IN THE LITERATURE:Combating Coercion: Breech Birth, Parturient Choice, and the Evolution of Evidence-Based Maternity Care


  • Andrew Kotaska MD, FRCSC

    Corresponding author
    1. Andrew Kotaska is Clinical Director, Department of Obstetrics and Gynecology, Stanton Territorial Hospital, Yellowknife, Northwest Territories and Lecturer, University of Manitoba, Winnipeg, Manitoba, Canada.
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Dr. Andrew Kotaska, Stanton Medical Clinic, 550 Byrne Road, Box 10, Yellowknife Northwest Territories, X1A 2N1 Canada.


ABSTRACT: In 2001 the term breech trial led the American and Royal Colleges of Obstetricians and Gynecologists (ACOG and RCOG) to issue black-and-white “cookbook” guidelines condemning vaginal breech birth. Since then, women have been coerced, both overtly and covertly, into having cesarean sections. New evidence and a better understanding of the limitations of the term breech trial have led both the ACOG and RCOG to replace their 2001 guidelines with new ones that re-open the door for planned vaginal breech birth, acknowledge the evolving understanding of the nature of evidence, and emphasize the importance of external validity in the evaluation of complex phenomena. Parturient choice and clinical judgment are re-introduced. (BIRTH 34:2 June 2007)