The international study widely known as the Term Breech Trial was published in October 2000 (1) and resulted in a call for all babies known to be in the breech position at term to be delivered by Caesarean section (CS). This caused dissension at the time among many midwives and others, who felt that there were flaws in the conclusions drawn, that CS rates would rise unjustifiably and that skills of supporting vaginal breech births would be lost.
Five years on, a 'Clinical opinion' feature in the American Journal of Obstetrics & Gynecology (2) says:
'On the basis of the end points of neonatal morbidity and death, the authors of the term breech trial concluded unequivocally that cesarean delivery was safer for breech babies.
'Analysis of the original and new data gives rise to serious concerns as far as study design, methods and conclusions are concerned. In a substantial number of cases, there was a lack of adherence to the inclusion criteria. There was a large interinstitutional variation of standard of care; inadequate methods of antepartum and intrapartum fetal assessment were used, and a large proportion of women were recruited during active labor. In many instances of planned vaginal...