Population trends in cesarean delivery for breech presentation in the United States, 1997-2003

Abstract

Objective-To determine if cesarean delivery for breech has increased in the United States.Study Design-We calculated cesarean rates for term singletons in "breech / malpresentation" from 1997-2003 using National Center for Health Statistics data. We compared rates by sociodemographic groups and state. Multivariable logistic regression models were constructed to see if factors associated with cesarean delivery differed over time.Results-Breech cesarean rates increased overall from 83.8% to 85.1%. There was a significant increase in rates for most socio-demographic groups. There was little to no increase for mothers < 30 years. There was wide variability in rates by state, 61.6%-94.2% in 1997. Higher breech incidence correlated with lower cesarean rates, suggesting potential state bias in reporting breech. Conclusion-In the UnitedStates, breech infants are predominantly born by cesarean. There was a small increase in this trend from 1998 to 2002. There is wide variability by state, which is not explained by socio-demographic patterns, and may be due to reporting differences.

External cephalic version at term: a cohort study of 18 years’ experience

“…In 2000, the Term Breech Trial (TBT) reported a significant reduction in perinatal morbidity and mortality for breech babies delivered by planned caesarean, estimating an excess mortality of 1% with planned vaginal breech birth, and little alteration in maternal morbidity. Despite subsequent studies questioning the validity of these findings, the TBT led to a substantial rise in elective caesarean numbers for breech presentation worldwide . Nevertheless, subsequent analyses have suggested that the risk of planned breech birth is lower, and follow‐up data from the TBT revealed no reduction in the risk of death or neurodevelopmental delay in children at 2 years of age delivered by caesarean .…”

Recurrence of breech presentation in consecutive pregnancies

“…Much attention has been focussed on the optimal mode of delivery for breech-presenting babies. Following the findings of the Term Breech Trial, of fewer adverse outcomes among those delivered by planned caesarean section than by planned vaginal delivery,2 birth is now more likely to occur by caesarean section 3. Regardless of mode of delivery, there are increased risks of adverse maternal or neonatal outcomes associated with breech presentation 4,5…”

National Partnership for Maternal Safety: Consensus Bundle on Safe Reduction of Primary Cesarean Births— Supporting Intended Vaginal Births

“…Breech presentation at term can be a significant contributor to cesarean births; 85% of women with persistent breech presentations at term undergo cesarean birth . In an effort to reduce this potential effect, an opportunity exists to promote techniques to change breech presentation to vertex.…”