What's one of the worst things a baby can do to a mother (and her partner) at the time of delivery? It decides to be born feet or bottom first, rather than head first. Wrong-way birth is called breech birth, and it can have major health consequences for the baby. Women and their partners should never make a hasty or emotional decision on whether or not to have a cesarean section.
The Society of Obstetricians and Gynecologists of Canada (SOGC) recently stated doctors should no longer opt for cesarean section for breech birth.
This decision is adding fuel to the fire for organizations who want women to have the personal right for vaginal delivery even for breech births.
What are the possible hazards of vaginal birth when the fetus is out of position?
For several years, vaginal delivery was considered too dangerous in this case and cesarean section became the preferred choice of doctors. Medical schools have therefore not trained young doctors about the technique of breech delivery. In addition, many older doctors with this expertise have either died or retired.
TRAINING PROGRAM
If I were a woman, I would not agree to fly with an inexperienced pilot. Nor would I want to have a wrong-way baby delivered by a doctor who lacked expertise.
To correct this shortage, the SOGC says there will be a national training program. I wish the SOGC and patients luck for this is easier said than done.
First, there are few doctors who can teach this technique. There are also few cases in university hospitals as only 3%-4% of births are wrong-way births. It also takes many breech deliveries for doctors to become proficient. And how will they teach doctors already in practice?
But let's assume this monumental task can be accomplished. There's another major problem, lawyers. Litigation lawyers must be rubbing their hands in glee -- it was in part because of law suits that vaginal breech deliveries were largely discontinued years ago.
What will lawyers (and willing patients) be looking for following a wrong-way delivery? They will be looking for a baby that is not perfect and has been injured in some way by vaginal birth. And asking why the doctor didn't choose cesarean delivery.
The real tragedy is a baby who has been severely brain-damaged in childbirth. A baby whose feet and buttocks were delivered first without trouble, but the fetal head, larger than expected, became stuck in the bony birth canal causing a traumatic wrong-way delivery. All too often in the past this has caused brain injury and families have sued for millions of dollars.
I have no crystal ball, but I believe this guideline issued by the SOGC will have limited success with huge economic costs.
Women and their partners who want the right to "catch" their baby should also be willing to sign a legal document that they also accept the possible complications. I realize that cesarean section poses a risk of infection and other surgical problems. But I'd beg for a cesarean section after what I have personally observed over the years.
But, as always, these decisions must be between patient and doctor.
W. Gifford-Jones, MD is the pen name of Dr. Ken Walker, graduate of Harvard Medical School. Diana Gifford-Jones is his daughter, a graduate of Harvard Kennedy School. Their latest book, “No Nonsense Health” is available at: Docgiff.com
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