Running head: SAFETY OF VAGINAL BREECH DELIVERY 1

Research Article on the Safety of Vaginal Breech Delivery

Stephanie Preston
English 1050
Instructor: Franny Kinslow Brewer
July 31, 2018
SAFETY OF VAGINAL BREECH DELIVERY 2

Abstract

Vaginal breech birth delivery is considered safe when attended by a highly-trained physician. In

the research, there were still many conflicting studies. The consensus was fairly split as to

whether it was safe. Looking further into many different research articles it showed that for the

most part those that believed it not to be safe did not selectively choose the clients, they were

randomized instead. The American College of Obstetrics and Gynecology’s committee opinion

number 340 helped decode many of the studies and help me come to my conclusion. Vaginal

breech birth is safe when attended by a highly-trained physician and specific strict criteria is used

when selecting clients who are eligible for a vaginal breech delivery.
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Research Article on the Safety of Vaginal Breech Delivery

Breech presentation occurs in approximately 3-4% of term pregnancies every year.

(ACOG, 2016). Vaginal breech births can be safe when attended by a trained physician and the

client has gone through a rigorous screening process. I have reviewed four peer-reviewed articles

surrounding the topic of vaginal breech delivery in out of hospital births. The following is what I

have found in support of my thesis, vaginal breech birth is safe when attended by a highly-

trained physician and the client has undergone a strict screening process to determine that

vaginal breech is the most appropriate method of delivery.

In 2000, a study was done by Hannah, M., Hannah, W., Hewson, E., Hodnett, S., Saigal,

S., & Willian, A., titled Planned caesarean section versus planned vaginal birth for breech

presentation at term: a randomised multicenter trial, nicknamed Term Breech Trial. In this

study, the authors used a large population to attempt to determine the safety of vaginal breech

birth in 121 centers in 26 countries. The study participants were randomized between vaginal

breech birth or cesarean delivery. No specific parameters were used to select the vaginal breech

candidates. The study specified that only experienced obstetricians should oversee all births but

no limitations were set on other types of interventions to be used. The Hannah et al. study (2000)

showed that planned cesarean sections were the best mode of delivery for a singleton breech due

to reduced neonatal mortality.

Shortly after the Term Breech Trial (Hannah et al., 2000) the American College of

Obstetrics and Gynecology released committee opinion No. 265 referencing the Term Breech

Trial and its findings, in committee opinion 265 ACOG recommended that planned vaginal

breech was no longer appropriate (ACOG, 2006). After Hannah et al.’s Term breech trial in 2000
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and after the ACOG committee opinion 265 several more studies were released that reexamined

the outcomes of the 2000 Term Breech Trial. (ACOG, 2006)

One of the studies that challenged the outcomes of the 2000 Term Breech Trial was the

study done by Alarab, M., Regan, Cl., O’Connell, M., Keane, D., O’Herlihy, C., & Foley, M

titled Singleton vaginal breech delivery at term: still a safe option. Alarab et al. did a similar

study to the 2000 Term Breech Trial except they used a strict criteria. Each participant had to

meet the following criteria in order to be selected to attempt a vaginal breech delivery, “1)

estimated fetal weight of 2,500-3,800 g; 2) deepest amniotic fluid pool 30 mm or more; 3)

normal fetal morphology and normal placental location; 4) absence of hyperextension of the fetal

head (an angle exceeding 90); and 5) flexed (complete) or extended (frank) breech presentation.”

(Alarab et al., 2004 pg408). They also specified that no artificial oxytocin was to be used during

a vaginal breech delivery and that external cephalic version be attempted when appropriate

(Alarab et al., 2004). The Alarab et al. study (2004) concluded that vaginal breech delivery is

still a safe option as long as a strict criterion is followed for who should and should not attempt a

vaginal breech birth and an experienced physician attends the birth. From these two studies,

Hannah et al., and Alarab et al., the difference in outcomes could possibly be attributed to the

fact that the Hannah et al. study did not follow the same guidelines when selecting candidates

and therefore the outcomes were drastically different.

One of the practice techniques mentioned in the Alarab et al. study that was not

mentioned in the Hannah et al. study was external cephalic version (ECV). ECV is the manual

rotation of a fetus while still in the womb to try to move a baby into a more favorable positon

before birth to help avoid a cesarean section (ACOG, 2016). It is estimated that 20-30% of

women who are eligible to undergo a ECV are not even being offered the option of external
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cephalic version when offering one can be the difference between the ability to have a vaginal

birth or needing to undergo a cesarean section (ACOG, 2016). In fact offering an external

cephalic version reduces the risk on a noncephalic birth by 60% (Alarab et al., 2004). In 2016

ACOG released a practice guideline suggesting that ECV be offered to all women whose babies

are in a breech presentation if there are no other contraindications (ACOG, 2016).

As stated earlier, after the study by Hannah et al. (2000) other studies were done to re-

evaluate the safety of vaginal breech birth. After the subsequent studies were done that clarified

the long-term risks, ACOG revised their committee opinion 265 and in July of 2006 they

released committee opinion 340 (ACOG, 2006). ACOG committee opinion 340 stated that the

decision about attempting a vaginal breech delivery should be determined by the experience of

the health care provider. Many health care providers are opting for cesarean deliveries because of

the dwindling expertise with vaginal breech deliveries (ACOG, 2006). One fact of importance

when reviewing the ACOG committee opinion 340 is that the opinion was reviewed and

reaffirmed in 2016, showing that no new research has emerged to sway ACOG’s opinion in a

different direction.

The research is conclusive: vaginal breech delivery is a safe option for birthing people as

long as a strict guideline is followed when selecting who is a good candidate, and when an

experienced physician is in attendance at the birth (Alarab, 2004). Many more studies still could

be done to explore vaginal breech deliveries extending into out of hospital birth versus hospital

births and the various interventions that are used.

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References

Alarab, M., Regan, C., O’Connell, M., Keane, D. O’Herlihy, C., & Foley, M., (2004) Singleton

vaginal breech delivery at term: still a safe option. The American College of Obstetricians

and Gynecologists, 103(3), 407-412.

American College of Obstetricians and Gynecologists. (2016) Practice bulletin: external cephalic

version. Obstetrics and Gynecology, 127(2), e54-e61.

American College of Obstetricians and Gynecologists. (2006) Committee opinion: mode of term

singleton breech delivery, Obstetrics and Gynecology, 108(1), 1-3.

Hannah, M., Hannah, W., Hewson, S., Hodnett, E., Saigal, S., & Willian, A. (2000). Planned

caesarean section versus planned vaginal birth for breech presentation at term: a

randomised multicenter trial. The Lancet, 356, 1375-1382.