Mandatory section for breech thrown out!

[baybee]

Five years to the term breech trial: The rise and fall of a randomized controlled trial.
American Journal of Obstetrics & Gynecology. 194(1):20-25, January 2006.
Glezerman, Marek MD

Abstract:
Objective: On the basis of the end points of neonatal morbidity and death, the authors of the term breech trial concluded unequivocally that cesarean delivery was safer for breech babies.

Study design: Analysis of the original and new data gives rise to serious concerns as far as study design, methods, and conclusions are concerned. In a substantial number of cases, there was a lack of adherence to the inclusion criteria. There was a large interinstitutional variation of standard of care; inadequate methods of antepartum and intrapartum fetal assessment were used, and a large proportion of women were recruited during active labor. In many instances of planned vaginal delivery, there was no attendance of a clinician with adequate expertise.

Results: Most cases of neonatal death and morbidity in the term breech trial cannot be attributed to the mode of delivery. Moreover, analysis of outcome after 2 years has shown no difference between vaginal and abdominal deliveries of breech babies.

Conclusion: The original term breech trial recommendations should be withdrawn.

(C) Mosby-Year Book Inc. 2006. All Rights Reserved.

[eleven]

I am so torn about this! I am so happy that they are recognizing that mandatory cesareans for breech births are unnecessary, yet I am so sad for all of the poor mothers who had to undergo surgery because of the original study.

I also wonder whether this will make a difference realistically. Right now we have a culture of breech=cesarean and a generation of OB/GYNs who simply don't have any experience with breech vaginal deliveries.

Does anyone happen to know when the original trial took place?

Thank you for sharing this. Hopefully it will create change.

[minkajane]

I had a C/S for breech baby with mean military bully doctors.

[Charles Baudelaire]

I had a C/S for breech baby with mean military bully doctors.

And when I found out that my dd was breech -- I was in second-stage labor at the time -- I went with the C-section against my clear preferences because of that stupid study since I was afraid of the morbidity/mortality rate difference the study focused on.

Damn.

[minkajane]

I didn't even get the chance to make a decision. They just told me no. No discussion, nothing. Just "you're a first time mom, no way." Grrrr...

[lizziejackie]

[QUOTE=pease]
Right now we have a culture of breech=cesarean and a generation of OB/GYNs who simply don't have any experience with breech vaginal deliveries.
/QUOTE]

I so agree with this statement. Part of our reason for a skyrocketing c/section rates (and for "increased risks" on breeches) is because doctors just don't know how anymore. And when they don't know how, and yet try, they screw things up. The risk comes from being untrained and out of practice.

I am happy they want to throw out the breech thing. It needs to go. Too many unnec. c/s because of it. Doc's need to start learning what it takes to deliver 10% of babies. It might also bring back birthing multiples vaginally -- as the excuse now is that "one is breech".

I hope this goes someplace, I really do. Time to stop this craziness.

[lrlittle]

i just had my baby boy last week...planned hospital breech birth. quite a ride since the time we found out he was breech. the research we did paid off and we found a doc (maybe the only one in our city) that has years and years of experience in vaginal breech births. it was an unbelievable experience in so many ways. and our little boy is incredible!!

[be11ydancer]

Yep, my second was a c-sec due to being breech. This time around, I'm using midwives who are experienced in delivering breech at home. They claim that there is almost no difference between butt first or head first and have never had a problem.

[ChattyCat]

Hopefully, this will translate into women having more options, but somehow I doubt the OBs will listen.

My sister had to have a csec for her twins, but it was because they were both sideways. I remember her DR saying that if the presenting twin was head down they would have delivered them both vaginally. They would have just turned the second twin after the first was delivered. I thought that was kind of cool.

[mandemack]

I didn't even get the chance to make a decision. They just told me no. No discussion, nothing. Just "you're a first time mom, no way." Grrrr...

Yep. Me too. :irked:

[Stayathomemommy]

they told me the same thing about my twins. since twin A was head down all was good. they turned baby B from breech to head down and still sectioned me because her heart rate didnt look good. turning a baby is so brutal for mom and baby. the whole thing was a huge bummer

[savdoc2]

I didn't even get the chance to make a decision. They just told me no. No discussion, nothing. Just "you're a first time mom, no way." Grrrr...


Same here.

My second was also breech, but we did an ECV and she turned!! Great VBAC!! Such an amazing birth - nothing like the tear filled section. :(

[mollyeilis]

I also wonder whether this will make a difference realistically. Right now we have a culture of breech=cesarean and a generation of OB/GYNs who simply don't have any experience with breech vaginal deliveries.


Yes and no.

No because that study allowed practitioners to never learn how to help with breech. (of course, hands off being the most important for a breech or so I've read, the training could be simple like the radical midwives website says, *sit in the corner and slowly drink a pint or sit on your hands, just stay away*)

Yes because now anyone being bullied can actually say "it makes no difference, that study was WRONG". That's helpful with people one runs into in everyday life, don't you think? To be able to say "they were wrong and they've admitted it in their own journal" is HUGE, IMO.