Breech Babies Face Increased Death Risk From Vaginal Delivery

A team of researchers have found that breech babies face a 10-fold increased risk of fetal mortality from vaginal delivery than C-section.

Breech birth is when a baby's feet or buttocks are positioned to be delivered first. In the U.S., 1 in every 25 births is breech birth. This is a very complicated delivery that often results in the death of both the mother and the child. To overcome these challenges, babies in breech position can be delivered through Cesarean-section. The C-section is known to improve the neonatal outcome; however, 40 percent of the term breech births in the Netherlands are vaginal deliveries.

The new Dutch study found that vaginal delivery increases mortality risk of breech babies as compared to the C-section.

A randomized controlled trial, conducted in 2000 by Hannah et al., looked at the type of deliver on mother and infant outcomes. Once the breech trial was done, there was a significant drop in perinatal mortality among the women who underwent planned C-section as compared to those opting for elective vaginal delivery. 

Medical evidence showed that there was 94 percent rise in elective Cesarean rates and in Netherlands the rate increased from 50 - 78 percent. According to the Centers for Disease Control and Prevention, in the U.S. between 1996 and 2009, the rate of C-section increased to 60 percent and in 2012 nearly 33 percent of all deliveries were done via C-section.

"As an obstetrician, ensuring the health and safety of the mother and infant during child birth is of the utmost importance," said lead study author Dr. Floortje Vlemmix from the Department of Obstetics and Gynecology, Academic Medical Center, University of Amsterdam in the Netherlands. "Our study focuses on understanding if the increase in ceseareans following the term breech study had any impact on neonatal outcomes."

In this study, the researchers looked at 58,320 women who had term breech deliveries at Netherlands hospitals. The group included singleton term breech babies delivered between 37-42 weeks. The study, however, excluded infants who had any birth defects or stillbirths. The data was retrieved from the Dutch National Perinatal Registry, from 1999-2007, which included 96 percent of all births in the Netherlands.

The results indicated that elective C-section rates soared from 24-60 percent resulting in drop of infant mortality from 1.3/1000 to 0.7/1000.  The rate of perinatal mortality was same in group of planned vaginal deliveries. They estimated that in order to prevent one perinatal birth, there had to be 338 cesareans. 

"While elective C-section has improved neonatal outcomes there is still a good number of women who attempt vaginal birth," concludes Dr. Vlemmix. "Our findings suggest there is still room for improvement to prevent unnessary risk to the infant. We recommend using measures to turn the baby (external cephalic version) to prevent breech presentation at birth and counselling women who want to proceed with a vaginal breech birth."

The study was documented in Acta Obstetricia et Gynecologica Scandinavica.