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Planned caesarean safest for breech delivery

But absolute risks of vaginal delivery still small, analysis of published evidence shows

Caroline White

Thursday, 30 July 2015

A planned caesarean section birth is ‘safest’ for breech delivery, but the absolute risks of vaginal delivery are small, reveals an analysis* of the available published evidence in BJOG: An International Journal of Obstetrics and Gynaecology.

The best way to deal with breech babies is the subject of ongoing debate, as C-section is not without risk. The researchers therefore pooled the data from 27 relevant studies, involving just short of 259,000 women, to find out the absolute and relative risks of death and complications associated with planned vaginal breech delivery up to seven days after the birth. 

The analysis suggests that the overall perinatal mortality in the planned vaginal delivery and planned caesarean section groups for a term breech baby were 253 (0.3%) and 79 (0.05%), respectively.

In other words, the absolute risks of perinatal mortality in planned vaginal and planned caesarean deliveries were about 1 in 300 and 1 in 2,000, respectively.

These results were lower than the perinatal mortality rates associated with a vaginal delivery where the baby was positioned head first in a WHO study. This found the risk of foetal and neonatal death was 0.39 and 0.38%, respectively.

Furthermore, the absolute risks of neurological problems, birth trauma, 5 minute Apgar score of less than seven, and neonatal asphyxia were 0.7%, 0.7%, 2.4% and 3.3%, respectively.

Study co-author Yifru Berhan, Professor of Obstetrics and Gynaecology at Hawassa University College of Medicine and Health Sciences, Ethiopia, commented: “Our results show that the relative risk of perinatal mortality and morbidity was between 2 and 5 times higher in planned vaginal breech delivery compared to planned caesarean section birth. However, the absolute risks were very small.”

He added: “Although the controversy is still unresolved, our study substantiates the practice of individualised decision making around delivering a breech baby. Future research should focus on a comparative study on vaginal breech and non-breech delivery.”

Professor Alan Cameron, Vice President of Clinical Quality for the Royal College of Obstetricians and Gynaecologists (RCOG), commented: “The College currently recommends that caesarean delivery is the safest mode of delivery for the baby when in a breech position.

“However, there are benefits and risks associated with both caesarean delivery and vaginal breech birth, and women are encouraged to discuss and weigh up the options with their obstetrician so they can choose the best plan for themselves and their baby.”

Royal College of Midwives practice and standards professional advisor, Mervi Jokinen, added: “This is an interesting topic where some studies have had a significant impact in changing practice, reducing women’s choice, and to some extent contributing to the rising numbers of caesarean sections globally.”

She continued: “The authors conclude even combining all the studies does not necessarily give the right answers on an individual level. All births carry an element of risk, however small.

“The important issue here is that women are aware of the evidence around breech birth, including the risks and the benefits of either a vaginal delivery or caesarean, so that they can make a decision about how they want to give birth. It is important that they discuss this with their midwife or doctor.”

* Berhan Y and Haileamlak A. The risks of planned vaginal breech delivery versus planned Caesarean section for term breech birth: a meta-analysis including observational studies. BJOG: An International Journal of Obstetrics & Gynaecology, 2015. DOI: 10.1111/1471-0528.13524

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