Oct. 25, 2000 TORONTO (October 19, 2000) -- A study funded completely by the Canadian Institutes of Health Research (CIHR), which has been fast tracked for publication in The Lancet, has proven that in the case of full term breech presentation, the safest method of delivering babies is via caesarian section.
Dr. Mary Hannah, Professor of obstetrics and gynecology at Sunnybrook and Women's College Health Sciences Centre, University of Toronto, and a senior researcher at the Centre for Research in Women's Health led the study, which included 2,088 women from 121 hospitals in 26 countries. The study was supposed to last for five years but stopped two years earlier than expected due to an interim analysis that showed major benefits for babies randomized to the caesarian section group compared to the vaginal birth group.
Overall, the study found that babies of women in the caesarian section group were three to four times less likely to die or have serious problems in the first six-weeks of life compared to those in the vaginal birth group (1.6% vs. 5.0%). The benefits from a planned caesarian section were greater in centers in developed countries with the difference in risk of death or serious problems for the baby being 0.4% vs. 5.7%, compared to the difference in centers in developing countries 2.9% vs. 4.4%. There was no difference in problems for the mother in the two groups regardless of whether the woman delivered in a developed or developing country, and the overall risk was low (less than 4%).
"It was our concern that vaginal births would disappear as an option when babies presented in the breech position as the more skilled clinicians left the profession. If it was true that planning for a caesarian section was not substantially better than planning for a vaginal birth and research were to prove this, then we felt that the move towards more caesarian sections might stop," says Dr. Hannah. "When we conducted the interim analysis we were surprised to see that a policy of planned caesarian section was substantially better for the baby in a breech presentation at term, and when all the data were analyzed, the benefit was found to be greatest in developed countries such as Canada and the United Kingdom."
In total, the worldwide $2.3 million study concluded that 14 additional caesarian sections are needed to avoid one death or serious problem for the baby. For centers in developed countries an additional seven caesarian sections would be needed to avoid one death or serious problem for the baby. For centers in developing countries an additional 39 caesarian sections would be needed to avoid one death or serious problem for the baby.
"Dr. Hannah's ground-breaking, innovative work reinforces CIHR's dedication to supporting Canada's best clinical researchers," said Dr. Alan Bernstein, President of CIHR. "Her research will have global implications in the health research arena and that's what CIHR is all about."
"Caesarian section is generally associated with a higher risk of problems for the mother than vaginal birth," Dr. Hannah says. "However, in the Term Breech Trial there was no benefit to the mother of a planned vaginal birth possibly because about 43% of mothers in that group ultimately delivered by caesarian section and because the caesarian sections done in that group were usually done after labor began, on an emergency basis. Whereas, many of the caesarians in the planned caesarian section group were undertaken prior to labor, on an elective basis. Also, we only have information about serious problems in the first six weeks postpartum. A follow-up component of the study is in progress that will give us additional information about the health of mothers at three months and two years postpartum."
In Canada, about 12,000 - 16,000 women will deliver a baby in breech presentation at term every year.
Sunnybrook and Women's College Health Sciences Centre is transforming health care through the dedication of its more than 6,000 staff members who provide compassionate and innovative patient care. A unique focus on women's health, academic research and an affiliation with the University of Toronto distinguishes Sunnybrook & Women's as a leader in Canadian health care. Sunnybrook & Women's specializes in caring for newborns, adults and the elderly, treating and preventing cancer, heart problems, bone and muscle conditions and trauma.
The Centre for Research in Women's Health was founded in 1995, and is a partnership of the University of Toronto and Sunnybrook and Women's College Health Sciences Centre. The Centre is committed to conducting and fostering women's health research which is relevant to women's lives, and to promoting its application in diverse communities. The Centre advocates for a broad definition of women's health that incorporates the social determinants of health and is a research leader in areas such as reproductive health, breast cancer, osteoporosis, addictions and drug therapy, and violence against women.
CIHR is Canada's major federal agency for health research. Its objective is to excel, according to internationally accepted standards of scientific excellence, in the creation of new knowledge and its translation into improved health for Canadians, more effective health services and products and a strengthened Canadian health care system. Working with its partners in universities, hospitals, government and the voluntary health sector, CIHR is an interactive approach to health research that will 'virtually' connect scientists from a broad range of health research disciplines from coast to coast.
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