PRO & CON.

Should planned cesarean section be standard for all singleton breech babies?

YES Planned cesarean section should be standard for all singleton breech babies at term.

The Term Breech Trial, in which I served as an investigator, clearly shows that planned cesarean section is much safer than planned vaginal delivery. I have completely changed my practice as a result of this trial (Lancet 356[9239]:1375-83, 2000).

Only if a cesarean section poses potentially fatal risks for the mother is it reasonable to consider a planned vaginal delivery for a single breech baby at term. For example, in a letter published in the Lancet a doctor in Gambia said that a planned C-section for a breech baby in that country could have dangerous consequences, noting that once a woman has a C-section--for a breech baby or any other reason--she is at risk for uterine rupture in future pregnancies. That risk is especially great in Gambia, where women often have six to eight pregnancies and give birth at home.

The Term Breech Trial has been questioned by some because it spanned so many countries. But in fact, this is one of its strengths because the results are widely generalizable.

Critics have argued that results obtained in countries with high perinatal mortality are not applicable to the United States. This is simply not true.

When comparing results from countries a high perinatal mortally rate--defined as more than 20 deaths per 1,000 births--with countries that have lower rates, the safety of planned cesarean over planned vaginal birth remains striking in both groups.