Evidence for the safety of physiologic vaginal breech birth

Question 1

What are the 5 categories of safety to consider when asking the question: Is Vaginal Breech Birth Safe?

Answer 1

1) Short term safety for baby (late pregnancy, labor and birth)
2) Long term safety for baby (ie. childhood/adolescence)
3) Short term safety for mom (labor and birth)
4) Long term safety for mom (rest of reproductive years + future pregnancies/births)
5) Safety for mom’s future child/children

Question 2

Who is vaginal breech birth slightly riskier for in the short term and why?

Answer 2

The baby

Question 3

What helps mitigate the short-term risks of vaginal breech birth?

Answer 3

The experience of the provider is inversely correlated with the short-term safety risk to the baby associated with vaginal breech birth

Question 4

What was the difference found in PNM/NNM between the pVBB and pCS groups in the Term Breech Trial (2000)

Answer 4

pVBB = 13 deaths per 1000
pCS = 3 deaths per 1000

Question 5

What are some of the critiques associated with the Term Breech Trial?

6 critiques listed

Answer 5

• Randomization occured at birth in many cases
• high rates of non-participation
• 20% of participants did not have a skilled breech provider
• > 30% of the centers had no access to US to confirm head flexion
• inconsistent labor management
• suboptimal standards of care

Question 6

What was the difference found in Neonatal Morbidity between the pVBB and the pCS groups in the TBT (2000)?

Answer 6

pvBB = 3.8 per 1,000
pCS = 1.4 per 1,000

Question 7

In the TBT what were the measures of neonatal morbidity?

Answer 7

Seizures, serious birth trauma, extremely low 5-min APGARs, intubation, ventilation for over 24 hours and long NICU stays

Question 8

What are the RCOG (Royal College of Obstetricians and Gynecologists) estimated stats for risk associated with planned C-section

Answer 8

0.5 in 1,000

Question 9

What are the RCOG (Royal College of Obstetricians and Gynecologists) estimated stats for risk associated with planned cephalic vaginal birth

Answer 9

1 in 1,000

Question 10

What are the RCOG (Royal College of Obstetricians and Gynecologists) estimated stats for planned vaginal breech birth

Answer 10

2 in 1,000

Question 11

What were the results of the 2 year follow up study to the TBT?

Answer 11

This study, which measured long term outcomes of baby’s born in the TBT at two years of age, found no differences between the two groups (pvBB and pCS) in terms of risk of death and neurodevelopmental delay