« Some Midwives to be given Medicare numbers | Main | Postnatal recovery Japanese style »

Term Breech Trial discredited

There was a post on the Irish Midwifery Mailing list that caught my eye last week. Declan Devane, a midwife researcher who keep a close eye on the professional journals, posted this brief abstract about the famous Term Breech Trial, that has resulted in routine caesarean births for all breech babies around the “developed” world. The date the item appeared in the AJOG wasn’t given.

Five years to the term breech trial: the rise and fall of a randomized controlled trial.

OBJECTIVE: On the basis of the end points of neonatal morbidity and death, the authors of the term breech trial concluded unequivocally that cesarean delivery was safer for breech babies.

STUDY DESIGN: Analysis of the original and new data gives rise to serious concerns as far as study design, methods, and conclusions are concerned. In a substantial number of cases, there was a lack of adherence to the inclusion criteria. There was a large inter-institutional variation of standard of care; inadequate methods of antepartum and intrapartum fetal assessment were used, and a large proportion of women were recruited during active labor. In many instances of planned vaginal delivery, there was no attendance of a clinician with adequate expertise.

RESULTS: Most cases of neonatal death and morbidity in the term breech trial cannot be attributed to the mode of delivery. Moreover, analysis of outcome after 2 years has shown no difference between vaginal and abdominal deliveries of breech babies.

CONCLUSION: The original term breech trial recommendations should be withdrawn.

Glezerman, Marek, Department of Obstetrics and Gynecology, Wolfson Medical Center, The Helen Schneider Hospital for Women, Holon, Israel.

American Journal of Obstetrics and Gynecology.

Of course, the flaws in this trial were known at the time, and there were calls for it to be abandoned before it was finished. There was much discussion amongst the researchers in the various countries and you can read more about this on Maggie Banks’ website.

In March there will be an important international meeting in Canada to discuss Breech Birth. It will be interesting to see what recommendations emerge from this gathering, in light of the results of the trial, its aftermath and the lack of evidence to support current routine caesarean for breech babies. Even if the results of the Term Breech Trial are discredited, changing practice habits of practitioners, who have lost their skills and confidence around facilitating vaginal breech births, will be the tough ask.

For women with breech babies, getting their baby to turn will still be the best step. The article on how to do this can be found here.

Posted by andrea at January 16, 2006 03:11 PM