Here's a good recent article: Alan T.N. Tita, et al, "Timing of Elective Repeat Cesarean Delivery at Term and Neonatal Outcomes," New England Journal of Medicine 360 (January 8, 2009): 111-120.

This article cautions that even delivering at 38 weeks by cesarean is associated with respiratory and other adverse neonatal outcomes. Since gestational age estimates can easily be off by a week or two, scheduling a c-section at 39 weeks is risky. This mother certainly has a right to ask for a delay in the timing of the c-section. Or alternatively: can she find a doctor to turn the baby? Or find an older physician who is adept at vaginal breech births?

These types of dilemmas increasingly faced by mothers indicate the need for women to clamor for obstetric residents to learn how to deliver breech babies vaginally. So much knowledge is being lost and recent studies indicate that vaginal breech deliveries can be as safe as elective cesareans. If we now can "choose" an elective cesarean what happened to our ability to choose a vaginal breech birth? As breastfeeding advocates, we all have to be concerned about the seemingly endless increase in the c-section rate. The way babies are born certainly affects breastfeeding success.

You should encourage this mom to simply let her doctor know what she wants and why she wants it. Patient's wishes trump the doctor's wishes. All medical students learn this during their first weeks in medical school.

Jackie Wolf
Professor
Department of Social Medicine, Ohio University

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