Sunday, October 17, 2010

Readings on breech birth

I recently came across these two articles about vaginal breech birth and wanted to pass them along. The first is an editorial by Dr. André B. Lalonde in the Journal of Obstetrics and Gynaecology Canada, titled Vaginal Breech Delivery Guideline: The Time Has Come (full text PDF). Dr. Lalonde is the executive vice-president of the SOGC. In the editorial, he reviews the changes that occurred after the Hannah trial and describes the most recent evidence that planned vaginal breech birth can occur safely. He then outlines Canada's need for re-training in vaginal breech birth. An excerpt from his conclusion:

Women in Canada and abroad are requesting the option of breech vaginal delivery. Will it be obstetricians and gynaecologists offering this, or, since many hospitals are not offering breech vaginal delivery, will women rely on midwives to do so? Some women with a breech presentation elect to deliver at home because they believe they will be refused a breech vaginal delivery at the hospital. It is urgent that we take on this responsibility and that every hospital in Canada offer safe breech vaginal delivery. We need to meet with our colleagues in midwifery to support their request for breech vaginal delivery in hospital and access to consultation with their obstetrician colleagues.

The other article of interest is Evolving Evidence Since the Term Breech Trial: Canadian Response, European Dissent, and Potential Solutions (full text PDF). Written by Betty-Anne Daviss, Kenneth C. Johnson, and André B. Lalonde, this article also appeared in the JOGC. The authors surveyed the 30 largest maternity hospitals in Canada to see how their breech policies changed after the initial Hannah findings and then again after the two-year followup. They found that "Hospitals were almost five times more likely to adopt a policy of requiring Caesarean section for breech delivery when current evidence suggested that it decreased risk for the neonate than they were to reintroduce the option of vaginal breech delivery when it did not." They concluded: "The weight of epidemiologic evidence does not support the practice developed in Canadian hospitals since the Term Breech Trial that recommends delivery by Caesarean section for all breech presentations. Obstetric and midwifery bodies will require creative strategies to make clinical practice consistent with current national and international evidence."

And if you're new to this blog, please visit these earlier posts addressing breech birth, mostly in chronological order:


  1. Reading the first, I thought, "Oh, encouraging!" Then, after the second, "Oh, discouraging!"

  2. I feel so strongly that vaginal birth delivery should be an option for all women. Doctors and midwives should be trained to attend breech births. I am one of the lucky few who was able to deliver my breech baby at home. My own very competent midwife could not legally attend my breech home birth alone, but there was another unlicensed and very experienced midwife in my area who agreed to come. I will be forever grateful for her. I also feel very fortunate that there are even OBs in my area who will attempt vaginal breech births. I know most women are not so fortunate. There are so few doctors and midwives with breech experience.

    Here's the link to my birth story and photos (birth happened to fast to get it on video unfortunately) for those interested:


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