Scheduled Cesareans: The Best Option for Breech Babies?

A large study randomly assigning women with breech babies (buttocks, rather than head down presentation) to planned cesarean or planned vaginal birth, concluded that babies delivered by planned cesarean had better outcomes, and their mothers did no worse. Nearly 2,100 women from 26 countries, with a full-term baby in the frank breech position (hips flexed, legs straight) or complete breech (hips flexed, knees bent), took part.

Looking at how babies fared in countries with a high standard of medical care, no babies died during labor or shortly after birth among the 514 women in the planned cesarean group. Two deaths that might have been averted by planned cesarean occurred among 511 babies in the planned vaginal birth group. Two newborns in the planned cesarean group experienced serious complications, versus 26 in the planned vaginal birth group.

As for women, nearly 60 percent of all women in the planned vaginal birth group had cesarean sections, a percentage not atypical of other studies of vaginal breech. Of the 1,041 women in the planned cesarean group, 41 experienced serious complications, versus 32 of the 1,042 women in the planned vaginal birth group. Statistical calculation showed that this difference was likely due to chance.

Over the past thirty years, controversy has raged over the safest way to deliver breech babies. Doctors have long known that breech babies had poorer outcomes compared with head-down babies. However, it has been impossible to determine what related to the hazards of vaginal breech birth and what was due to other factors. For example, premature babies are more likely to be breech, as are babies with certain physical abnormalities or inborn neuromuscular problems. In addition, breech babies may be injured during birth by birth attendants who lack the special knowledge and skills needed at vaginal breech births. Universal cesarean section would also presumably increase maternal risks over vaginal birth.

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