Breaching the Breech Protocol Tuesday, October 26, 2010
TAU researcher advocates returning to old-school methods for delivering breech babies
Most babies are delivered head-first, but in about 4% of all deliveries babies are "born breech" — with their buttocks or feet first. Doctors usually exercise caution and use caesarean sections (C-sections) as the delivery method of choice for such births, believing it safer for the baby. After a large-scale international study in 2000, C-sections became the near-universal choice for such births.
But now researchers at Tel Aviv University are saying that, under certain circumstances, traditional vaginal delivery for breech babies is not only safe for baby, but even safer for mommy.
Recent studies by a group of scientists including Prof. Marek Glezerman of Tel Aviv University's Sackler Faculty of Medicine and the Rabin Medical Center make this case. Published in major obstetric journals world-wide and presented recently at the Canadian Congress on Breech Delivery, Prof. Glezerman's research indicates that breech babies are no more at risk during vaginal delivery than C-section, and there is reduced morbidity and mortality for the mothers. Based on his findings, Prof. Glezerman is campaigning worldwide for a return to skilled vaginal delivery of breech babies.
The safer way for moms
Caesarean section, explains Prof. Glezerman, is not just another method of delivery. A major surgical procedure, a C-section is not only riskier for a woman and decreases chances she will be able to breastfeed, it also increases maternal risks in future pregnancies. A large number of C-sections are performed because a woman had a breech presentation in the past, he explains — once a woman has delivered by C-section, it becomes more dangerous and occasionally impossible to deliver vaginally, since the uterine walls and muscles are at increased risk for rupture.
While it is much easier to perform a C section than successfully deliver a breech baby vaginally, says Prof. Glezerman, many women can benefit medically by the return to traditional techniques. "We are trying to unite obstetricians and midwives in the field to revive vaginal delivery for breech presentations," he notes. Prof. Glezerman's initiative provides scientific evidence to those physicians and midwives looking to return to more traditional birth methods for breech.
Back to the future
Prof. Glezerman says that retraining the obstetrics community in these traditional methods is an urgent task, because the medical field now has two generations of medical residents with hardly any training in vaginal birth for breech deliveries. "The skill has disappeared," he explains. "Residents are no longer taught these techniques, and senior physicians are doing it less and less. We need to go back to the future and relearn what has been forgotten."
At the Rabin Medical Center in Israel, Prof. Glezerman runs workshops for the newest generation of gynaecologists and obstetricians on techniques for vaginal delivery for breech babies. His courses include techniques of breech delivery, changing presentation from breech to head and management of different breech presentations. With these workshops, Prof. Glezerman hopes to reintroduce critical delivery skills into the field, and raise awareness that breech presentation of babies does not always necessitate C-section deliveries.
Of course, says Prof. Glezerman, physicians still need to be able to recognize dangerous risks when they arise. In those cases, vaginal delivery is not a viable option — but doctors must judge each situation individually.
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