The researchers carefully designed this trial to finally settle the question:
-- They only accepted full term, normally-formed babies of average weight into the trial.
-- They excluded babies coming feet first, or whose heads were tipped back -- problems that increase the risk of complications during labor and birth.
-- Randomly assigning women to one group or the other assured that the groups of women and babies were similar at the start.
-- The large number of participants meant that differences in the rates of adverse outcomes would emerge, even if they were rare.
-- Only doctors experienced with vaginal breech birth were to attend women assigned to the planned vaginal birth group.
-- The breech delivery technique used was that which is currently considered best and safest.
-- The researchers limited their assessment of complications to those that were potentially life-threatening or could mean permanent injury.
In short, the many strengths of this trial leave no room to doubt the validity of its conclusions. And its results give new emphasis to the importance of external cephalic version, a technique whereby in the last few weeks of pregnancy, doctors try to turn the baby head down by manipulating the mother’s belly.
Reference: Hannah ME et al. Planned caesarean section versus planned vaginal birth for breech presentation at term: a randomised multicentre trial. Lancet 2000;356:1375-83.