We'd all love to be able to predict the future, especially when it comes to how a baby will be born: by vaginal, operative, or cesarean delivery. A cesarean delivery after labor is significantly more likely to lead to complications like hemorrhage or infection than a scheduled cesarean delivery. However, for the average low-risk woman, a spontaneous vaginal delivery is safer than any cesarean delivery. Obstructed (or stalled) labor is one of the largest contributors to our rising cesarean delivery rate. Therefore, predicting which women will ultimately need a cesarean delivery for obstructed labor could potentially lead to more effective care and possibly fewer complications. One approach to predicting mode of delivery is by analyzing the pelvic muscles as viewed through ultrasound.
The Term Breech Trial in 2000 changed the way we deliver babies. Ever since Dr. Hannah published that pivotal study, obstetricians have increasingly favored delivering breech (butt first) babies by c-section instead of vaginal delivery. By term, which is 37 weeks of pregnancy and later, only about 3 to 4% of infants are breech. However, earlier in pregnancy, many more infants haven’t had a chance to flip over to head first yet. At 26 weeks, a quarter of infants are breech, and at 32 weeks, 15% are still breech. What happens if a baby is born preterm? More of these infants are in the breech position, but we don’t have a pivotal randomized trial like the Term Breech Trial to guide us.