Re-engaging with vaginal breech birth: A philosophical discussion

In November 2012, over 200 birth professionals including midwives, obstetricians, alternative therapists and birth supporters gathered together in Washington, USA for the third International Breech Birth Conference. It is internationally acknowledged that the incidence of breech presentation at term (37 weeks onwards) stands between 3-4% (Hickok et al, 1996; Royal College of Obstetricians and Gynaecologists (RCOG), 2006), so why does such a seemingly niche midwifery area warrant such an international effort? The aim of the conference was to connect practitioners passionate about breech birth with a view of taking newly acquired and consolidated knowledge back to prospective places of work, reigniting the discussion and developing vaginal breech practice which has become a disappearing art form since the Term Breech Trial (TBT) (Hannah et al, 2000).

Fourteen years ago, the TBT (Hannah et al, 2000) was published in the Lancet, with its conclusions providing persuasive confirmation that vaginal breech birth was high risk, having adverse effects for both mother and fetus. The trial transformed breech birth practices across the world with startling immediacy (Lawson, 2012) the trial itself being stopped earlier than originally planned because ‘the lives of mothers and babies were at risk’ (Hannah et al, 2000: 219). Since then vaginal breech birth has been a topic of heightened debate within the community and has decreased in practice partly due to caesarean section becoming progressively safer and more widely used, and partly because of the indications of the TBT. The TBT has been widely criticised and the original findings have been disputed by a number of participants who were present at the Breech Birth Conference (Glezerman, 2006; Bisits, 2012) along with the original authors, who subsequently found in their 2-year follow up that there were no differences in outcome deriving from mode of delivery (Whyte et al, 2004) for either the mother or the baby. However, because it continues to inform current practice on an international level, it is important for midwives to fully understand the flaws of the TBT.