Canada to support vaginal breech birth!

Read all about it on Stand and Deliver and The Unnecessarean.

In a nutshell, the Canadian version of ACOG (the SOGC) has reviewed the literature on breech birth and determined that there is insufficient evidence to say that all breeches must be born vaginally. Many vaginal birth and vaginal breech birth advocates have been saying that there were problems with some of the breech trials that seemed to show a problem for years, so it is nice to see that the SOGC seemingly confirms that.

This does not mean that it is 100% safe for all breech babies to be born vaginally — if you do an internet search, I’m sure you’ll find numerous stories in which it did not work out. But I think the worst statistics the pro-C-section people had to offer was 6% of breech babies being serious injured or killed (I don’t remember the study for sure, but it seems like that has been the number bandied about — Pinky, do you have anything more certain on that?). Which means that 94% will do just fine. And trying to figure out which breech babies will be in the “6%” category and which will be in the “94%” category will be the subject of much discussion, I’m sure. There are some definite contraindications, but a whole lot of middle ground to study. [Update -- Pinky corrected me to say that it's 6/1000, so that means it's 0.6% of breech babies possibly harmed by vaginal birth and 99.4% that will do just fine.]

Apparently, one of the factors in the SOGC’s decision was that some women have chosen out-of-hospital births as an alternative to automatic C-section, since that was their only “choice” in a hospital. Since a lot of U.S. hospitals and/or doctors will no longer allow VBACs, regardless of the reason for the initial C-section, many women have found the “automatic C-section for a breech” to have the unfortunate negative consequences of morphing into “automatic C-sections for all babies.”

Now the question becomes, what will ACOG do?

For more information, check out Science and Sensibility‘s post on this topic.

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6 Responses

  1. I have yet to see a breech vaginal birth. I’ve been in L&D for over 8 years. It is truly a dying art.

  2. I have seen 2 breech deliveries. One was a woman who came in with her baby’s bum on her perineum. The Doc was experienced in breech birth and thought it best to deliver her breech. I think if we tried to get her into the OR, the baby would have popped out anyhow so that was the scenario. Other baby was the second twin, which was a planned breech delivery.

    The statistic I got was 6 out of 1000 will die. Problem being they don’t know which 6 it will be. Certainly some folks are a better bet than others. The second twin is a good bet since you know the first twin could fit just fine.

    I cannot imagine the United States will be doing vag breeches any time soon. I think it should be taught because you never know when you will be somewhere without an operating room. Babies are still delivered in taxi cabs and the subway. Also 3rd world countries do not have an OR open and staffed. So I think if is important to research it some more.

  3. Ah, 6/1000 — much better! I must’ve missed a 0 somewhere. :-) [I know this probably seems weird, but the reason I mentioned you by name is that I had a faint recollection that you had mentioned that factoid on Dr. Amy's blog whenever (18 months?) ago when the topic turned to VBB on a thread I commented on, so I thought you had done some research on it and could cite your sources. I haven't done just too terribly much on it, and didn't feel like researching a lot -- wanted to do a quickie post.]

    I’ve read a few pretty bad “second twin” vaginal birth recently — whether breech or vertex; but many good twin VBs over the years, so I know it *can* be done. Some of the ones I’d classify as “bad” were Twin B got a broken arm when the doctor dragged her out hastily (for no apparent reason other than the idea that she had to be born within minutes of her sister); and 1 vag, 1 C/s due to breech or transverse w/no attempt at turning the baby; and variations on those themes — just because the doctors wouldn’t “do” vaginal breech birth. That might have been a good thing because a scared practitioner that doesn’t know jack about breech birth may cause more problems than he might solve, so a C-section might be safer in that instance. But, again, another important reason to know and research this, in addition to what you’ve said — that C-sections are not always going to be available when babies are breech, so good breech-catching skills should be taught.

    And I’ve read some good and some bad vaginal breech births.

  4. I think this is where it is very important to know your Doctor. If my Doctor was not inclinded to do a breech twin or a version of the second twin, then I would prefer to have a C-section for both babies.

    Some Docs are able but unwilling to do a version or a breech twin. And more times than not, those skills are needed for the second twin. So if they are unwilling to do these maneuvers, I think the pregnant woman needs to know that so she can make an informed choice.

  5. [...] birth was even attempted (even though the Canadian version of ACOG, the SOCG, has recently said the evidence does not support 100% C-section for breech), and filed a complaint with the midwifery board; I seem to recall that [...]

  6. A very promoting work by Canada, really very nice job.

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