A new study by researchers from the Netherlands finds that breech babies have a higher risk of death from vaginal delivery than elective Cesarean section.
Cesarean section (C-section) is a surgical procedure that involves delivering a baby through an incision made in the mother’s abdomen. Mothers can choose to have a C-section, or the procedure may be carried out in the event of unforeseen medical problems that may cause harm to the mother or infant.
If a baby is in a breech position for delivery – the infant’s buttocks or feet are in place to come out first instead of their head – a C-section may be performed to reduce the risk of subsequent complications. According to the American Pregnancy Association, 1 in every 25 full-term births is breech.
The research team – led by Dr. Floortje Vlemmix of the Department of Obstetrics and Gynecology at the Academic Medical Center, University of Amsterdam in the Netherlands – notes that C-section rates significantly increased after a 2000 study – named the Term Breech Trial – claimed C-sections dramatically reduce the risk of infant mortality among breech babies, compared with vaginal deliveries.
In the US, the rates of C-sections soared 60% between 1996 and 2009, from 20.7% of total births to 32.9%. The Netherlands saw C-section rates increase from 50% to 78% from 2000 to 2008.
In this latest study, results of which are published in the journal Acta Obstetricia et Gynecologica Scandinavica, Dr. Vlemmix and colleagues wanted to see how the rise in C-section rates has impacted neonatal outcomes from breech birth.
The team analyzed data from the Dutch national perinatal registry from 1999-2007. They identified 58,320 women who delivered singleton breech babies between 37 and 42 weeks’ gestation at hospitals in the Netherlands.
The researchers note that mothers who had stillbirths or whose infants had birth defects were excluded from the study.
Results of the study revealed that among these women, elective C-section rates increased from 24% in 1999 to 60% in 2007. This resulted in a reduction in neonatal mortality from 1.3 births in every 1,000 to 0.7 births in every 1,000, while no reduction was found among women who opted for a vaginal birth.
“Despite the lower percentage of women opting for or offered a vaginal delivery, and despite a higher emergency Cesarean rate during vaginal breech birth, neonatal outcome within the planned vaginal birth group did not improve,” they note.
Dr. Vlemmix says that regardless of evidence that C-sections improve neonatal outcomes for breech deliveries, 40% of women still choose to have a vaginal birth. Such deliveries, he says, result in a 10-fold higher neonatal mortality risk than elective C-sections.
“Our findings suggest there is still room for improvement to prevent unnecessary risk to the infant. We recommend using measures to turn the baby (external cephalic version) to prevent breech presentation at birth and counseling women who want to proceed with a vaginal breech birth.”
Despite the positive association with C-sections in this study, concerns have been raised surrounding the long-term risks of the procedure.
Earlier this year, Medical News Today reported on a study published in the journal PLOS ONE, which claimed babies delivered by C-section are more likely to be overweight as adults.
A more recent study, published in PLOS Medicine, suggested that having a C-section for a first birth may increase the risk of future stillbirth and ectopic pregnancy.