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BJOG release: Caesarean birth ‘safest’ for breech delivery, but the absolute risks of vaginal delivery remain small

News 29 July 2015

The relative risks of a baby dying or suffering complications after a vaginal breech delivery are higher than in planned caesarean section, however, the absolute risks are low, suggests a new study published today in BJOG: An International Journal of Obstetrics and Gynaecology (BJOG).

How a baby is delivered for breech presentation is a debated topic. Much research, including the Term Breech Trial in 2000, has concluded that planned caesarean is the safest delivery method and the majority of term breech presentations in developed nations over the last decade were delivered by caesarean section. However, there is contrary evidence to suggest that vaginal delivery is still a safe option in selected women with breech presentation and the risks of C-section must also be considered.

This large study used 27 articles with a total sample size of 258,953 women to determine the absolute and relative risks of mortality and morbidity associated with planned vaginal breech delivery from delivery up to 7 days after the birth.

The results suggest that the overall perinatal mortality in the planned vaginal delivery and planned caesarean section group for a term breech baby were 253 (0.3%) and 79 (0.05%) respectively. In other words, the absolute risks of perinatal mortality in planned vaginal and planned caesarean deliveries were about 1 in 300 and 1 in 2000 respectively.

These results were lower than the perinatal mortality rates associated with a vaginal delivery where the baby was positioned head first in a WHO study which found the risk of fetal and neonatal deaths to be 0.39 and 0.38%, respectively.

Additionally, the absolute risks of neurological problems, birth trauma, a 5th minute Apgar score (method to quickly summarise the health of newborn children) of less than seven and neonatal asphyxia were 0.7%, 0.7%, 2.4% and 3.3% respectively.

Yifru Berhan, Professor of Obstetrics and Gynecology at Hawassa University College of Medicine and Health Sciences, Ethiopia and co-author of the study said:

“Our results show that the relative risk of perinatal mortality and morbidity was between 2 and 5 times higher in planned vaginal breech delivery compared to planned caesarean section birth. However, the absolute risks were very small.

“Although the controversy is still unresolved, our study substantiates the practice of individualised decision making around delivering a breech baby. Future research should focus on a comparative study on vaginal breech and non-breech delivery.”

Michael Marsh, BJOG Deputy Editor-in-chief added:

“This is a comprehensive study which uses all the available data on breech delivery and provides useful information about the relative and absolute risks of vaginal breech delivery.

“Midwives and obstetricians should carefully explain the risks and benefits of vaginal versus caesarean section breech birth to women so that an informed decision can be made. This paper provides valuable data that will help in these discussions."

For more information please contact Rebecca Jones, Media and PR Manager, on 020 7772 6444 or

BJOG: An International Journal of Obstetrics and Gynaecology is owned by the Royal College of Obstetricians and Gynaecologists (RCOG) but is editorially independent and published monthly by Wiley. The journal features original, peer-reviewed, high-quality medical research in all areas of obstetrics and gynaecology worldwide. Please quote ‘BJOG’ or ‘BJOG: An International Journal of Obstetrics and Gynaecology’ when referring to the journal and include the website: as a hidden link online.

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Berhan Y, Haileamlak A. The risks of planned vaginal breech delivery versus planned caesarean section for term breech birth: A meta-analysis including observational studies. BJOG 2015: DOI; 10.1111/1471-0528.13524