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. 2025 May 22;24(1):582.
doi: 10.1186/s12912-025-03220-8.

Strategies to reduce cesarean deliveries: surveying Polish midwives and midwifery students on external cephalic version practices

Maisa Manasar-Dyrbuś  1 , Anna Janik  2 , Cecylia Jendyk  3 , Agnieszka Drosdzol-Cop  3 , Anna Brzęk  4 , Rafał Stojko  3 , Jakub Staniczek  3
Affiliations

Strategies to reduce cesarean deliveries: surveying Polish midwives and midwifery students on external cephalic version practices

Maisa Manasar-Dyrbuś et al. BMC Nurs. .

Abstract

Objectives: This study aimed to evaluate the knowledge and experiences of Polish midwives regarding the external cephalic version (ECV), as well as to examine their practices related to this procedure and the perceived barriers to its implementation.

Materials and methods: A cross-sectional, online survey was conducted using a 22-item questionnaire developed by the authors. The survey targeted midwives and midwifery students, collecting demographic data, professional experiences, and detailed responses about knowledge, practices, and perceptions related to ECV.

Results: Among 535 respondents, nearly one-third were midwifery students, and the rest were professional midwives (mainly with a master's degree). ECV was performed in over a quarter of respondents' workplaces, with 40% reporting personal experience with the procedure. Support for ECV in primiparas was highest among students and midwives with a master's degree, and lowest among those with a bachelor's. A similar pattern was observed in multiparas, with elective cesarean section more often chosen by bachelor 's-level midwives and least by students (p < 0.001). Less experienced midwives more frequently expressed concerns about complications and emergency cesarean delivery. Cesarean section was preferred in outpatient and prenatal class settings, while ECV was favored in clinical and district hospitals. Regardless of experience, the majority recognized the need for ECV training, with the strongest support among students (90.4%, p = 0.031).

Conclusions: The study highlights moderate awareness and limited experience with ECV among Polish midwives. The findings emphasize the necessity of structured educational programs to improve competency and confidence in ECV, particularly in outpatient and prenatal classes.

Clinical trial number: Not applicable.

Keywords: Breech presentation; Delivery; External cephalic version; Midwives.

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Conflict of interest statement

Declarations. Ethics, consent to participate, and consent to publish declarations: This procedure was approved by the Chair and Clinical Department of Gynecology, Obstetrics and Oncological Gynecology Review Board, Faculty of Health Sciences in Katowice, Medical University of Silesia in Katowice of Silesia on 10.04.2024 (Ref. NGP/23/2024). All participants were made aware that their submission of responses constituted an agreement to participate. Study was conducted using the principles of medical research ethics, including the Declaration of Helsinki. All personal data were securely protected and were not shared outside the participating research center. According to Polish law, including Article 21 of the Act on the Profession of a Physician (Journal of Laws 2021, item 790), this study did not meet the definition of a medical experiment. It, therefore, did not require approval or a waiver of consent from a bioethics committee, as it was based solely on medical records without patient involvement or additional procedures. It also did not meet the criteria for a clinical trial under Regulation (EU) No 536/2014. Participation in the study was entirely voluntary, and informed consent was implied by accessing the provided link and completing the survey. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Concerns of midwives regarding the external cephalic version (ECV) procedure based on years of professional experience (S-Students; <5 years; 5–20 years; >20 years). Responses were rated on a 5-point Likert scale; bars represent mean ± SD. Higher scores indicate greater concern
Fig. 2
Fig. 2
Concerns of the medical staff regarding the external cephalic version (ECV) procedure depending on education level (S-Student; B-Bachelor degree; M-Master degree). Responses were rated on a 5-point Likert scale; bars represent mean ± SD. Higher scores indicate greater concern
Fig. 3
Fig. 3
Midwives’ concerns regarding the external cephalic version (ECV) procedure are based on the hospital’s referral level. (I-Ist level; IInd level; IIIrd level). Responses were rated on a 5-point Likert scale; bars represent mean ± SD. Higher scores indicate greater concern
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