The Latest on Breech Birth
In a previous post I had written that the opinions of ACOG (American College of Obstetricians and Gynecologists) are not the “be all and end all” of legitimate opinions on safe birth.
Right on cue, ”SOGC” or the Society of Obstetricians and Gynaecologists of Canada, has issued a statement on the safety of vaginal breech birth.
ACOG, as you might know, reccommends cesarean birth for nearly all breech babies. This reccommendation is found in Committee Opinion # 265, issued in 2001; followed up by Committee Opinion #340, issued in 2007. Specifically they say in the earlier opinion ”Patients with persistent breech presentation at term in a singleton gestation should undergo a planned cesarean delivery.” They do give an exception for cases where birth is imminent when the breech is discovered, or when the breech baby is the second baby in a twin pregnancy. They further clarify in 2007 that vaginal breech might be offered a bit more freely, but “Cesarean delivery will be the preferred mode for most physicians because of the diminishing expertise in vaginal breech delivery.” Of the few care providers I know who are willing to attend a vaginal breech birth, most are unwilling to “allow” this option for first time moms.
SOGC, in their most recent statement, has cleared the way for Canadian women to pursue vaginal breech birth if the baby is a “frank” breech (the most common type) or a “complete” breech with a flexed or nuetral head, weighs between 2500 and 4000 g, the cord is not presenting first, the maternal pelvis is adequate, and there is no fetal anomally incompatible with vaginal birth. However, even in light of these restrictions, the SOGC statement specifically says that women who choose to labor despite having “contraindications” have the right to do so, and should be treated with respect and given the best care possible. In fact, this sentiment of allowing “informed refusal” is repeated several times in the paper.
In my clients, half of the cesareans are performed for breech…so I’m really hoping that some of this philosophy will rub off down here in the States.
Ugh, I liked! So clear and positively.