Obstetricians debate whether Caesarean section is always best for breech babies

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About 32 weeks into her first pregnancy, Christie Craigie-Carter's obstetrician told her that the baby she was carrying was ... breech ... and that she'd have to give up her dream of a natural delivery and have a Caesarean section instead.

Desperate to avoid surgery, Craigie-Carter said she wanted to deliver the baby naturally anyway, but her doctor told her that such a procedure was simply too dangerous. "She said I wouldn't find a obstetrician on the East Coast who would deliver a breech baby vaginally," recalled Craigie-Carter.

When she asked her obstetrician to try to turn the baby into a head-down position ... Craigie-Carter was told that such a maneuver might endanger the baby's life ...

Craigie-Carter went into labor just before her due date and her son Joshua was delivered -- via C-section ...

Her experience highlights a debate over whether breech babies should always be delivered by C-section or whether there are cases where a natural delivery is a safe option.

In the United States, such babies are routinely delivered by C-section, in large part because of an international study ... that found breech babies faced greater risks when delivered naturally. But the issue has received fresh attention following the decision last June by the Society of Obstetricians and Gynaecologists of Canada to reverse past opposition to natural deliveries and suggest that "planned vaginal delivery is reasonable in selected women."

The American College of Obstetricians and Gynecologists remains firmly opposed to vaginal deliveries of breech babies ... Yet some obstetricians believe that breech delivery is reasonable in certain cases and bemoan the loss of this skill among obstetricians trained today.

"When I started in residency [in the late 1970s] we did not do C-sections on breeches at all; it was normal to have a vaginal breech," said Michael Hall, 59, an obstetrician- gynecologist in Colorado. He has done about 300 vaginal breech deliveries in his career and continues to do them for carefully selected pregnancies: when labor has been normal, the baby is not too big or in the footling position, and the width of the mother's pelvis is adequate.

In a January 2006 article, Marek Glezerman, head of obstetrics and

gynecology ... argued that the study's recommendations should be withdrawn because most of the deaths or post-birth problems reported in the research "cannot be attributed to the mode of delivery." Glezerman reported that the study included cases of planned vaginal deliveries of breech babies when "there was no attendance of a clinician with adequate experience." ...

The second article ... found that "when strict criteria are met before and during labor," planned vaginal delivery of singleton fetuses in breech presentation at term remains a safe option that can be offered to women."

Fischbein, a California obstetrician ... has delivered about 200 breech babies vaginally but in August was told by his hospital to stop. "The bottom line is litigation mitigation and economics," he said.

Regardless of expert guidelines, the reality is that few doctors who graduated in the last decade have the skills to deliver breech babies naturally. Lawrence said American medical students are taught the theory behind vaginal breech deliveries and have access to computer simulation training, but exposure to real cases is limited to residents who happen to be on call when a mother presents with a breech baby in advanced labor and it is too late to perform a Caesarean.

Craigie-Carter, for one, would approve of that approach. After Joshua was born, she went on to have two more breech babies. The first was delivered by C-section. But for the second one, she found a skilled midwife near her New York home who was willing to help her deliver naturally. Her son Ryan was born without complications.

Melissa Maimann, Essential Birth Consulting 0400 418 448