Cesarean Delivery the Safer Bet for Breech Babies, Study Finds

The dramatic shift to elective cesarean when faced with delivering a breech baby has reduced infant deaths, researchers concluded after reviewing data from the Dutch national perinatal registry from 1999 up to 2007.

This shift in The Netherlands came about after the Term Breech Trial 2000 results were published, which concluded that planned cesarean delivery is better than planned vaginal delivery for term breech babies, although serious maternal complication were similar for delivery methods.

Pertinent Points

- Infant death rates among term breech babies are higher in vaginal deliveries compared with those born via c-section.

- Still, in The Netherlands, 40% of women attempted vaginal delivery of breech babies, leading the researchers to suggest improved counseling and taking measures to turn the baby in utero.

In this new study, however, researchers were interested in how this shift affected neonatal outcomes.

Given that the researchers found that 40% of women with a breech baby still attempt a vaginal birth, they hoped that their study would be used to offer data when counselling women about the decision to attempt to deliver a breech baby vaginally. These vaginal deliveries have a 10-fold higher fetal mortality rate when compared with cesarean, the researchers concluded.

“Our findings suggest there is still room for improvement to prevent unnecessary risk to the infant,” said lead study author Floortje Vlemmix, MD, from the Department of Obstetrics and Gynecology, Academic Medical Center, University of Amsterdam, The Netherlands, in a news release. “We recommend using measures to turn the baby (external cephalic version) to prevent breech presentation at birth and counseling women who want to proceed with a vaginal breech birth.”

In The Netherlands, c-section rates jumped from 24% to 60% after the publication of the Term Breech Trial 2000. The result was a drop in infant mortality from 1.3 per 1,000 to 0.7 per 1,000, the authors reported (odds ratio, 0.51; 95% confidence interval, 0.28–0.93). But while there was a drop in the overall death rate, the rate remained essentially stable among babies born by planned vaginal delivery (1.7/1000 vs 1.6/1000; odds ratio, 0.96 [95% confidence interval, 0.52–1.76]).

The researchers determined that 338 c-sections would be needed to prevent one death.

The study included 58,320 women with a term breech delivery and only looked at singleton pregnancies. Infants with birth defects and stillbirths were not included.