Heads or tails? While only 4 percent of babies are in the breech position—buttocks or feet-first instead of head-down—at term, the decision about whether to deliver these babies vaginally or via planned C-section is a hot-button international topic. In the United States, C-sections are performed for the majority of breech deliveries—and a new study out of ACTA Obstetricia et Gynecologica supports this approach.
Dutch researchers evaluated the outcomes of more than 58,000 women who had term breech deliveries. They found a 10-fold increase in neonatal mortality in breech babies delivered vaginally compared to those delivered by elective C-section. (Researchers found a death rate of 1.6 per 1,000 babies delivered with a planned vaginal breech birth. There were no deaths in the C-section group.)
This isn’t the first study to find improved outcomes among breech babies delivered via C-section. In 2000, a study known as the Term Breech Trial (TBT) found significantly fewer newborn deaths among breech babies who were delivered via planned C-section compared to those who were delivered vaginally.
The impact the TBT has had on the delivery of full-term singleton breech babies can’t be understated: In the U.S., the C-section rate for breech deliveries increased from about 84 percent before the TBT to nearly 87 percent after its publication.
It also changed how American doctors are trained. Since the TBT, “there’s an entire generation of OB/GYNs who aren’t practicing in a day when planned vaginal delivery is an acceptable approach for term breech babies,” says Alison G. Cahill, M.D., Chief of the Division of Maternal-Fetal Medicine at the Washington University in St. Louis School of Medicine. “So they haven’t been trained how to do them.” The American College of Obstetrics and Gynecology’s Committee Opinion on Mode of Term Singleton Breech Delivery highlights this reality: “Cesarean delivery will be the preferred mode of delivery for most physicians because of the diminishing expertise in vaginal breech delivery,” the statement says.
While the TBT had a significant influence on breech deliveries in the U.S. and many other countries, it didn’t affect the standard of care as drastically in the Netherlands. (Read more about the TBT here: Turn, Baby, Turn.) This enabled researchers to collect substantial data on both vaginal and C-section outcomes for term breech deliveries for the new study.
“This new study provides further evidence that C-sections for breech babies have better outcomes than planned vaginal deliveries,” says Dr. Cahill.
Of course, C-sections aren’t without substantial risks, too. If you’re at term, and your baby is breech, discuss these options with your doctor to determine the best approach for you and your baby:
- An external cephalic version. This procedure involves lifting and turning your baby from the outside. It’s only tried if you’re at least 36 weeks pregnant—if it’s performed before then, the baby could change position again or need to be delivered too early. Although unlikely, the procedure can stimulate labor.
- Waiting it out. “If you don’t attempt a version, there’s a small chance your baby might flip itself to the head-down position by the time you’re in labor,” Dr. Cahill says.
- Scheduling a C-section. The TBT suggests performing a C-section at 39 weeks if your baby is in the breech position, says Dr. Cahill. (In general, C-sections that are unplanned or performed after you’re already in labor have more risks than scheduled C-sections, she explains.)