Doctors in position for surgical births.

Byline: The Register-Guard

As the number of Caesarean sections has grown over the past decade, the risk of the surgery has decreased - a benefit to mothers and babies who may die without the procedure. Advances in technology, along with the technique and skill of surgeons, have increased the safety of the C-section.

But that phenomenon has caused the practice of vaginal breech delivery to wane.

Historically, dozens of maneuvers have been used to deliver babies in any position: the Mauriceau-Smellre-Veit move is used for breech babies whose heads are trapped; the Woods corkscrew when a baby's shoulder won't budge.

In 2004, 29.1 percent of all births were delivered surgically, up from 20.7 percent in 1996, according to the National Center for Health Statistics.

Only about 10 percent of births actually require surgery, suggesting that more mothers are simply choosing to deliver that way, perhaps unnecessarily, said Eugene naturopathic gynecologist and retired obstetrician Dr. Jan Stafl.

Parents, not doctors, are creating the demand for Caesareans, said obstetrician Dr. Brant Cooper.

"The C-section rate is not being driven by the obstetricians - the ironic thing is patients are driving up those rates," Cooper said. "The public is overwhelmingly telling us that we take too many chances with babies."

In a July 2006 study, the American College of Obstetricians and Gynecologists recommended Caesarean section for doctors delivering breech babies. It found that 1.6 percent of breech babies died during a scheduled C-section, while 5 percent died during a vaginal delivery.

But the reason it called for C-section in breech births was not tied to an inherent risk involved with vaginal breech deliveries - the study found that doctors today lack the experience and expertise to perform vaginal breech deliveries.

"Even in academic medical centers where faculty support for teaching vaginal breech delivery ... remains high, there may be insufficient volume of vaginal breech deliveries to adequately teach the procedure," the study said.

Midwives say their experience has kept them up on the art of vaginal breech delivery.

Their skill, they say, must remain alive to provide options for mothers who do not want surgery.

Doctors and midwives have divergent perspectives on the best way to handle risky births because of the wildly different training, said Holly Scholles, vice chairwoman of the state Board of Direct Entry Midwifery, which oversees licensed midwives.

"If you work in a hospital, Caesarean sections feel really safe to you, because you do them all the time," Scholles said. "And for midwives, vaginal breeches feel more comfortable because we do them all the time."

- Andrea Damewood