C-sections shouldn't be 'automatic' for breech births, Canadian doctors say
Last Updated: Wednesday, June 17, 2009 | 3:04 PM ET
CBC News
Most women could deliver a breech baby by pushing. (CBC)Doctors should not automatically opt to do caesarean sections for breech births, according to new guidelines released Wednesday by the Society of Obstetricians and Gynaecologists of Canada.
In about three to four per cent of pregnancies, or about 11,000 to 14,500 pregnancies in Canada, according to Statistics Canada, the baby presents with its feet or buttocks first, instead of head first — a breech birth.
"Breech pregnancies are almost always delivered using a caesarean section, to the point where the practice has become somewhat automatic," Dr. Robert Gagnon, a principal author of the new guidelines and chair of the society’s maternal fetal medicine committee, said in a release.
"What we’ve found is that, in some cases, vaginal breech birth is a safe option, and obstetricians should be able to offer women the choice to attempt a traditional delivery."
When a vaginal delivery is an option, breech births should be done in a hospital, the society recommended, as some will still require a C-section, the group noted.
Many Canadian obstetricians lack training in a technique to accommodate vaginal breech birth, so universities, hospitals and health professionals need to work together to provide the training so more women may choose to attempt to deliver that way, said Dr. André Lalonde, the society's executive vice-president, who has delivered many breech babies vaginally.
The technique is performed when the cervix is completely open and it's time for the woman to push the baby out. No forceps or vacuum can be used until the baby is delivered to its umbilicus, and then pressure is applied over the pubic bone to deliver the baby's head and shoulders, Lalonde said from the society's annual meeting in Halifax.
The technique was done before, but doctors stopped using it after a study in 2000 suggested C-sections were safer. When long-term followup showed no difference, and women continued to request vaginal breech deliveries, the society reconsidered its approach.
About 70 per cent of women could deliver a breech baby vaginally, Lalonde said, but they need to be carefully selected since the baby's head could become entrapped.
Attempting a vaginal breech birth is not recommended:
- In any situation in which a C-section would normally be recommended.
- If the baby weighs less than 2,500 grams (5.5 pounds) or more than 4,000 grams (8.8 pounds).
- If the baby presents with one foot towards the birthing canal, since the umbilical cord is likely to drop into the vagina, reducing the baby's blood supply.
- If the mother has a narrow or small pelvis, tumour or fibroids.
- If the baby's umbilical cord is positioned in such a way that it is likely to become entangled or compressed during delivery.
- If the baby's head is hyperextended.
An experienced obstetrician should be present to attend the delivery and to offer a C-section if labour does not progress smoothly or complications arise, the society said.
