Absolutely agree with this, Dory. In addition, the problems of the TBT are huge (even if not related to intention to treat analysis).

The participation of centres which didn't have high vaginal breech rates before the trial, so effectively on a learning curve in the course of the trial. The surprising finding that 2 years down the line, the long-term morbidity is higher in the CS arm - which rather evens things out. Cronk et al would cite the missed opportunity to compare upright posture with dorsal. The fact that the statistically significant reduction in intrapartum/neonatal deaths with planned CS of TBT is misrepresented by reg as "breech is very dangerous and your baby is likely to die".

And the consequence is that registrars (and midwives) are, on the whole, now much less experienced in breech delivery - so it's something of a self-fulfilling prophecy.

I read the research.

The reasearch is hugely flawed, and it is widely accepted in both midwifery and obstetric circles that that is the case. But it is still heavily applied to practice.

Why? If this was a piece of midwifery research with such huge gaps and fundamental flaws, it would never have been published, never mind being referred to on an almost daily basis with women with breech presenting babies on board, in obstetric clinics up and down the country.

I believe fear and control to be the answers to this question.

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Love Dory xxx
Just keep swimmin', just keep swimmin'....

Have you just been offered a place? If so and you want a mentor please post in post this forum (also post here if you would like a mentee)

Your guess is as good as mine...feeling that CS is just easier, lack of experience (think consultants less inclined to really put the screws on a woman, than a consultant - but maybe that's just my impression), fear of litigation as tracyb says...

Horrible when you see a woman in established labour being forced to make a decision and told CS is only safe option.

It was well known before TBT that vaginal breech was less safe than vaginal cephalic, so in a sense there always has been fear around it. Cronk would say danger was mostly iatrogenic caused by inappropriate traction - but even if (unwittingly) iatrogenic, not surprising if obs breathed a big sigh of relief not to have to do them anymore (their way, I mean - not upright).

Oooooh...don't get me started on the Hannah trial! Just finished my dissertation on management of breech and my first chapter was on the TBT. As well as the other methodological flaws already mentioned, they also stipulated centres must have a 40% vaginal breech delivery rate in order to be included in the trial. The result was some centres tripled their vaginal delivery rate!!

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4th year student midwife at UCLan

I think the thing to remember here is that this is all based on obstetric opinion, therefore their take will be to 'help the woman and 'save' the baby'. They feel they can do this quicker and with more success in the operating theatre (where they feel comfortable) rather than by letting a woman listen to her own body and stand and watch the process. Doctors DO, they DONT watch!
Therefore, any research from an obstetric viewpoint is likely to be flawed in this way. Just my tuppance worth there!
KS x

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Kentish Spitfire
Moderator, Student Services
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"It's better to be thought a fool - rather than proved a fool!"

Just got in from work and have had a quick read through the posts last night. Sorry I wasn't around to join in.

Some really interesting points being made here. I shall ponder on these....! Off to bed now.

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