Changes to Care for Moms with Breech Pregnancies

The standard of care in Canadian hospitals since 2000 has been to deliver all breech babies by caesarean section. This method of delivery was based on solid research which showed the risks for potential harmful outcomes to the baby were too high for vaginal delivery. The Society for Obstetricians and Gynegologists of Canada has recently announced that this standard care will be reversed.

It is a basic premise of mechanics. The largest part of a fetus is the head-- and breech babies have their heads delivered last. There is always a risk that the head will prove too large for the mother's pelvis which results in fetal death and dismemberment as well as major injury to the mother during attempts to save the baby.

The other harsh reality is that delivery with best outcomes for mom and baby requires genuine finesse and loads of experience-- neither of which is easily found in our latest generation of obstetricians. They haven't seen or done enough breech deliveries to be good at it.

As a labour and delivery nurse in her third decade of experience, I have seen the time where breech pregnancies were delivered without a c-section. I have also seen babies severely compromised in the process when the obstetrician is not skilled enough to do it.

Two issues present themselves in the world of medical liability:

1. Will mothers be completely informed and truly understand the risks their babies face? If a delivery goes very wrong during this period of attempting to reduce the c-section rate by any means possible, can the defence argue against years of evidence that planned c-section delivery is best for the baby's safety?

2. Thousands of women were not given the choice in the type of delivery. Does this mean they have grounds to question that lack of options should obstetricians return to vaginal delivery of term breech pregnancies?

Breech deliveries are high risk, even in the operating room babies can have a traumatic delivery, cases presenting themselves over the next few years will require specialized expertise to determine if every possible factor was considered before the method of delivery was determined.