Breech delivery is a very controversial topic in the birth world here in the United States.. I recently read an article(*1) from a Dr speaking about her own experience of having a breech baby. She shares so many of the common concerns that expecting women have when they find out their baby may be or is for a fact breech. These feelings include fear, worry, doubt in their body’s ability to birth naturally, and the list goes on and on. The women in this case who have had natural healthy vaginal deliveries before feel conflicted because they are hearing a Dr telling them vaginal birth is too risky but this woman believes in her body and in her gut instinct and she believes her body is more than capable. What is this woman to do when her Dr is telling her vaginal birth is not an option? The reality is that women are not being fully informed on the true risks and benefits of the vaginal option with their breech baby and this must change! Providers need to start having an open and true informed discussion with their patients about the real risks of both vaginal birth and Cesarean section delivery. All too often women find that they do not even have an option, if their baby is breech they are required to have a c-section. Is this the best option? Is this really safer for mom and baby? Let us open up the discussion to find out what is really behind this controversy.
In the year 2000 there was a clinical trial called the Term Breech Trial (*2) and they came to the conclusion that c-section was safer and therefore ACOG recommended routine surgical deliveries for all breech babies. Let us dig deeper into this trial. In this trial there were 2083 participants. 1041 planned c-sections and 1042 planned vaginal birth. Of the 1042 planning a vaginal birth only 591 actually delivered vaginally which is about a 57% rate of the total who attempted it. (The c-section rate(*3) in this country overall is 32% on average.) Of the 1042 babies who were either born vaginally or planned a vaginal birth but ended up with a c-section, a poor outcome(either trauma or death) occurred 52 times or 5% of the time. Of the planned c-sections this occurred 17 out of 1042 or 1.7% of the time.
This can seem as if it is a clear cut case. Let us now examine the rate of maternal death or severe trauma. In the planned c-section group this happened 41 out of 1042, 3.9% and of the planned vaginal deliveries it occurred 33 out of 1042, 3.2%.
So the risk to the mothers is pretty much the same between those who had vaginal birth and those who had a planned c-section.
However, we really need to dig deeper into these results. Some of the babies born vaginally died of circumstances that had nothing to do with the route of delivery. Specifically, 2 of the vaginal birthed babies died of infection that began several days after delivery, not at all associated with their mode of delivery. Another investigation(*4) into the Term Breech Trial done 2 years later states “Most of the children with serious neonatal morbidity after birth survived and developed normally. In this cohort, 17 out of 18 children with serious morbidity in the original study were normal at this 24-month follow-up. Another explanation is that the use of pooled mortality and morbidity data at the time of birth overstated the true long-term risks of vaginal delivery.”
Based on the few follow up trials done, beginning in 2002, ACOG went on to change their statement on vaginal breech birth and are now in support of informed consent! This is exactly what they say right on their own website published in June 2006: “Since that time, there have been additional publications that modify the original conclusions of the 2000 Term Breech Trial. The same researchers have published three follow-up studies examining maternal outcomes at 3 months postpartum, as well as outcomes for mothers and children 2 years after the births.” “There are many retrospective reports of vaginal breech delivery that follow very specific protocols and note excellent neonatal outcomes. One report noted 298 women in a vaginal breech trial with no perinatal morbidity and mortality. Another report noted similar outcomes in 481 women with planned vaginal delivery. Although they are not randomized trials, these reports detail the outcomes of specific management protocols and document the potential safety of a vaginal delivery in the properly selected patient.”
In light of this information we need to more closely consider that the bigger issue here is the fact that women deserve true informed consent and to be lead to the more up to date research. We recognize that it is very hard to find a provider who will consider ‘allowing’ a breech birth. This does not mean that surgical delivery is safer, it is just what is more convenient for some providers. Keep searching! There is a provider out there who might be willing to work with you!
We, as women, need to speak up for ourselves. We need to do our own research and bring this information to our Dr’s or midwives. Unfortunately, many Dr’s and midwives are not giving full informed consent. This means they are not giving you ALL the information.
The reality is that c-sections, although now routine, are not risk free or easy. They severely interfere with the mother baby bonding hour after birth. C-sections are also a major operations that take weeks if not longer to recover from.
We as women need to listen more to our own inner voice. If you do not agree with what you have been told then keep seeking until you find the right answer that you can feel good about.
This brings us to the deeper and more important issue of the relationship between women and their providers. This is why midwifery care is so paramount to pregnancy and birth. I, as a midwife, help families feel respected and valued. I also help babies to be born gently. What I provide for my families is a trusting relationship. I support their decisions. We are able to work together to come to a care plan that we can all be comfortable with. This is important in every single pregnancy and birth and not only in the breech situation, but MOST important when we are facing a breech baby.