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Trends in vaginal breech delivery
  1. Mark P Hehir
  1. Correspondence to Dr Mark P Hehir, Department of Obstetrics and Gynaecology, Rotunda Hospital, Parnell Square, Dublin 1, Ireland; markhehir23{at}gmail.com

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Approximately 3% of infants are in the breech position at delivery.1 In clinical practice, this presents challenges regarding mode of delivery, and has provoked debate involving clinicians and patients, which have been both complex and polarising. In retrospective cohort studies, breech presentation has been associated with an increased risk of neonatal mortality compared with the overall obstetric population, however, these risks have been shown to be decreasing due to improving intrapartum management of breech presenting infants.2

Owing to potential difficulties and adverse outcomes associated with vaginal breech delivery, the appropriate mode of delivery of a breech presenting infant was investigated by the term breech trial, which took place during the late 1990s.3 The trial proved to be controversial in its design as well as in its findings. The results recommended elective caesarean delivery of breech infants at term, and this practice was suggested to be associated with fewer adverse fetal outcomes than vaginal delivery of term breech infants. Further population-based studies, however, have suggested varying levels of benefit in improved outcomes compared to the term breech trial. These real-world clinical findings suggest that, in a system where vaginal breech delivery is widespread, the difference in outcomes between vaginal and caesarean delivery can be small, while these differences are more stark in a setting where the rate of vaginal breech delivery is small.4 ,5 The term breech trial was widely credited as the death knell for vaginal breech delivery, with its findings being adopted with an exceptional level of acceptance within the obstetric community and hence caesarean delivery has become the standard method of delivery for breech presenting infants. Published data, however, have suggested that a decrease in vaginal breech delivery was widespread prior …

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