Samenvatting

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׳ 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.