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Women to be offered planned vaginal breech deliveries.

Recent research has suggested that elective caesarean section (CS) for breech delivery at term is the safest option for most women. However, CS delivery is not without risks for subsequent pregnancies including life-threatening problems for mother and baby such as uterine scar dehiscence, placenta praevia or placenta accreta.

A paper published in The Obstetrician & Gynaecologist (TOG) sets out the instances when vaginal breech births could be offered, instead of c-sections. Basil van Iddekinge from Johannesburg, who authored the paper, said "Since the 'Term Breech Trial' was published in the Lancet in 2000, CS has been widely adopted as the delivery method of choice for women presenting with a persistent breech presentation at term. However, with potential risks to mothers in future pregnancies being identified, it seems reasonable to offer women the option of a planned vaginal breech delivery at term provided strict selection criteria are met."

"Whether this option is offered or not, teaching of vaginal breech delivery (and external cephalic version) must continue to remain an integral part of the trainee programme otherwise this option will not be viable in the future. It is also inevitable that vaginal breech deliveries will still occur and these may be in emergency situations that will be more difficult to manage than planned term deliveries."

Professor Neil McClure, TOG editor-in-chief said, "The caesarean section rate in the UK is high, at 25%, which is above the World Health Organization's recommended rate of between 10-15%. Whilst we would promote normal birth, there are certain instances where caesarean sections are integral to ensuring a safe birth, and pregnancies where the baby is in a breech presentation is one such example. However, this does not mean that c-sections should always be offered as there are instances where breech delivery or ECV are viable options, provided the maternity unit and doctors have the support they need to help the mother deliver successfully."

Van Iddenkinge B. Planned vaginal breech delivery: should this be the mode of delivery of choice?. TOG 2007;9:171-176.
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Title Annotation:Worldwide news
Publication:International Midwifery
Date:Sep 1, 2007
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