ObGyn Intelligence
Evidence Matters
Prepare
Evidence Library › Cesarean delivery › Reasons for cesarean
Evidence Library · Reasons for cesarean

Breech: the baby is bottom or feet first

The trial that changed practice, and the follow-up that complicated it.

About 3% to 4% of babies are breech at term. In 2000 a large randomized trial found that planned cesarean reduced the combined risk of newborn death or serious newborn problems from 5.0% to 1.6%. Practice changed worldwide almost overnight.

The story did not end there. When the same children were examined at two years of age, there was no difference: death or developmental delay occurred in 3.1% of the planned cesarean group and 2.8% of the planned vaginal group. A large French and Belgian observational study of 8,105 term breech births, conducted under strict selection and delivery protocols, found no significant difference in serious newborn outcomes between planned vaginal and planned cesarean birth.

What this adds up toPlanned cesarean for breech clearly reduces short-term newborn harm. Whether it improves outcomes measured years later is not established. Where experienced clinicians and strict protocols exist, planned vaginal breech birth remains defensible. In most US hospitals that expertise no longer exists, which is itself a legitimate reason to recommend cesarean.
Where this comes from:
278. Hannah ME, Hannah WJ, Hewson SA, Hodnett ED, Saigal S, Willan AR. Planned caesarean section versus planned vaginal birth for breech presentation at term: a randomised multicentre trial. Lancet. 2000;356(9239):1375-1383.
279. Whyte H, Hannah ME, Saigal S, Hannah WJ, Hewson S, Amankwah K, et al. Outcomes of children at 2 years after planned cesarean birth versus planned vaginal birth for breech presentation at term. Am J Obstet Gynecol. 2004;191(3):864-871.
280. Goffinet F, Carayol M, Foidart JM, Alexander S, Uzan S, Subtil D, et al. Is planned vaginal delivery for breech presentation at term still an option? Am J Obstet Gynecol. 2006;194(4):1002-1011.

Covered in the essential classes

Continue

More from During pregnancy

This page is educational. It supports the conversation with your own clinicians. It is not consent to any treatment, and it cannot assess you. If you are worried about a symptom now, see urgent warning signs.