases of breech presentation at term in France, where planned vaginal delivery are recommended by the French College of Gynecologists and Obstetricians ( CNGOF) when conditions are optimal. Methods. The analysis included 6,080 women with a live fetus in breech presentation at term, from the PREMODA prospective survey, in 138 French maternity units between 1 June 2001 and 31 May 2002. Women with previous cesarean sections were excluded. The analysis to identify risk factors for planned cesarean used a multilevel logistic model. Results. The planned cesarean rate was 63.5%. The maternal factors most strongly associated with a decision for planned cesarean were parity ( adjusted OR: 2.56 ( 2.29 - 2.88)) and maternal age >= 35 years ( ORa: 1.38 ( 1.18 - 1.61)). No association was found between institutional factors, such as maternity size and level of care, although a centre effect was documented ( p < 0.001). Conclusion. The variation in planned cesarean rates between maternity units was not associated with their structural characteristics, but was related to a characteristic specific to each centre, and, thus, suggests that despite the current guidelines in France, obstetricians have diverse opinions about the best mode of delivery for breech presentations.