Breech babies have higher risk of death from vaginal delivery compared to C-section

August 11, 2014

While a rise in cesarean section (C-section) delivery rates due to breech presentation has improved neonatal outcome, 40% of term breech deliveries in the Netherlands are planned vaginal deliveries. According to a new Dutch study that is published today in Acta Obstetricia et Gynecologica Scandinavica, a journal of the Nordic Federation of Societies of Obstetrics and Gynecology, there is a 10-fold increase in fetal mortality in vaginal delivery for breech presentation compared to elective C-section.

Up to 4% of deliveries are breech births—when the baby is delivered buttocks or feet first, instead of in the head-first position. A 2000 study by Hannah et al. was the largest, randomized controlled trial to examine the type of deliver on mother and infant outcomes. After the term breech trial reported a significant decrease in perinatal mortality among women who had a planned C-section compared to those opting for elective , C-section rates increased dramatically.

In fact, medical evidence found that following publication of the term breech trial results, elective cesarean rates in Australia increased to 94% (2008) and in the Netherlands that rate rose from 50% to 78%. In the U.S., the overall cesarean rate climbed nearly 60% from 1996 to 2009 and in 2012 was at 33% of all deliveries according to the Centers for Disease Control and Prevention (CDC).

"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."

For this retrospective study, researchers studied 58,320 women who had term breech deliveries at hospitals in the Netherland. The group included singleton term breech babies delivered between 37 and 42 weeks, but excluded infants who had any birth defects (congenital malformations) or stillbirths (antenatal death). Researchers used data from the Dutch national perinatal registry from 1999 to 2007, which includes 96% of all births in the Netherlands.

Findings indicate that elective C-section rates increased from 24% to 60%, resulting in a decrease of infant mortality from 1.3/1000 to 0.7/1000. Perinatal mortality remained the same in the group of planned vaginal deliveries. Researchers determined that there needed to be 338 cesareans to prevent one perinatal death. Further analysis could not identify pregnancy related factors that placed women at low versus high risk of poor neonatale outcome during vaginal breech birth.

"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 at birth and counselling women who want to proceed with a vaginal breech birth."

Explore further: Vaginal delivery as safe as cesarean for most early preterm births

More information: "Term Breech Deliveries in The Netherlands: Did the Increased Caesarean Rate Affect Neonatal Outcome? A Population Based Cohort Study." Floortje Vlemmix, Lester Bergenhenegouwen, Jelle M. Schaaf, Sabine Ensing, Ageeth N. Rosman, Anita C.J. Ravelli, Joris A.M. van der Post, Arno Verhoeven, Gerard H. Visser, Ben Willem M. Mol and Marjolein Kok. Acta Obstetricia et Gynecologica Scandinavica; Published online: August 11, 2014. DOI: 10.1111/aogs.12449

Related Stories

Vaginal delivery as safe as cesarean for most early preterm births

August 6, 2012
Vaginal delivery for early preterm fetuses presenting head first, or vertex presentation, had a high rate of success with no difference in neonatal mortality compared to cesarean delivery, a new study published in the American ...

Study finds planned C-sections provide no advantage over planned vaginal birth of twins

February 11, 2013
In a study to be presented on February 14 at the Society for Maternal-Fetal Medicine's annual meeting, The Pregnancy Meeting, in San Francisco, researchers will report findings that suggest that planned birthing of twins ...

Anesthesia increases success rates of turning breech babies, reduces delivery costs, study finds

April 18, 2013
(Medical Xpress)—When a baby is in the breech position at the end of pregnancy, obstetricians can sometimes turn the baby head-down to enable a safer vaginal birth. In the past, women were not given anesthesia during the ...

Recommended for you

First time mums with an epidural who lie down more likely to have a normal birth

October 18, 2017
Adopting a lying down position rather than being upright in the later stages of labour for first-time mothers who have had a low dose epidural leads to a higher chance of them delivering their baby without any medical intervention, ...

Mice delivered by C-section gain more weight than those delivered naturally

October 11, 2017
Mice born by Caesarian section gained on average 33 percent more weight in the 15 weeks after weaning than mice born vaginally, with females gaining 70 percent more weight.

Study shows epidurals don't slow labor

October 10, 2017
Epidural analgesia - a mix of anesthetics and narcotics delivered by catheter placed close to the nerves of the spine - is the most effective method of labor pain relief. In widespread use since the 1970s, epidurals have ...

Progesterone does not prevent preterm birth or complications, says study

October 3, 2017
An increasingly popular hormonal "treatment" for pregnant women with a history of preterm birth does not work, a major new international study shows.

Study questions practice of placenta eating by new moms

September 29, 2017
(HealthDay)—You may have heard that some new mothers choose to eat their own placenta after childbirth. But there's no indication the trendy practice offers any health benefits, and some evidence it could prove dangerous, ...

Hope for couples suffering IVF miscarriage

September 20, 2017
Women who miscarry during their first full round of IVF are more likely to have a baby after further treatment than women who don't get pregnant at all.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.