Birth injuries and fetal demise are increased with breech deliveries, according to a new study published in the New England Journal of Medicine (NEJM). A “breech delivery” is one where the baby is delivered vaginally while in the breech, or feet first, position. The solution to risks associated with breech presentation is to deliver the baby via cesarean section. According to the study, C-section carries its own risks, but some of those risks involve future pregnancies.
The NEJM article reports on a study of Dutch birth registries. It found that infant morbidity and mortality rates were significantly improved following an increase in elective cesarean deliveries for infants presenting breech. Vaginal delivery of term breech infants result in almost twice as many deaths, more than twice as many depressed infants, and more than twice as much neonatal trauma.
The American College of Obstetrics and Gynecology (ACOG) recommends cesarean delivery for breech presentations unless the physician is uniquely experienced in breech deliveries. ACOG states that “cesarean delivery will be the preferred mode for most physicians because of the diminishing expertise in vaginal breech delivery.”
From the standpoint of an Ohio medical malpractice attorney, this information shows that obstetricians, like other doctors, owe a duty to fully counsel their patient about the risks of vaginal delivery with a term baby presenting in the breech position. This communication must include full disclosure of the physician’s experience in delivering breech babies as part of an informed consent discussion. If a doctor fails to discuss the risks of vaginal delivery or his/her limited experience with vaginal breech deliveries, and birth injuries (such as cerebral palsy or Erb’s palsy) or death ensue, a claim for medical negligence may arise.
The authors of the NEJM article noted that 40% of women with breech presentations still attempt vaginal delivery. Given the “relative safety of an elective cesarean,” I question whether doctors are counseling their patients fully and accurately about the risks of breech delivery.