Vaginal Breech Birth - Evidence for breech safety

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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) 

 



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Spinning Babies is facing an immediate "migration," new software installation for the behind the scenes portion of the website at cost of $680. This massive update is crucial for security and functionality. Alternatively, I could take the 100+ pages down and restart the site with new software at a lower cost, but much less content. Would you be ok with a 10 page site carrying only an outline of information? That's about how many other websites treat their content.

 Are you a woman or a loved one of a woman helped to avoid a cesarean by Spinning Babies Website? Has Spinning Babies helped you serve birthing families with techniques for labor progress? Do you have a little time to help Spinning Babies in return? If the migration costs $680 and 100 of my loyal users gave $68 dollars each, we'd get it covered. 

Did you know that Spinning Babies was hacked a few summers ago and had to go off line while I found hosting with security? Security is a real issue on the internet. 

Several years ago a grandmother donated $150 after a visit to Spinning Babies Website helped her daughter avoid a cesarean. Once a woman sent $50 because exercises on Spinning Babies stopped her hip pain and she was able to sleep well for the first time during the end of her pregnancy. Today, just a few dollars a year come through donations. Ever since the booklet went on sale donations dropped off. Could it be that people think sales income is significant to carry the website? I wish it were so, and do hope to boost the store soon.

Right now Spinning Babies is in need and so I'm asking those of you among my 4000 daily visitors to give something back. "Wait, Seriously?" you ask, "4000 people a day and only a few small donations a year!?" Yep, that's true.  If 100 of you, 1/40th of one day's visitors, gave $6.80, or about 5 British Pounds (or, 68 people giving 10.00 each) we could get this job done and secure the website. 

ICould it be that Spinning Babies has become such a part of the childbirth education scene that its taken for granted? Spinning Babies doesn't get grants. Spinning Babies isn't a nonprofit (But my husband will be surprised to hear that.)  I love giving this information as a gift to the birthing world, I'm rather delighted to help a woman understand she doesn't have to accept a cesarean before labor just because her baby is posterior! Or, help a woman flip her breechling head down. But with the cost of web maintainance increasing, I have to rethink how I might support my work.  

If you aren't able to give such a chunk of change, can you send your sympathy for $5? Or, are you a loyal Spinning Babies user who gives their undying support for $100? 

What ever you can send now will be seen as a huge message of support to keep Spinning Babies safe and online. Protecting one woman's birth just takes 4 minutes.

How are we doing? First day, 6 donations: $80 was given, Second day,  2 donations: $20.   Third day 3 donations: $70.  We can do it! Can we do it in a week??