Vaginal Breech Birth

Canadian Obstetrician and Breech expert, Andrew Kotaska was a lead writer of the new Canadian breech guidelines for the Society of Obstericians and Gynecologists of Canada. He wrote an article telling why the Term Breech Trial failed to show an honest assessment of the safety of vaginal breech birth among its 126 hospital settings. He is a wonderful teacher with clear insights:
 
Poor results from centers with inadequate resources following a liberal protocol
do not have external validity in settings with better support and more cautious protocols. 

- Andrew Kotaska, MD

 

Betty-Anne Daviss is a Canadian CPM studying breech birth in Canada, Germany and Israel. Betty-Anne is doing amazing work to help parents, physicians and midwives communicate and learn from one another to increase the safety of vaginal breech birth in the hospital. She collects data from around the world on the data base that she and her epidemiologist husband Ken use to study natural and midwifery based birthing. They've have also recently published a breech article with Dr. Andre Lalonde, head of the Society Obstetrics Gynaecology Canada. Their article about hospital policies on vaginal breech birth from the Journal of Obstetrics and Gynaecology of Canada documents that the evidence does not support a policy of routine Cesarean Section for breech birth. Here is a bit of the abstract, read the abstract at their site. This has the UK/Canadian spellings.

Evolving Evidence Since the Term Breech Trial: Canadian Response, European Dissent, and Potential Solutions.
J Obstet Gynaecol Can. 2010 Mar;32(3):217-24.
Daviss, BA, Johnson, KC, Lalonde A.

The authors wished to gain insight into Canadian hospital policy changes between 2000 and 2007 in response to (1) the initial results of the Term Breech Trial suggesting delivery by Caesarean section was preferable for term breech presentation, and (2) the trial’s two-year follow-up and other research and commentary suggesting that risks associated with vaginal breech delivery and delivery by Caesarean section were similar. We also wished to determine the availability of vaginal breech delivery and the feasibility of establishing breech clinics and on-call squads, and whether these could include midwives.

20 maternity centres in six provinces participated.

Hospitals were almost five times more likely to adopt a policy of requiring Caesarean section for breech delivery when current evidence suggested that it decreased risk for the neonate than they were to reintroduce the option of vaginal breech delivery when it did not.

They found that practice changes are quickly following the evidence that breech birth shouldn't be by cesarean only.  Obstetric and midwifery bodies will require creative strategies to make clinical practice consistent with current national and international evidence.

Full text available  at (http://www.sogc.org/jogc/backIssue_e.aspx?id=87