Planned Vaginal Breech Delivery Births - Choice Or Safety?

Main Category: Pregnancy / Obstetrics
Also Included In: Women's Health / Gynecology
Article Date: 01 Aug 2007 - 1:00 PDT

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Recent research has demonstrated that elective caesarean section for breech delivery at term is the safest option for most women. In the UK, 11% of all caesarean sections are performed as a result of breech presentation.

However, caesarean sections are not without risks for subsequent pregnancies including life threatening problems for mother and baby such as uterine scar dehiscence, placenta praevia or placenta accreta.

A new paper to be published in The Obstetrician & Gynaecologist ( TOG ) sets out the instances when vaginal breech births could be offered, instead of c-sections. As an alternative to caesarean sections, external cephalic version (ECV) can be carried out at 37 weeks to encourage the baby into a head-first position but obstetricians recommend that this is carried out only if there is immediate access to emergency caesarean section.

Women should be provided with full information of their options. The small risks of ECV include fetal distress and the onset of early labour. As a result, many women choose to undergo a caesarean section.

Retired Associate Professor of Obstetrics and Gynaecology at Johannesburg Hospital and the University of Witwatersrand, Basil van Iddekinge, who authored the paper, said "Since the 'Term Breech Trial' was published in the Lancet in 2000, elective caesarean section has been widely adopted as the delivery method of choice for women presenting with a persistent breech presentation at term. However, with longer follow-up of the children from this trial and with potential risks to mothers in future pregnancies being identified, it seems reasonable to offer women the option of a planned vaginal breech delivery at term provided strict selection criteria are met, delivery protocols are in place and experienced medical attendants are available for the delivery."

"Whether this option is offered or not, teaching of vaginal breech delivery (and external cephalic version - turning the baby from a breech to a head presentation in the womb) must continue to remain an integral part of the trainee programme otherwise this option will not be viable in the future. It is also inevitable that vaginal breech deliveries will still occur and these may be in emergency situations that will be more difficult to manage than planned term deliveries."

Professor Neil McClure, TOG editor-in-chief said, "The caesarean section rate in the UK is high, at 25%, which is above the World Health Organization's recommended rate of between 10-15%."

"Whilst we would promote normal birth, there are certain instances where caesarean sections are integral to ensuring a safe birth, and pregnancies where the baby is in a breech presentation is one such example. However, this does not mean that c-sections should always be offered as there are instances where breech delivery or ECV are viable options, provided the maternity unit and doctors have the support they need to help the mother deliver successfully."

The Obstetrician & Gynaecologist ( TOG ) is published quarterly and is the Royal College of Obstetricans and Gynaecologists' (RCOG) medical journal for continuing professional development. TOG is an editorially independent, peer reviewed journal aimed at providing health professions with updated information about scientific, medical and clinical developments in the specialty of obstetrics and gynaecology.

Reference

Van Iddenkinge B. Planned vaginal breech delivery: should this be the mode of delivery of choice?. The Obstetrician & Gynaecologist 2007;9:171 - 6.

Royal College of Obstetricians and Gynaecologists

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