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More choice needed for breech births

Hospitals should offer women pregnant with breech babies vaginal births as well as caesarean sections, say experts.

A Lancet study published in 2000 suggested that elective caesarean was the safest option for most women with breech babies.

But writing in The Obstetrician and Gynaecologist, experts say that mothers-to-be should be provided full information of all the available options.

Professor of Obstetrics and Gynaecology Basil van Iddekinge says that since the Lancet study, hospitals have widely accepted elective caesarean for women presenting with breech at term as the "delivery method of choice."

He adds, however, that "it seems reasonable to offer women the option of a planned vaginal breech delivery at term provided strict selection criteria are met, delivery protocols are in place and experienced medical attendants are available at delivery."

The journal's Editor-in-chief Neil McClure said: "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 external cephalic version are viable options, provided the maternity unit and doctors have the support they need to help the mother deliver successfully."

Campaigner Jackie Drew who gave birth to a breech baby boy a month ago found it hard to decide her safest option.

"Even in the hospital people had very different opinions about how to go about it. It was very difficult to be sure how risky it would be," she says.

"You're pushed into a corner to having to have a caesarean because you'll probably have inexperienced staff for a vaginal delivery."

She adds that this is a risk not many first-time mothers are happy to take.

The Obstetrician and Gynaecologist

Your comments: (Terms and conditions apply)

"Thirty years ago I had a breech presentation. I was 30 and this was my first child. I am so glad I asked for a CS under Epidural as the umbilical cord was twice round my daughter's neck and was also pretty tight. I had to argue with two consultants as both had different views on birth delivery. I am just glad that I had some knowledge of the risk involved as no knowledge was forthcoming from medical staff" - Name and address supplied

"Because of litigation, medical and midwifery staff will always err on the cautious side and any available research that suggests one type of delivery to be more risky to mother or baby than another would be recommended with extreme caution. We have to remember that whatever criteria is used for selection, that any labour and delivery outcome in any woman is an unknown entity and that many obstetric emergencies happen with great speed and are often unpredictable. The understaffed midwifery profession at the moment are stretched enough providing care to all women and their role is becoming increasingly difficult so this climate must be stressed with great significance when informing mothers of their choices" - Name and address supplied

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