BMJ  2005;331:698-699 (24 September), doi:10.1136/bmj.331.7518.698-b

Letter

Short term outcomes lead to long term questions

The first 150 words of the full text of this article appear below.

EDITOR—Lavender et al add evidence to the debate about a randomised controlled trial comparing vaginal birth with caesarean surgery.1 However, we need to think even more widely, and more long term, about this possibility, as highlighted recently by the term breech trial. Researchers randomised breech babies to vaginal birth or caesarean and concluded, in the year 2000, that caesarean birth was safer. Virtually overnight, vaginal breech birth disappeared as an option for women worldwide.

Follow-up of children from the term breech trial at age 2, published in 2004, found that differences between groups had disappeared: vaginal breech birth was no more risky for offspring in the longer term.2 Many health professionals are unaware of this about face, and the equation of caesarean and breech remains unaltered.

The term breech experience highlights the importance of adequate sample size2 and long term follow-up, but even two years is inadequate after . . . [Full text of this article]

Sarah J Buckley, general practitioner

Anstead, QLD 4070, Australia sarahjbuckley@yahoo.com


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Relevant Article

Could a randomised trial answer the controversy relating to elective caesarean section? National survey of consultant obstetricians and heads of midwifery
Tina Lavender, Carol Kingdon, Anna Hart, Gill Gyte, Mark Gabbay, and James P Neilson
BMJ 2005 331: 490-491. [Extract] [Full Text] [PDF]

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