* The decision regarding the mode of delivery should depend on the experience of the healthcare provider. Cesarean delivery will be the preferred mode of delivery for most physicians because of the diminishing expertise in vaginal breech delivery.
* Planned vaginal delivery of a term singleton breech fetus may be reasonable under hospital-specific protocol guidelines for both eligibility and labor management.
Interestingly, ACOG's counterpart in Canada, the SOCG, has taken a stronger stance in support of vaginal breech birth at term. The SOCG now recommends revising their undergraduate and postgraduate training requirements to include theoretical and hands-on vaginal breech skills, and to promote training of current health care providers in those skills as well. In their 2009 clinical practice guidelines titled, Vaginal Delivery of Breech Presentation, labor selection criteria, contraindications, and labor management guidelines are offered. However, most impressive is SOCG's perspective regarding a woman's autonomy and the expectation of how the facility and staff should honor her wishes.
"Women with a contraindication to a trial of labour should be advised to have a Caesarean section. Women choosing to labour despite this recommendation have a right to do so and should not be abandoned. They should be provided the best possible in-hospital care."
Breech presentation is considered by some to be a variation of normal, and for others as a high-risk scenario. Evidence shows that it does carry more risk than vertex presentation and it is vital to address those risks during the informed choice discussion. According to SOCG, even with careful case selection and labor management, perinatal mortality occurs in approximately 2 per 1000 births and serious short-term neonatal morbidity in approximately 2% of breech infants. However since long-term neurological infant outcomes do not differ by planned mode of delivery even in the presence of serious short-term neonatal morbidity, it is reasonable for some women to seek a trial of labor. No suitable candidate should be forced to birth via major abdominal surgery without offering a trial of labor. Neither should a woman be forced into a lower resource birth setting (giving birth out-of-hospital) due to a lack of a higher resource setting permitting a trial of labor.
It is wise for all birth attendants to seek training to facilitate vaginal breech birth because it is not uncommon to experience an unexpected breech presentation. In order for training opportunities to exist, the ability for health care providers to offer safe breech birth options should be revived for the women who would seek them.
Many thanks to Jodie Myers for capturing such lovely video of a home breech birth attended by Dr. Fischbein titled, "Aurora's Birth."