Feet First

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Katie Ashwill, NWHN Health Information Intern
Tue, January 11, 2011

Researchers at Tel Aviv University in Israel are advocating for the revival of breech births. Breech presentation occurs when a fetus does not adequately prepare for “delivery position,” as defined by the American Pregnancy Association, in which its head shifts near the birth canal. In breech situations, the baby is positioned with its feet near its head in a folded style, its feet directed downward toward the birth canal, or its knees crossed and curled up against its chest. Conventionally, doctors perform caesarean sections on women who are expected to give birth to breeched babies if the fetus cannot be repositioned in the weeks leading up to delivery.

External cephalic version is the common first response to modifying the fetus position during the latter half of the third trimester. This practice, usually abbreviated as version, involves a doctor---with assistance from another healthcare professional and ultrasound---physically encouraging the baby to reposition itself within its mother’s uterus. This does not always work because some stubborn babies revert back to breech position days later. Within a few weeks of delivery, it is too large to “turn” and will remain breeched for the long haul. This is the point at which obstetricians propose the C-section option.

The Tel Aviv study was published internationally this past December in various obstetric journals. The results have caused pandemonium among professionals in the field. The research indicates that breeched babies are no more at risk of complications during vaginal delivery than C-section. Although, C-Sections are common surgeries (the most common surgical procedure among women) they are more invasive than vaginal birth. C-sections can be necessary when a woman is hemorrhaging, or when the umbilical cord is in a position that cuts off oxygen to the baby, but more obstetricians are performing C-sections out of sheer personal convenience. While C-sections may be necessary for some breeched births, the research suggests that the main reason doctors favor caesarean delivery in breech presentation circumstances is because they are no longer trained to deliver babies in breech position.

Obstetric students were accustomed to this method of delivery generations ago, before C-sections were commonplace. Some say that C-sections have replaced the necessity of this training, but many scientists and practitioners disagree. As Professor Glezerman, the principal investigator in this study insists, a C-section is not just an alternative method of delivery, but a major surgical procedure. C-sections may be the prototypal approach to breech deliveries, but a vaginal breech delivery would offer women another birthing option. Many modern women choose to give birth in the home, in which case a C-section could disrupt the natural birthing process. Also, considering that it isn’t unheard of for that surprise taxi-cab delivery to be a breech-positioned baby, this option could be viable in urgent situation. Integrating breech delivery training for future obstetric students may be a standard worth exploring.






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Great blog!!

When the doctors are programmed as they are now to use c sections as common practice, it will be hard to turn this trend around. But we should for the reasons that you mention! Makes great sense to me.

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