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APHA Scientific Session and Event Listing

Kenneth C. Johnson, PhD, Evidence and Risk Assessment, Public Health Agency of Canada, 120 Colonnade Rd, Ottawa, ON K1A 0K9, Canada, 613 730 0282, Ken_LCDC_Johnson@phac-aspc.gc.ca and Betty-Anne Daviss, MSc, RM, Midwifery Collective of Ottawa, 36 Glen Ave, Ottawa, ON K1S 2Z7, Canada.

The original interpretation of the Term Breech Trial, published in the Lancet in October 2000, suggested that planned caesarean section is better than planned vaginal birth for the term fetus in the breech presentation. The manner in which it was promoted and implemented created overnight change in practise. Supporting editorials and articles suggested there should no longer be any disagreement about breech management; Grand Rounds and hospital meetings promoted acceptance of the conclusions; and studies monitoring its impact on practice fuelled the unquestioning environment of North America. Women were told unequivocally that they should plan a cesarean section in order to avoid losing their baby or having major negative sequellae. Many practitioners are unaware that four years later, the two-year follow-up to the trial published final conclusions that “planned cesarean delivery is not associated with a reduction in risk of death or neurodevelopmental delay in children at 2 years of age,” a reversal of the original conclusions. These final conclusions were published in a less widely read journal, the American Journal of Obstetrics and Gyncecology, did not receive the same media attention, discussion, or acclaim, and have resulted little in change of practice. In parts of Europe, there was concern about the appropriateness of the original trial design of the Term Breech Trial and the relevance of the resulting year 2000 publication. Several European obstetrical centres made declined participation in the North American-led trial. The developments of the European studies and implications for North American practise will be presented.

Learning Objectives: At the conclusion of the session, the participant (learner) in this session will be able to

• Explain the fallacy of using single studies to drive practise, using the Term Breech Trial (TBT) as an example.
• Summarize the differences between the outcomes of the TBT and its 2-year follow-up.
• Take home tools with which to approach local health care professionals and change public opinion in order to turn the breech issue around.

Keywords: Maternal and Child Health, Access to Care

Presenting author's disclosure statement:

Any relevant financial relationships? No