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In the U.S. today, about 4 percent of babies are breech at full term, which means they’re in position to exit the uterus feet- or butt-first rather than headfirst. Before 1959, virtually all such babies were safely delivered vaginally; today, most are born by Cesarean section. But as more mothers and babies are experiencing sometimes serious complications associated with surgical deliveries (in 1970, the C-section rate was 5.5 percent; today it’s 34 percent), some experts are re-evaluating their position regarding breech births.
Beginning in the 1960s, obstetricians gradually shifted the way they delivered breech babies because they preferred the predictability and the presumed greater safety of a C-section birth. But not every doctor jumped on the C-section wagon immediately; many continued favoring vaginal breech births. That is, until the Hannah Term Breech Trial (TBT) published in 2000 brought them to a screeching halt. The TBT followed 2,083 breech babies in 26 countries, randomly assigned to either vaginal or planned C-section delivery. Early data suggested fewer newborn deaths and injuries occurred in the C-section group. “The impact of this study was stunning,” says Heather Weldon, M.D., an OB-GYN at Southwest Medical Group OB/GYN Associates in Vancouver, Wash. “Within months, breech C-sections went from 50 percent to 80 percent and, by 2006, 90 percent. Then, we found out the study was flawed.”
In fact, critics began poking holes in the TBT immediately after its publication. For example, some poor outcomes attributed to vaginal delivery occurred in birth centers that used substandard techniques or unskilled birth attendants. Some babies had genetic defects or were premature. In short, most weren’t injured because they were delivered vaginally, but because of other factors. Further study indicated that most of the babies recovered fully from their birth injuries regardless of delivery method, and researchers also hadn’t factored in the increased health risks resulting from C-sections.
“The data actually support vaginal breech birth as safe in certain scenarios and not in others,” says Amy M. Romano, C.N.M., M.S.N., associate director of programs at Childbirth Connection, a nonprofit organization dedicated to promoting evidence-based maternity care. “The results should have supported informed decision-making, but instead, hospitals reacted by taking that choice away from women.” Another unfortunate result was that medical schools quit teaching vaginal breech delivery skills to entire generations of new doctors. “Any care provider can get surprised by a breech baby during labor, but many doctors don’t know what to do and that’s dangerous,” says Ina May Gaskin, C.P.M., founder of The Farm Midwifery Center in Tennessee and author of Ina May’s Guide to Childbirth (Random House) and Birth Matters (Seven Stories Press).