Research, Articles & opinions 
 
 

The published research evidence is a powerful tool when trying to make a decision regarding birth mode for your breech baby, or when trying to find support for a vaginal breech birth.

This page offers some of the important research that has influenced the availability of Vaginal Breech Birth. We have made a few comments on the literature, and provided links to the publications that published the original studies.

 
The Term Breech Trial: Original Report

Planned caesarean section versus planned vaginal birth for breech presentation at term: a randomised multicentre trial
 Mary E Hannah MDCM,   Walter J Hannah MD,   Sheila A Hewson BA,   Ellen D Hodnett PhD,   Saroj Saigal MD  and  Andrew R Willan PhD
 
The Term Breech Trial (TBT), published by Dr. Mary Hannah in The Lancet in October 2000, appeared to definitively answer the question as to whether vaginal or caesarean birth was safer.   The trial was international, although several European countries with very high vaginal breech birth success rates declined to participate.  Criteria for "patient" participation in the study were a baby who had reached term (ie was not pre-or-post-mature), of average projected birth weight, with a frank or complete breech presentation.  Participating hospitals were required to have a significant vaginal breech birth rate in order to qualify, in order to ensure the experience and expertise of the attending obstetricians.

The trial was cut short due to what appeared to be a significantly higher risk to the vaginal birth group. This caused an international movement among obstetricians and obstetrical societies to recommend "elective" caesarean section (ie caesarean before the start of labour, usually at 38-39 weeks) to all mothers carrying a baby in breech presentation at term.
 
The Lancet 2000; 356:1375-1383
 
 
Inappropriate use of randomised trials to evaluate complex phenomena: case study of vaginal breech delivery
Andrew Kotaska, MD 
 
Kotaska suggests that for a complicated and highly variable situation such as breech birth, the method taken by the Term Breech Trial is inappropriate, and widespread acceptance of this trial's results has breached the limits of evidence based medicine.  The trial failed to adequately appreciate both the complex nature of vaginal breech delivery and the complex mix of operator variables necessary for its safe conduct, rendering the conclusion excessively simplistic and an inappropriate basis for a widespread obstetrical standard of care.
 


Five years to the term breech trial: The rise and fall of a randomized controlled trial
Marek Glezerman, MD
 
Glezerman analyzed  the original term breech trial and finds fault with the study design, methods and conclusion.  Glezerman concludes that the “original term breech trial recommendations should be withdrawn.”
American Journal of Obstetrics and Gynecology (2006) 194, 20–5
 


Is planned vaginal delivery for breech presentation at term still an option? Results of an  observational prospective survey in France and Belgium
F.  Goffinet,  M.  Carayol,  J.  Foidart,  S.  Alexander,  S.  Uzan,  D.  Subtil,  G.  Bréart
 
Researchers compared outcomes for planned cesarean and planned vaginal birth for breech  babies among 8,105 women in France and Belgium.  Of those who planned a vaginal birth, 71% were successful and there was no significant  difference in outcomes between the vaginal birth and cesarean delivery groups.
 
American Journal of Obstetrics and Gynecology, Volume  194, 
Issue  4, Pages  1002-1011
 


Term Breech Trial:  2 Year Follow Up

A questionnaire was also sent to mothers at the two year mark.  In relation to the questions that were included, there was no difference in the health of mothers.  It should be noted that the questionnaire does not appear to have included questions about VBAC (Vaginal Birth After Caesarean) attempt, failure and success rates, or secondary infertility.  The abstract may be viewed at:


Legal Rights of the Pregnant Woman
 
"Bioethics for clinicians: 12. Ethical dilemmas that arise in the care of pregnant women: rethinking "maternal–fetal conflicts"
Elizabeth Flagler, MD; Françoise Baylis, PhD; Sanda Rodgers, LLB/BCL, LLM
CMAJ 1997;156:1729-32

While not specifically about breech birth, this article refers to the relevant Canadian laws regarding the rights of the pregnant woman.  Specifically, that she may not be obliged or coerced into unwanted interventions by a caregiver who disagrees with her informed choices during pregnancy or birthing.  In particular, it is considered unethical for caregivers to state or imply that the mother's choices are selfishly endangering the baby in order to obtain consent for medical interventions.  Read this article at: