This was in the local paper yesterday.

Hospitals adopt caesareans for breech babies
Natural breech births abandoned by Vancouver hospitals because of higher
risk
Karen Gram Vancouver Sun

Pregnant women whose babies are in a breech position can no longer
expect to deliver naturally at Vancouver hospitals. Despite efforts to
reduce the number of caesarean sections in Vancouver, Canadian
obstetricians and gynecologists now recommend caesarean sections for
breech deliveries. Vancouver hospitals have adopted the guideline as
protocol.

The change follows the publication of a multi-site study of more than
2,000 breech births. The study reported that full-term breech babies
born vaginally were three times more likely than their caesarean
counterparts to suffer severe illness or die.
About three per cent of full-term births are breech.

Today, if a fetus is breech, the Society of Gynecologists and
Obstetricians of Canada recommends a trained physician attempt to
externally turn it at 37 weeks. That works in about half the cases. If
it doesn't, the mother should be offered a caesarean section and
informed of the current reasoning.
"There is overwhelming evidence that if, at term, the baby is upside
down, the interests of the baby are better served by a C-section," said
Dr. Robert Liston, head of obstetrics at B.C. Women's Hospital in
explaining why the hospital no longer recommends vaginal delivery for
upside-down fetuses. Fetuses that present sideways, with a shoulder
pointing to the cervix, already get an automatic caesarean because the
prospect of delivering a baby in this position is hazardous for both
mother and child.

Physicians have suspected for about 15 years that breech deliveries harm
the babies, says Liston, but they lacked qualitative studies to prove
it. And since caesarean births are said to be four times as likely to
lead to severe complications for the mother, vaginal births were usually
attempted with full-term breech babies.

Caesareans were also considered undesirable because they are more costly
than vaginal births. They require the use of operating rooms, longer
hospital stays and the cost of nursing, anesthetic and pediatric
services. They also require a much longer recovery time for the mothers.

Fears of maternal complications were assuaged by the study, which found
that when women are healthy, the risk of post-birth complications are no
different for those who delivered vaginally than for those who had
C-sections.
"The beauty of this latest study is that it is pretty Grade 1 evidence."
says Liston. The study was randomized, controlled and involved various
locations in North America.
Liston says the statistic suggesting a four-fold increase in
complications for the mother from a caesarean is skewed because it
includes women who had a surgical delivery because they were already
seriously ill. In the more recent study, all the women had the same
level of health at the start. Whether they had a vaginal or C-section
delivery, the incidence of complications, such as hemorrhage, infection
or injury to the birth canal, was about three per cent.

The change in policy will negatively affect efforts to reduce the
percentage of C-sections, which stands at 22 per cent in Vancouver
compared to a national average of about 19 per cent, and about 17 per
cent in rural areas, acknowledged Liston. But since it will only affect
about 1.5 per cent of full-term births, the impact is minimal, he
argued.

Besides, he said, "for me personally, the issue is not the number of
sections, the issue is the number of sections done for appropriate
reasons.  I don't know what the right number of C-sections is, but I
want to make sure women are informed and make decisions they are
comfortable with."

Liston says he doubts C-section rates will fall any further. The most
common reason for a caesarean is prolonged labour and Liston says modern
women are less and less tolerant of a long labour. They are also less
tolerant of pain, as evidenced by the increasingly common use of
epidural medication during labour, he says. About 70 per cent of first
time labouring mothers opt for an epidural in the Lower Mainland as
compared with only 15 per cent in Kelowna, where anesthetists are not on
24-hour call.

"People don't like pain and I can understand that," says Liston. The
trouble is, statistics indicate that if a woman uses an epidural, she is
more likely to have a caesarean.

             ***********************************************
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html