One thing a pregnant woman doesn't want to hear is that her fetus is in the breech position. In the United States, at least, having a baby who wants to come out feet first is an almost certain prescription for a cesarean section.
But that’s not true all over the world. In the Netherlands, for example, 40 percent of mothers who know their babies are in the breech position still attempt a vaginal delivery. This is risky: Ten times as many breech-positioned babies die when delivered through the vagina than via C-section.
A group of researchers at the University of Amsterdam were concerned that many women in their country weren't opting for a C-section even when their fetus was facing the wrong way: “We had some indications that the C-section rate for breech presentation at term had not risen as much in the Netherlands as in other countries,” says Floortje Vlemmix, a resident in the university’s obstetrics and gynecology department. “We wanted to investigate whether neonatal outcome had improved due to the rise in C-section, and if there was still room for improvement.”
Babies born by C-section are less likely to breastfeed and more likely develop asthma, allergies, and obesity—and may even have psychological problems associated with their birth.
In short, they wanted to confirm whether increasing the popularity of surgical deliveries would help more babies survive.
The researchers gained access to the Netherlands Perinatal Registry, which tracks almost all of the country’s pregnancies and births—women voluntarily grant access to their data when they go in for prenatal care. The researchers were particularly interested in a subset of about 58,000 women who carried singleton breech fetuses between 1999 and 2007, and gave birth between 37 and 41 weeks’ gestation.
The resulting study, published earlier this month in Acta Obstetricia et Gynecologica Scandinavica, found that a seminal report called the Term Breech Trial—which was published in 2000 and had a “worldwide impact” on how doctors deal with breech babies—caused a marked uptick in the number of C-sections performed on Dutch women carrying breech babies: The number jumped from 24 percent to 60 percent. In that group, the mortality rate for babies fell. But in the shrinking (but still significant) group of mothers who chose to deliver their breech babies vaginally, the mortality rate of the newborns stayed almost exactly the same.
Granted, a C-section is a major surgery with a long recovery time and possible negative effects on both mother and baby. As the study says, “The relative safety of an elective cesarean should be weighed against the consequences of a scarred uterus in future pregnancies.” Other recent studies have shown that babies born by C-section are less likely to breastfeed and more likely develop asthma, allergies, and obesity—and may even have psychological problems associated with their birth.
Still, this study’s results are unequivocal about the fact that an elective C-section is still the best choice for a breech baby, since a vaginal delivery could kill the infant. “C-section is the safest mode of delivery for the breech presenting baby at term," Vlemmix says, "and that should be discussed with all women.”
Rosie Spinks contributed reporting.