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Bringing Back Vaginal Breech Birth


Since 2006, a central focus for us has been on bringing back vaginal breech birth.  Betty-Anne had attended vaginal breeches internationally prior to doing them at home in the 1980s and at the Riverside Hospital in Ottawa under obstetric supervision in the early 1990s.  She now has full breech privileges at the Montfort Hospital, where she attends vaginal breeches as the primary care provider without transfer to obstetrics. 
 
As Canadian researchers working internationally, we were the principal investigators on a study called,
Does breech delivery in an upright position instead of on the back improve outcomes and avoid caesareans? in which we compared the upright position (kneeling, on hands and knees, or standing) to vaginal delivery on the back in Frankfurt, Germany for the years 2004-2011.  It was published in November 2016 and online in February 2017.
 
 In 2014 we also worked on an article with Anke Reitter as the lead author called "Does Pregnancy and/or Shifting Positions Create More Room in a Woman's Pelvis?" in which we compared 50 pregnant and 50 non-pregnant women taking a kneeling crouched position and then supine position that demonstrated that the measurements of the pelvis shift, indeed are quite dynamic depending on the position of the mother.
Download the fist two pages of the article (PDF)

In 2010, we published the study and commentary on the state of vaginal breech in Canada and Europe entitled Evolving Evidence Since the Term Breech Trial: Canadian Response, European Dissent, and Potential Solutions. View the abstract below

 

How to Best Study Breech

In May 2015 Lyons et al. published a Canadian registry study in the Journal of the American College of Obstetrics and Gynecology, entitled Delivery of Breech Presentation at Term Gestation in Canada, 2003–2011.
Download the fist two pages of the article (PDF)

Betty-Anne wrote a letter to the journal about it, edited by Savas Menticoglou (co-author of the SOGC guidelines on breech birth) and Andrew Bisits, head of Obstetrics at the Royal Women's Hospital in Sydney, but upon waiting for the feedback from the two obstetricians, the letter to the editor arrived later than the others and the editors did not publish it. Although the Editors suggested that instead, we write a commentary, we were too busy with getting out the Frankfurt article to go back to do so. As we think the letter provides an important perspective.
Download the letter to the editor (PDF)

We have concerns both about Randomized Controlled Trials (see Evolving Evidence Since the Term Breech Trial), and in registry studies for different reasons (see introduction and discussion in "Does breech delivery in an upright position instead of on the back improve outcomes and decrease cesarian section?". We will elaborate on this further in the future.

 

Conference History

In 2009, Betty-Anne organised the scientific program for an extremely successful two-day Breech Birth Conference and one-day Breech Birth Workshop in Ottawa in 2009 that attracted over 250 midwives, OBs and mothers. The overallConference was organised by the small but mighty Ottawa-based Coalition for Breech Birth. It really changed Ottawa because it was hard to ignore experts from around the world saying the same thing, "Let's Make Vaginal Breech Birth Available Again," but with a NEW APPROACH. 

Then, again with Betty-Anne as the scientific coordinator and the Coalition for Breech Birth, led by Robin Guy, we organised another 2-day breech conference in Washington, D.C. in 2012.  

In 2012 we were invited to speak at a breech conference in Sydney and travelled on to Melbourne and Warrnambool on the south coast of Australia, with Frank Louwen and Jane Evans: The world agrees: breech births not the risk they were.

Betty-Anne has done workshops and presentations on breech birth at obstetric units or conferences in Argentina, Australia, China, Czech Republic, Germany, Ireland, the Netherlands, Norway, and in the U.S. (in Denver, New York City, Portland, Oregon, Washington D.C.), and in Canada (in Calgary, Montreal, Ottawa, Toronto, Vancouver, and Winnipeg) and acted as the scientific coordinator for the last two international breech birth conferences in Ottawa, Canada, and Washington, DC. She has also conducted full day workshops at Ryerson University as well as Grand Rounds at Michael Garron Hospital.



Evolving Evidence Since the Term Breech Trial: Canadian Response, European Dissent, and Potential Solutions.
J Obstet Gynaecol Can. 2010 Mar;32(3):217-24.
Daviss, BA, Johnson, KC, Lalonde A.

Abstract

Objectives: We wished to gain insight into Canadian hospital policy changes between 2000 and 2007 in response to (1) the initial results of the Term Breech Trial suggesting delivery by Caesarean section was preferable for term breech presentation, and (2) the trial’s two-year follow-up and other research and commentary suggesting that risks associated with vaginal breech delivery and delivery by Caesarean section were similar. We also wished to determine the availability of vaginal breech delivery and the feasibility of establishing breech clinics and on-call squads, and whether these could include midwives.

Methods: In 2006, we sent surveys to the 30 largest maternity centres in Canada asking about their changes in practice in response to results of the initial Term Breech Trial and the subsequent two-year follow-up and the possibility of establishing breech clinics and on-call delivery squads and whether they could include midwives.

Results: Of the 30 surveys sent, responses were received from 20 maternity centres in six provinces. Hospitals were almost five times more likely to adopt a policy of requiring Caesarean section for breech delivery when current evidence suggested that it decreased risk for the neonate than they were to reintroduce the option of vaginal breech delivery when it did not. A breech clinic was considered possible, feasible, and desirable by only one centre, and forming a breech squad was similarly regarded by only two hospitals; 70% of respondents, however, did not entirely dismiss either possibility.

Conclusions: The weight of epidemiologic evidence does not support the practice developed in Canadian hospitals since the Term Breech Trial that recommends delivery by Caesarean section for all breech presentations. Obstetric and midwifery bodies will require creative strategies to make clinical practice consistent with current national and international evidence.

View the full text

 


Newly developed Canadian Guidelines for breech birth from the Society of Obstetricians and Gynaecologist of Canada recommend vaginal breech birth as a preferred option when criteria are met.



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