June 11, 2014 — While breech deliveries in the U.S. are typically performed via cesarean section, a growing number of physicians in Germany are allowing women to attempt to deliver vaginally before resorting to surgery, the Wall Street Journal reports.
A fetus is considered breech if it is positioned with the feet or buttocks, rather than the head, facing down in the uterus as a woman's due date approaches. About 4% of fetuses are in the breech position at the end of pregnancy, according to the Journal. Doctors sometimes attempt to turn the fetus by strategically applying pressure to the woman's abdomen.
Although vaginal breech delivery carries the risk of the fetus' head becoming stuck in the birth canal, recent studies have shown that vaginal breech delivery can be safe under certain circumstances. The American College of Obstetricians and Gynecologists in 2012 reaffirmed its 2006 position that vaginal breech delivery is a "reasonable" option, depending on the experience of the physician, noting that studies show it is no more risky than a planned C-section if certain precautions are taken.
Further, the Society of Obstetricians and Gynaecologists of Canada has noted that vaginal births have benefits over C-sections for women, including less recovery time and better odds for future vaginal deliveries. The group cautions that a C-section may still be necessary if a vaginal delivery is not progressing properly and recommends that breech vaginal births take place in a hospital.
According to the Journal, many physicians in Germany also attest that vaginal breech delivery is an appropriate choice, as long as stringent criteria are met and an experienced physician monitors the situation. In 2012, about 8.4% of breech fetuses in Germany were delivered vaginally, an increase from 7.2% in 2009, according to an Aqua-Institute survey on German births.
However, medical professionals say a resurgence in breech vaginal deliveries is unlikely in the U.S., in part because most American physicians are not experienced with the special techniques needed for such births. In addition, a fear of malpractice lawsuits deters physicians from attempting the deliveries (Holzer, Wall Street Journal, 6/9).