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Should we be doing vaginal breech deliveries again?
December
01 ,
2008
In the now famous "Term Breech Trial" whose results were released in 2000, the final demise of the planned vaginal breech delivery was finally sealed. Once and for all, a multi center, worldwide study was done across 26 countries, 121 birthing centers, and over 2,100 women was performed. The results of the study were supposed to be conclusive, serious injury occurred in only 17 of 1039 (1.6%) babies born by c-section, versus 52 of 1039 (5%) in the vaginal group had a serious injury. Since then, worldwide, planned vaginal breech delivery has become a thing of the past.
Is this a good thing? One researcher, Marek Glezerman M.D. of Tel Aviv University, Israel, thinks the study was flawed, and has bemoaned the fact that this choice of vaginal delivery for breech babies at term has all but vanished completely.
Among his criticisms are as follows: - Many of the babies which suffered injuries would not have been allowed to undergo a planned breech delivery in a modern facility. Things such as hyper extension of the head (where the baby's neck is extended - as if the baby was looking up at the stars) and overweight babies were included in the group. These babies should not have been allowed into the study in the first place.
- Many of the injuries occurred when the person attending the delivery did not have adequate experience.
- Many of the injuries had nothing to do with the mode of delivery
Despite Dr. Glezerman's objections, it is still considered standard of care not to deliver baby vaginally if it is known to be presenting in the breech position. We may never know if he is right, as the number of practitioners skilled in breech vaginal delivery becomes less and less with passing time.
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