Vaginal Breech Delivery at Term: the Doctors' Dilemma

"When an operation is once performed, nobody can ever prove that it was unnecessary". The Craze for Operations from The Doctor’s Dilemma: Preface on Doctors by George Bernard Shaw, 1909. Breech presentation complicates 3-4% of deliveries at term and it is associated with an increased risk of perinatal mortality and morbidity. The increased fetal risks may be due to the hypoxia or trauma associated with a vaginal delivery, but this can be minimised if cases suitable for vaginal delivery are carefully selected and labour is supervised by experienced clinical staff. The increased fetal risk may also be due to other causes, such as congenital malformations, which are independent of the mode of delivery. Before 2000, the elective caesarean section (CS) rate for breech presentation had been rising as obstetricians attempted to avoid the fetal risks associated with vaginal delivery