Quick versus standard vaginal birth when a baby is bottom-down

What is the issue?

The best outcomes in childbirth for both mothers and babies are when babies are born head-first. If the baby is in another position, there is a higher risk of complications including the need for caesarean section. In a ‘breech presentation’ the unborn baby is bottom-down instead of head-down. This review looked for evidence about whether a quicker birth might be better in such cases.

Doctors call the quicker birth ‘expedited delivery’. It means that the baby’s head appears just one contraction after its tummy has appeared.

Why is this important?

Quicker births might prevent babies from not getting enough oxygen. This is a risk in breech births because the cord can get squashed. If the cord is squashed, not enough blood gets to the baby. However, the methods used to make the birth quicker might harm the baby or the mother.

What evidence did we find?

No reliable studies were found - (we searched for studies up to May 2015).

What does this mean?

There is no evidence from reliable studies about whether speeding up the birth (‘expedited delivery’) is helpful if the baby is bottom down.

Authors' conclusions: 

There is not enough evidence to evaluate the effects of expedited vaginal breech delivery.

Read the full abstract...
Background: 

In a vaginal breech birth there may be benefit from rapid delivery of the baby to prevent progressive acidosis. However, this needs to be weighed against the potential trauma of a quick delivery.

Objectives: 

The objective of this review was to assess the effects of expedited vaginal delivery (breech delivery from umbilicus to delivery of the head within one contraction) on perinatal outcomes.

Search strategy: 

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 May 2015) and reference lists of retrieved studies.

Selection criteria: 

Randomised trials of expedited vaginal breech delivery compared with delivery not routinely expedited in women undergoing vaginal breech delivery.

Data collection and analysis: 

Two review authors independently assessed the one identified trial for inclusion.

If studies are included in future updates, two review authors will assess risk of bias, extract data and check data for accuracy.

Main results: 

No studies were included.

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