One of the most active controversies in obstetrics today concerns the proper obstetrical management of the breech presentation. It has long been recognized that breech presenting infants are at increased risk for birth related injuries and subsequent childhood morbidity. Therefore, many obstetricians suggest that all breech presentations should be delivered by cesarean section in an attempt to decrease potential adverse consequences to the newborn. Yet a review of the literature provides little scientific or statistical evidence supporting the need for cesarean delivery in all breech presentations, and obstetricians are currently being asked to justify the increase in the cesarean section rate for breech infants. The present study is proposed to evaluate the obstetrical management of breech presentation in relation to the morbidity experienced by the mother, infant, and the developing child in the hopes of developing criteria for managing breech presentation. The null hypothesis to be tested is: vaginally delivered breech infants are at equivalent risk for morbid events when compared to breech infants delivered by cesarean section. This non-concurrent prospective study will examine birth injuries, asphyxia, and neonatal complications in relation to method of delivery, as well as in relation to neurologic sequelae and early childhood development. The study population consists of the mothers and 1,593 breech infants who were delivered in Northern California Kaiser-Permanente Medical Care Programs in 1976 and 1977. A review of prenatal, labor and delivery, neonatal and pediatric medical records is being conducted to provide information concerning indications for method of delivery, delivery complications and injuries, maternal morbidity, characteristics of the infant at birth, neonatal complications, neurologic sequelae, and early childhood development. A systematic evaluation of method of delivery in relation to multiple maternal, infant and childhood outcomes will be made, allowing determination of the risks involved in vaginal and cesarean deliveries for breech infants and their mothers. This information will enable obstetricians to make informed decisions on the management and delivery methods of breech presenting infants such that the healthiest infant and mother can be obtained.
