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When Is a C-Section the Best Delivery Option?


More evidence that women are choosing cesareans comes from a London study showing that one-third of female obstetricians would choose a C-section for themselves, even if there was no medical indication for one. In Brazil, the C-section rate is estimated to be as high as 60% in the general population and 90% among the most affluent women.

Breech birth is one medical indication for C-section, but not everyone agrees that it is the best way to proceed. Some obstetricians may try to turn a breech baby from the outside in a technique known as ECV, then have the woman deliver the baby vaginally. This, however, does not work in all cases.

Tom Howard, MD, a practicing specialist in complicated pregnancies in Fort Worth, Texas, says ECV has "gone in and out of fashion," over the last 15 years or so but remains a popular choice with some doctors and patients.

But a study just published in the journal The Lancet may change the minds of some doctors who still perform vaginal deliveries for full-term breech babies, study author Mary Hannah, MD, tells WebMD.

In the study of more than 2,000 women with babies in the breech position, who were randomly assigned to a planned delivery either vaginally or by C-section, the stillbirth and newborn death rate for C-section babies was three times lower. The C-section babies also had fewer serious illnesses as newborns. The results were so much better with cesarean sections, in fact, that the study was stopped early.

"The finding of much better outcomes in the planned cesarean group ... would suggest that even with experienced people [performing vaginal deliveries], planned cesarean is still better," says Hannah, of Sunnybrook and Women's College Health Sciences Center at the University of Toronto.

She says that, ultimately, the decision regarding C-sections for breech birth will be up to the mother and her obstetrician. But based on the new study, she says, doctors now have clear evidence to turn to when helping women make the decision.



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