The Oregon Health and Science University Hospital (OHSU) is taking serious steps to reduce the number of c-section births.
They not only encourage VBACs (vaginal births after c-section) but they are now one of just a handful of hospitals in America that will allow for a planned vaginal BREECH birth. (Most babies move into a head-down position by about 32-34 weeks, but some stay in a head-up and buttocks or feet-down position known as “breech.”) Breech babies in the US are almost always born via c-section.
This started happening after a large randomized controlled trial, the “Term Breech Trial,” published in 2000, concluded that in breech births a c-section is safer for the baby. This study made a huge impact; these days the skills for delivering a baby breech have all but disappeared. But the Term Breech Trial has come under serious criticism– here’s a thorough breakdown of the issues written by Henci Goer, who concludes,
“Other breech studies contradict the findings of the Hannah study [the Term Breech Trial]. For example, a systematic review reports that most studies conclude that ‘vaginal delivery is safe, given a good selection of patients, assistance by qualified staff and careful management during the delivery’ (Haheim 2004)…. Despite a stream of articles discrediting the Hannah trial, influential institutions such as the Cochrane collaboration and the American College of Obstetricians and Gynecologists have not rescinded their endorsement of planned cesarean surgery for breech.”
But things are different in Canada.
In 2009, the Society of Obstetricians and Gynecologists of Canada took these issues seriously and changed their recommendations. An automatic planned c-section for all breech babies is no longer assumed. The Breech Birth Guidelines released in 2009 state that, “In light of recent publications that further clarify the lack of long-term newborn risk of vaginal breech delivery and the many cohort reports noting excellent neonatal outcomes in settings with specific protocols, it is acceptable for hospitals to offer vaginal breech delivery.”
While as many as 25% of babies can be breech at 32 weeks, only about 3-5% are breech at the time of birth. There are ways to try and turn a baby including positioning, acupuncture and something called an external version — the midwife or doctor uses his or her hands on mom’s belly to manually turn the baby. The results of baby-turning, or spinning, are good but some remain breech and some of those babies could be good candidates for a vaginal delivery.
So I offer three serious cheers to OHSU for taking many steps towards lowering the c-section rates in the US, and for practicing evidence-based medicine even if it’s in opposition to the status quo. These are the kinds of changes other care-providers and institutions need to make.