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Thursday, June 18, 2009

Canada Supporting Vaginal Breech Option

From page 68, Permission to Mother:

When I told my father-in-law, a retired obstetrician, about his grandson’s grand arrival, he told me, “I used to deliver footling breech babies, but an obstetrician at my [Ivy League] residency decapitated a baby. They stopped delivering breech vaginally.”

Intrigued to know why, I found results of a study conducted in 2000 known as the Term Breech Trial concluding that breech babies born by elective cesarean resulted in fewer complications for both mother and baby than born vaginally. Despite ACOG’s (the [US] professional society for obstetricians and gynecologists) follow-up recommendation that all breech babies should be delivered by cesarean, around the world, midwives are still delivering breeches.

I read a story in Midwifery Today about a midwife who planned to attend a known double footling breech. Kudos to him! My training as a physician would have made me decline a vaginal birth had I known ahead of time that David was breech. However, I have now been empowered by my “culturally unacceptable birth.” I continue to read on the topic and found a more recent analysis shows no difference in outcome between vaginal and abdominal deliveries of breech babies.

Now Canada's Society for Obstetrics and Gynecologists officially agrees:

No more automatic C-section for breech births, says Ob/Gyn Society

Halifax – June 17, 2009 – Physicians should no longer automatically opt for caesarean sections in the event of breech birth, according to new guidelines for Canadian health professionals released today by the Society of Obstetricians and Gynaecologists of Canada.

The guidelines are based on a comprehensive review of research and clinical evidence regarding the safety and outcomes of vaginal breech births compared with that of caesarean sections. In the final weeks of pregnancy, most babies will align themselves in the womb into a head down position, in preparation for birth. However, in approximately 3-4% percent of pregnancies, the baby will not align into this birthing position, and instead will present as a breech pregnancy, with its feet or buttocks positioned downwards towards the birthing canal.

“Breech pregnancies are almost always delivered using a caesarean section, to the point where the practice has become somewhat automatic,” said Dr. Robert Gagnon, a principal author of the new guidelines and Chair of the Society’s Maternal Fetal Medicine Committee. “What we’ve found is that, in some cases, vaginal breech birth is a safe option, and obstetricians should be able to offer women the choice to attempt a traditional delivery.”

I suffer inside everytime I hear that a woman couldn't find a provider to deliver her breech baby. I am excited that we have a current and official opinion.

So will ACOG share their opinion on this statement or will they declare War?


Jennifer said...

Thanks for sharing this. As of right now, at 29.3 weeks along, my baby is still heads up. I am seriously hoping she turns soon, otherwise my midwife will require I transfer to the ob. Have you seen the website I have only heard about it and wondered what you thought.

MomTFH said...

I sure hope the ACOG starts supporting more evidence based rather than defensive, intervention based care.

The key to the Canadian decision is that they want obstetricians to gain experience in this type of delivery. There is an ob/gyn near me who does vaginal breech delivery. I am hoping to ask him to shadow.

MamaOnABudget said...

around the world, midwives are still delivering breeches

Except in Australia now...,22049,25657779-5001021,00.html

Now it really makes me wonder with whom ACOG will side - Canada or Australia...

Mama to Monkeys said...

So will ACOG share their opinion on this statement or will they declare War?

I'm guessing they will either completely ignore it, or state something along the lines of "there's never been a reliable study for that in America".

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