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Friday, 20 October, 2000, 01:04 GMT 02:04 UK
Caesarean urged for breech babies
caesarean
Caesaran: the only safe way for breech babies
All women having a breech baby are likely to be told to have a caesarean section following publication of a "landmark" study.

Researchers who studied more than 2000 women whose babies were breech found that the risk of death or serious harm to the baby was more than three times lower in those who had a caesarean.

One of the UK team involved in the study said the results were so significant that all maternity units would be expected to change their practice immediately.

"We can't continue to do something that has been proven to be unsafe," Derek Tufnell, head of obstetrics and gynaecology at Bradford Royal Infirmary told BBC News Online.

Mr Tufnell, who also acts as an expert witness in court cases, said that, from now on if a woman has a damaged breech baby through normal delivery and had not been informed of the need to have a caesarean then the doctor would have no defence.

We can't continue to do something that has been proven to be unsafe

Derek Tufnell, head of obs and gynae, Bradford

"If you read this research then you will see this has to be followed - if what we are all about is ensuring healthy mums and healthy babies."

The research, co-ordinated by Mary Hannah and colleagues at Sunnybrook and Women's College Health Sciences Centre in Toronto is the first major study of its kind.

Doubt

Until now there has been some doubt about whether vaginal delivery or caesarean was preferable for full term breech babies.

The results from 26 countries, published in the Lancet, were unequivocal - three babies in the group which underwent caesarean section died compared with 13 in the group which delivered vaginally.

Fourteen babies in the caesarean section group suffered problems after birth, compared with 39 in the normal delivery group.

There was no difference in outcome for the mothers in both groups.

The results were even more striking in countries which have a very low infant mortality rate, such as the UK.
pregant woman
The baby can be turned before delivery

The researchers concluded that in these countries only seven caesareans are needed to avoid one "dead or compromised baby".

In the UK 2-3% of babies are breech, resulting in around 12,000 full term births a year and half of these are currently born by caesarean.

One option to avoid a caesarean is to attempt to turn the baby in the last weeks of pregnancy.

External version

According to Mr Tufnell, many obstetricians will attempt this technique of "external version".

Often the procedure fails but there is now likely to be a greater focus on ensuring its success as an alternative to surgery.

Belinda Phipps, chief executive of the National Childbirth Trust stressed that every woman expecting a breech baby should be offered external version.

It is very important that all woman can make an informed choice

Belinda Phipps, NCT

While she agreed that women anticipating a breech birth who are seeing an obstetrician should now opt for a caesarean she questioned whether the results of the study could also be applied to births overseen by midwives.

"If women cannot make a choice then that is very sad," she said.

"Midwifery support in labour is very important and midwives have a very good record in delivering breech babies."

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See also:

09 Aug 00 | Health
Big rise in Caesarean births
02 May 00 | Health
Crackdown on Caesarean boom
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