I have typed up and pasted below an editorial comment in the August ANZJOG regarding
breech birth. Good comment from an obstetrician. What we have all been saying for
years.
Cheers
Judy
Australian and New Zealand Journal of Obstetrics and Gynaecology 2003; 43: 261
Editorial comment
The current relentless drive for 'evidence-based care' in medicine has aims which must
be applauded. However, the consequences are not always beneficial to all, with a clear
tendency, at time, for the 'evidence' to be applied inappropriately.
Two manuscripts in this issue address the increasingly difficult subject of
breech presentation. 1, 2 The 'Term Breech' 3 study did show that Caesarean section
birth is associated with a higher likelihood of a quality outcome for singleton term
babies than vaginal breech birth. The short-term maternal outcomes reported appeared
to show that the increased use of Caesarean section was not to the detriment of the
mothers.
However, it did not examine longer term issues arising from Caesarean section,
such as puerperal depression after discharge from hospital, future changes in
fertility, and increasing morbidity and mortality in subsequent pregnancies. Equally,
it did not (and could not) examine the consequences of the study being applied to
other breech situations, such as multiple birth and preterm breech birth, and the
effect upon the training and experience of obstetricians who will, inevitably, be
faced with clinical situations such as the unexpected rapidly progressing vaginal
breech birth and the woman who exercises her autonomous right to make and informed
decision to attempt a term vaginal breech birth.
Kaushik and Gudgeon 2 rightly remind us tat, if we are to follow 'the
evidence' and advise all women with breech presentations that Caesarean section is the
preferred mode of delivery, we have a responsibility to temper this advice with
explanation of alternatives, including external cephalic version where appropriate. By
implication, methods of training obstetricians in the techniques of vaginal breech
birth must be found, to replace the experiential model used in the past.
Michael HUMPHREY
MB BS, PhD, FRANZCOG, FRCOG
References
1 Phipps H, Roberts CL, Nassar N, Raynes-Greenow CH, Peat B, Hutton EK. The
management of breech pregnancies in Australia and New Zealand. Aust NZ J Obstet
Gynaecol. 2003; 43: 294-297.
2 Kaushik V, Gudgeon G. Caesarean for breech: A paradigm shift? Aust NZ J Obstet
Gynaecol. 2003; 43: 298-301.
3 Hannah ME, Hannah WJ, Hewson SA, Hodnett ED. Saigon S, Willan AR. Planned caesarean
section versus planned vaginal birth for breech at term; a randomised multi-centre
trial. Term Breech Trial Collaborative Group. Lancet. 2000; 356: 1375-1383.
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