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VAGINAL BREECH DELIVERY : BIRTH PLAN & CONSENT FORM Primary Care provider (OB, FP or RM): Consenting Obstetrician: Reviewed by Attending Obstetrician(s) in labor: (name of OB if care transferred at
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How to fill out consent for normal delivery

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How to fill out consent for breech delivery:

01
Obtain the consent form: The first step is to ensure that you have the appropriate consent form for breech delivery. This form may be provided by your healthcare provider or hospital.
02
Read the form carefully: Take the time to read the consent form thoroughly. Pay close attention to the information provided, including the risks and potential complications associated with breech delivery.
03
Seek clarification: If you have any questions or concerns about the consent form, don't hesitate to seek clarification from your healthcare provider. It's essential to fully understand what you are consenting to.
04
Complete the form accurately: Fill out the consent form accurately and honestly. Provide all the requested information, including your name, contact details, and any relevant medical history.
05
Discuss your decision with your healthcare provider: Before signing the consent form, it's important to have a discussion with your healthcare provider. They can provide you with additional information about breech delivery and answer any further questions you may have.

Who needs consent for breech delivery:

01
Pregnant individuals: If you are expecting a baby and have been diagnosed with a breech presentation, you will need to provide consent for a breech delivery. This is to ensure that you are fully informed about the procedure and its potential risks.
02
Healthcare providers: Healthcare providers, including doctors, midwives, and nurses, also require consent for breech delivery. They need to ensure that you understand the risks and implications of this delivery method before proceeding.
03
Hospital or birthing facility: In some cases, the hospital or birthing facility where the delivery will take place may also require consent. This is to ensure that they have a record of your informed decision and can provide the necessary care.
In summary, anyone involved in the breech delivery process, including pregnant individuals, healthcare providers, and the hospital or birthing facility, may require consent. It is important to carefully read and fill out the consent form for breech delivery to ensure you are fully informed and understand the potential risks involved.
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Some factors that may contribute to a fetus being in a breech presentation include the following: You have been pregnant before. There is more than one fetus in the uterus (twins or more). There is too much or too little amniotic fluid.
Most women will never have the option to decide what they want to do when faced with a breech baby. A planned cesarean section is performed for 94% of all breech babies. If your provider is an OB, DO, or hospital CNM, you most likely will not be given a choice.
-No contraindication to vaginal birth (see below) -Estimated fetal weight at least 2500 g and not more than 4000 g -Gestational age 36 weeks or more -No hyperextension of the fetal head (i. e., an extension angle of greater than 90 degrees) -Frank or complete breech presentation (incomplete breech presentation is a
However, in the case of a breech baby, the pelvis or hips are delivered first and the mother's pelvis may not stay large enough for the fetal head that follows. The baby's head can therefore get stuck in the birth canal, which results in serious complications that can cause serious injury or even death for the baby.
Induction of labor for breech presentation does not seem to increase neonatal mortality or severe neonatal morbidity compared with planned cesarean delivery.
Criteria for a planned vaginal breech birth Documented evidence of counselling regarding mode of birth. Documentation of informed consent, including written consent from the woman. Estimated fetal weight of 2500-4000g. Flexed fetal head. Emergency theatre facilities available on site.

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Consent for breech delivery is an agreement between the healthcare provider and the patient (or patient's guardian) that outlines the risks, benefits, and alternatives associated with delivering a baby in a breech position, where the baby is positioned feet or buttocks first instead of head first.
Typically, it is the responsibility of the healthcare provider, such as an obstetrician or midwife, to obtain and file consent for breech delivery. The patient or guardian must also sign the consent form.
To fill out consent for breech delivery, the healthcare provider should clearly explain the procedure to the patient, document the discussion of risks, benefits, and alternatives, and have the patient sign the consent form. All relevant details should be filled out, including patient's name, date, type of delivery, and acknowledgment of understanding.
The purpose of consent for breech delivery is to ensure that the patient is fully informed about the potential risks and benefits of proceeding with the delivery in a breech position, and to ensure that they agree to the procedure based on that understanding.
The consent form for breech delivery must report information including the patient's name, the procedure being consented to, an explanation of the breech presentation, potential risks (such as delivery complications), benefits of proceeding, alternatives to breech delivery (like cesarean section), and the signatures of both the healthcare provider and the patient.
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