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C-section a safer delivery option for breech babies

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A Dutch study warns that babies born in the breech position have a 10-fold higher risk of death when delivered vaginally. The study, published in the Aug. 11 online Acta Obstetricia et Gynecologica Scandinavica, reported breech-positioned deliveries – when the baby emerges legs and buttocks first instead of presenting the head first – pose less of risk to the infant if done by Cesarean section.

According to a journal news release, one in every 25 deliveries is breech. After a 2000 study on breech births found that breech babies delivered vaginally had a 33 percent higher risk of injury or death, the number of C-sections rose dramatically.

For the latest study, the researchers – led by Dr.Floortje Vlemmix, of the department of obstetrics and gynecology at the Academic Medical Center, University of Amsterdam, Netherlands – set out to determine if the rise in C-sections had an impact on neonatal outcomes from breech births. To do so, Vlemmix and her team analyzed data from the Dutch national perinatal registry from 1999 to 2007.

“As an obstetrician, ensuring the health and safety of the mother and infant during childbirth is of the utmost importance,” Vlemmix said in the news release. “Our study focuses on understanding if the increase in Cesareans following the term breech study had any impact on neonatal outcomes.”

Participants in the study included 58,320 women who had delivered singleton breech babies between 37 and 42 weeks of gestation. Mothers who had stillbirths or whose infants had birth defects were excluded from the study.

Findings showed that among the study participants, elective Cesarean deliveries increased from 24 percent in 1999 to 60 percent in 2007. The number of deaths fell from more than 10 babies out of 10,000 in 1999 to seven babies out of 10,000 in 2007. In the planned vaginal delivery group, however, the neonatal death rate remained the same at about 17 babies out of 10,000 births.

The study authors noted that despite evidence that C-sections reduce the risk to breech babies, 40 percent of women still chose to have a vaginal delivery.

One expert who was not involved in the study noted that while the presented data had many strengths, there could have been something else unique to the women who chose vaginal births that increased risks to their babies.

“The headline message is that Cesarean section looks like the way to deliver breech babies at term,” Dr. Lucy Chappell, clinical senior lecturer at Maternal and Fetal Medicine at King’s College London, told Reuters Health in a phone interview.

Chappell indicated she would recommend women who were going to deliver a breech baby to plan on having a C-section. But she also noted that because Cesareans have associated costs and risks of their own, some women would prefer a vaginal birth. In these cases, she advises doctors to counsel their patients on the potential risks.

Vlemmix and her team acknowledged that more needed to be done to help women who opt for a vaginal birth when delivering breech babies.

“Our findings suggest that there is still room for improvement to prevent unnecessary risk to the infant,” said Vlemmix. “We recommend using measures to turn the baby to prevent breech presentation at birth and counseling women who want to proceed with a vaginal birth.”

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