GOLD Learning Speakers

It is no secret that vaginal breech birth can be dangerous; but can it be safe? Published in 2000, the Term Breech Trial suggested that cesarean section is markedly safer for all term breech fetuses in all clinical settings. It has led to a dramatic decrease in rates of vaginal breech birth and a reduction in the obstetrical skill set needed to attend them. Increased maternal morbidity and maternal deaths from unnecessary cesareans are now being observed. Unfortunately the Term Breech Trial protocol did not include adequate measures in the selection, intrapartum management and delivery technique to ensure safety. Larger trials with stricter safety measures have demonstrated that with a cautious protocol, breech birth can be conducted safely in appropriately supported obstetrical units. What are the important selection criteria, intrapartum management measures, and delivery techniques needed to ensure safety with vaginal breech birth? Dr. Kotaska will outline the safety deficits of the Term Breech Trial and contrast them to the practice of obstetrical units that have successfully demonstrated safe breech birth. Together with participants he will explore our understanding of the physiology of breech birth, identify key components that can compromise safety, and outline clinical measures to avoid or rectify them.

A belief that prolonged head-to-body delivery interval endangers the newborn underpins the common obstetrical practice of delivering the baby’s trunk immediately after the head is born. Without intervention, however, birth typically occurs in two steps: once the fetal head is delivered there is usually a pause, and the rest of the infant is born with the next contraction. Dr. Kotaska will discuss evidence showing that a two-step delivery does not increase the risk of fetal harm, may lower the incidence of shoulder dystocia, and should be considered physiologically normal, with implications for the definition of shoulder dystocia.