This is heartening from our new obs. Sally
-----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Maternity Ward Mareeba Hospital Sent: Friday, 22 August 2003 10:07 AM To: [EMAIL PROTECTED] Subject: [ozmidwifery] I have typed up and pasted below an editorial comment in the August ANZJOG regarding breech birth. G 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. ************************************************************************ *********** This email, including any attachments sent with it, is confidential and for the sole use of the intended recipients(s). This confidentiality is not waived or lost, if you receive it and you are not the intended recipient(s), or if it is transmitted/received in error. Any unauthorised use, alteration, disclosure, distribution or review of this email is prohibited. It may be subject to a statutory duty of confidentiality if it relates to health service matters. If you are not the intended recipients(s), or if you have received this e-mail in error, you are asked to immediately notify the sender by telephone or by return e-mail. You should also delete this e-mail message and destroy any hard copies produced. ************************************************************************ *********** -- This mailing list is sponsored by ACE Graphics. Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe.
