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In The News:
New Canadian Standards Reignite Debate Over Vaginal Delivery of Breech Fetuses

National Partnership for Women & Families
January 6, 2010

The issue of whether pregnant women whose fetuses are in a breech position should attempt to deliver vaginally is receiving fresh attention after a June 2009 decision by the Society of Obstetricians and Gynecologists of Canada to adopt guidelines approving of the method in certain cases, the Washington Post reports. According to the Post, many physicians consider vaginal delivery of fetuses in a breech -- or bottom-down -- position dangerous and recommend that the baby be delivered by caesarean section.

The American College of Obstetricians and Gynecologists opposes vaginal delivery in breech cases, which it says can result in the infant's head becoming lodged inside the woman; neck injuries and paralysis if the infant is delivered incorrectly; and pressure on the umbilical cord that could restrict blood flow. These dangers and other concerns were outlined in a landmark study -- published in 2000 in the Lancet -- that followed 2,088 women in 26 countries and is widely cited in arguments against vaginal breech deliveries. Although the study concluded that "[p]lanned caesarean section is better than planned vaginal birth for the term fetus in the breech presentation," it also found that "serious maternal complications are similar" with both methods.

However, a January 2006 article by Marek Glezerman, head of obstetrics and gynecology at Tel Aviv University, suggested that the earlier recommendations of the 2000 Lancet study be rescinded because a majority of the deaths or post-birth problems mentioned in the study "cannot be attributed to the mode of delivery." Another study published in April 2006 tracked 8,105 breech births in France and Belgium, where the study said vaginal breech deliveries are "a common practice." The study found that "when strict criteria are met before and during labor, planned vaginal delivery of singleton fetuses in breech presentation at term remains a safe option that can be offered to women." According to the study, the criteria for vaginal delivery included the woman's pelvic width, the position of the fetus's head, the fetus's weight, a carefully monitored labor and a frank breech position -- when the bottom is facing down and the feet are near the ears.

As the debate continues among experts, the "reality is that few doctors who graduated in the last decade have the skills to deliver a breech baby naturally," according to the Post. Although U.S. medical students are taught the theory behind breech vaginal delivery and might practice with computer simulations, there are few situations in which residents would ever face a real case. Meanwhile, SOGC has issued a call to older physicians with experience delivering breech infants vaginally to train younger doctors on the skill (Sutherland, Washington Post, 1/5).

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