Abstract

The publication of the Term Breech Trial 12 years ago caused an almost universal change in UK practise towards offering elective caesarean section to women with breech presentation at term. These results have entered the public psyche to such an extent that women no longer have confidence undergoing vaginal breech deliveries (VBD) and experience has been eroded such that clinicians no longer maintain their skills. This has implications for women wishing to undergo VBD as well as morbidity and mortality from increasing numbers of caesarean sections (CS). We sought to answer the question of whether it was suitable and safe to offer VBD to women presenting in labour rather than carrying out emergency CS.

Between 2002–2011, 502 women with breech presentation at term attended in labour. 77 (15%) had normal vaginal delivery, 219 (44%) had emergency CS and 206 (41%) had urgent CS. In the CS group, 51 (12%) required CS anyway; therefore 78% were suitable to consider VBD.

Only 47% of this group attempted VBD. The majority chose CS due to personal preference or recommendation from doctors, highlighting lack of confidence in VBD by both doctors and women.

5-minute Apgar scores were comparable between groups but morbidity from blood loss was higher in women undergoing emergency CS vs. VBD. (1250 ml vs. 686 ml).

We believe these results show that VBD can be safe in selected cases and the time has come for clinicians to regain their experience so that more women can be offered this birth option with confidence.