Term breech trial discredited.

The infamous Term Breech Trial, "Planned caesarean section versus planned vaginal birth for breech presentation at term: a randomised multicentre trial" was published in The Lancet in October of 2000. The study concluded that "planned caesarean section is better than planned vaginal birth for the term fetus in the breech presentation; serious maternal complications are similar between the groups." (1) The conclusions of this one study have resulted in routine cesarean births for all breech babies around the developed world.

Now the American Journal of Obstetrics and Gynecology has published a stinging critique that concludes the original study was deeply flawed and its conclusions unsupportable. The article thoroughly itemizes the methodological flaws and clinical problems with the Term Breech Trial and their results state that "most cases of neonatal death and morbidity in the term breech trial cannot be attributed to the mode of delivery" and that the "analysis of outcome after two years has shown no difference between vaginal and abdominal deliveries of breech babies." (2) Their powerful conclusion is that "the original term breech trial recommendations should be withdrawn."

It will be interesting to see what recommendations might emerge based on this paper in light of the results of the trial, its aftermath and the lack of evidence to support current routine cesarean for breech babies. Even if the results of the Term Breech Trial are discredited, changing practice habits of practitioners who have lost their skills and confidence around facilitating vaginal breech births will be hard to accomplish. Maybe Ina May can start doing in-services at hospitals across the country on how to manage a vaginal breech birth.

(1) M.E. Hannah, W.J. Hannah, S.A. Hewson, E.D. Hodnett, S. Saigal and A.R. Willan, Planned caesarean section versus planned vaginal birth for breech presentation at term: a randomised multicentre trial: Term breech trial collaborative group, The Lancet; Volume 356, Issue 9239, October 21, 2000, pages 1375-1383.

(2) M. Glezerman, Five years to the term breech trial: The rise and fail of a randomized controlled trial American Journal of Obstetrics and Gynecology, Volume 194, Issue 1, January 2006, Pages 20-25.