Planned vaginal breech delivery: current status and the need to reconsider

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Vaginal delivery of a breech baby is a necessary obstetrical skill since approximately 4% of babies at term are in breech presentation. Yet, on most delivery wards, the expertise required to deliver breech babies vaginally has virtually disappeared. Patients and obstetricians should be aware that there is no convincing evidence that cesarean section is better for the breech baby than assisted vaginal delivery, provided that certain strict criteria are met, and that cesarean section is associated with a higher risk of morbidity and mortality for the parturient than vaginal delivery. In addition, repeated cesarean sections carry additional substantial health risks for parturients. A trial of external cephalic version should be offered to all parturients who do not have contraindications for this procedure. Supraregional centers that specialize in breech delivery should be organized and basic simulator training for residents should be provided. In addition, a system of suprainstitutional standby teams of experienced obstetricians should be established to provide expertise in planned vaginal delivery.

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