Friday, June 19, 2009

Vaginal Breech Birth & SOCG

The Society of Obstetricians & Gynecologists of Canada (SOGC) has made a shocking announcement this week: to not only offer vaginal breech birth but to also establish training programs nationwide so physicians can once again become skilled in this lost art. From this article

Physicians should no longer automatically opt to perform a cesarean section in the case of a breech birth, according to new guidelines by the Society of Obstetricians and Gynecologists of Canada.

The new approach was prompted by a reassessment of earlier trials. It now appears that there is no difference in complication rates between vaginal and cesarean section deliveries in the case of breech births.

“The safest way to deliver has always been the natural way,” said Dr. Lalonde.

“Vaginal birth is the preferred method of having a baby because a C-section in itself has complications.”

The article goes on to cover the disadvantages of a c-section, which are so often ignored:

Cesarean sections, in which incisions are made through a mother's abdomen and uterus to deliver the baby, can lead to increased chance of bleeding and infections and can cause further complications for pregnancies later on.

“There's the idea out there in the public sometimes that having a C-section today with modern anesthesia and modern hospitals is as safe as having a normal childbirth, but we don't think so,” said Dr. Lalonde.

“It is the general principle in medicine to not make having a cesarean section trivial.”

And the true kicker that sets apart SOGC from ACOG:

The SOGC believes that if a woman is well-prepared during pregnancy, she has the innate ability to deliver vaginally.

I have to say I'm somewhat shocked at this turn of events. While eliminating universal c-sections for breech is a great strategy for reducing overall c-section rates, it's still a bit stunning to see such an organization reach the same conclusion, and then take the necessary steps to see it happen. No muss, no fuss. Simple, direct, evidence-based, effective.

I do think that last quote has quite a bit to do with it. At the heart of the matter, SOGC realizes that women can and will give birth with or without them, so it's advantangeous to them all to foster good relationships based upon respect and acknowleding their autonomy to make their own health care decisions, which means offering alternatives to automatic abdominal surgery when it's not needed.

This strikes at the heart of the differences between ACOG and SOGC - ACOG does not let evidence drive their decisions nor do they believe in womens' innate ability to deliver vaginally when well prepared. And it shows in our birth outcomes. Lucky us.


Jennifer said...

WOW! That is such an interesting article! I wonder if they have made any advancements to actually put this into practice - wouldn't that be something! Thank you so much for the information!

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