Grassroots Network Message 602003

Term Breech Trial flawed

 

 

Dear Friends,

 

The infamous “Term Breech Trial” (Hannah et al, “Planned cesarean section versus planned vaginal birth for breech presentations at term.” Lancet 2000. 21:1375-83), published five years ago, claimed that planned cesarean was safer for breech babies than vaginal delivery.  The study had a dramatic effect; quickly it became difficult to find any OB in the US who would “allow” a vaginal delivery for a breech baby.

 

Now the Green Journal (American Journal of Obstetrics and Gynecology) has published a stinging critique that concludes the original study was deeply flawed and its conclusions completely suspect (Glezerman M, “Five years to the term breech trial: The rise and fall of a randomized controlled trial.” Amer J Ob & Gyn (2006) 194, 20-5).  The article, published as a “clinical opinion” in the journal, thoroughly itemizes the methodological flaws and clinical problems with the Term Breech Trial. The conclusion: the recommendations of the original trial should be withdrawn.  He found that “most cases of neonatal death and morbidity in the term breech trial cannot be attributed to the mode of delivery.”

 

The author is pessimistic that even withdrawal of the original study and its recommendations will make any difference, because the recommendations were so in line with what American obstetricians wanted – a planned cesarean is easier and carries less legal risk for the OB. 

 

However, even if this critique does not change hospital policy, it is still a powerful tool for both midwives and mothers.  Now we have a paper published in a peer-reviewed journal pointing out that the term breech trial in fact did not find any difference between vaginal and cesarean deliveries of breech babies.  Furthermore, the article articulates some of the drawbacks inherent in randomized controlled trials (RCTs); that not all research questions can be answered with this “gold standard” research technique is important to understand.

 

One mother wrote to me: I am glad to have a refutation like this finally published but I am deeply saddened for all the women, including my daughter, who were forced to have c-sections based on the now-discredited article.

 

Sincerely,

Susan Hodges, “gatekeeper”

 

=================================================================

SHARE WITH OTHERS IN YOUR AREA! 

Feel free to forward the Grassroots Network messages to others who might be interested!

 

HOW TO JOIN THE GRASSROOTS NETWORK LIST

Visit the Citizens for Midwifery website at www.cfmidwifery.org . 

Scroll to the bottom of the page and enter your e-mail address.  It's that simple!

 

GET INVOLVED!

Are you interested in volunteering with some dynamic women in a supportive environment?

Help CfM promote the Midwives Model of Care!

We have many ways to get more involved ~ committees, state and regional representatives,

and smaller tasks that will help CfM grow stronger and become more effective.

Get in touch with us!

=================================================================