'Term Breech Trial' deeply flawed...

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Joined: 19 Oct 2005
Posts: 24
Location: Las Vegas, NV

PostPosted: Sat Feb 04, 2006 7:39 pm    Post subject: 'Term Breech Trial' deeply flawed... Reply with quote

Dear Friends,

The infamous “Term Breech Trial” (Hannah et al, “Planned cesarean
section versus planned vaginal birth for breech presentations at term.”
Lancet 2000. 21:1375-83), published five years ago, claimed that planned
cesarean was safer for breech babies than vaginal delivery. The study
had a dramatic effect; quickly it became difficult to find any OB in the
US who would “allow” a vaginal delivery for a breech baby.

Now the Green Journal (American Journal of Obstetrics and Gynecology)
has published a stinging critique that concludes the original study was
deeply flawed and its conclusions completely suspect (Glezerman M, “Five
years to the term breech trial: The rise and fall of a randomized
controlled trial.” Amer J Ob & Gyn (2006) 194, 20-5). The article,
published as a “clinical opinion” in the journal, thoroughly itemizes
the methodological flaws and clinical problems with the Term Breech
Trial. The conclusion: the recommendations of the original trial should
be withdrawn. He found that “most cases of neonatal death and morbidity
in the term breech trial cannot be attributed to the mode of delivery.”

The author is pessimistic that even withdrawal of the original study and
its recommendations will make any difference, because the
recommendations were so in line with what American obstetricians wanted
– a planned cesarean is easier and carries less legal risk for the OB.

However, even if this critique does not change hospital policy, it is
still a powerful tool for both midwives and mothers. Now we have a
paper published in a peer-reviewed journal pointing out that the term
breech trial in fact did not find any difference between vaginal and
cesarean deliveries of breech babies. Furthermore, the article
articulates some of the drawbacks inherent in randomized controlled
trials (RCTs); that not all research questions can be answered with this
“gold standard” research technique is important to understand.

One mother wrote to me: I am glad to have a refutation like this finally
published but I am deeply saddened for all the women, including my
daughter, who were forced to have c-sections based on the
now-discredited article.


Susan Hodges, “gatekeeper”
Alisa McAffee,
Waterbirth Supplies and Labor Tub Rentals in Las Vegas, NV
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