Vaginal Breech Birth: Safe?
My daughter was born breech (thanks to a great midwife and a very supportive hospital team). Everything turned out well for me, but is vaginal breech birth really safe?Question:
Wow, I'm impressed. A successful planned primigravida vaginal breech delivery -- that is quite rare in medical centers now. I'm so pleased for you and admiring of the supportive team you had working with you.
The midwives at The Farm in Tennessee have very good statistics for vaginal breech births and they have produced a beautiful video. The skill and patience of the attendant is critical and with so many cesareans being done, residents are losing opportunities to fine tune their breech delivery skills.
The literature is mixed with regards to the appropriateness of vaginal delivery. An Israeli trial quotes a figure of about 50 percent anticipated vaginal deliveries if the baby is breech. Another says 37 percent.
One of the articles I read pointed out that risk of fetal injury exists even if a trial of labor is implemented. The difficulty of doing research with breech presentations is demonstrated by a 1995 article in the American Journal of Obstetricians and Gynecologists, "Route of delivery for the breech presentation: a conundrum." It states: "A randomized clinical trial of larger fetuses in a breech presentation was considered extremely difficult".
Injuries to the fetus in a breech delivery are much more common than in a vaginal delivery. Entrapment of the head, nerve damage, organ injury, spinal cord injuries, fractures, hypoxia are all very real risks. William's Obstetrics quotes a study of 1016 breech deliveries where the overall mortality rate was 25 percent for breech births and 2.6 percent for nonbreech deliveries. This was for all births including preterm but when that is controlled, there is still a two-fold increased risk for the infant delivered as a breech compared with the overall population.
If you can do a Medline search of "labor and breech," you could read some current abstracts on this topic. You could also go to any medical bookstore and scan the breech chapters in William's Obstetrics by Cunningham or Maternal Fetal Medicine by Creasy and Resnick.Answer: