Evaluation should have included long term follow up of the mothers

BMJ 1996; 313 doi: http://dx.doi.org/10.1136/bmj.313.7060.817c (Published 28 September 1996) Cite this as: BMJ 1996;313:817
  1. Geraldine Barrett, Research fellow,
  2. Christina R Victor, Senior lecturer
  1. Department of Public Health Sciences, St George's Hospital Medical School, London SW17 ORE

    EDITOR,—We agree with the recommendations in P J Danielian and colleagues' paper and the accompanying editorial that a large randomised controlled trial is required to determine which is the safest and most acceptable mode of delivery in breech presentation at term.1 2 We are concerned, however, that the discussion, particularly in the editorial, does not mention the need for long term follow up of the mother.

    The authors of the editorial state that “increased maternal morbidity is an inevitable consequence of abdominal delivery” on the basis of evidence from the Cochrane meta-analysis of two randomised controlled trials that compared the policy of planned caesarean section with that of planned vaginal birth. Both of these trials measured maternal morbidity by short term variables such as blood transfusion, headache after spinal anaesthetic, wound infection, febrile morbidity, and length of stay in hospital.3 4 These measures are extremely important, but longer term measures of maternal morbidity, such as urinary incontinence, faecal incontinence, and dyspareunia, should also be included (along with measures of infant morbidity) to evaluate modes of delivery comprehensively.

    Few studies have investigated the long term health problems of women after childbirth. Our study of 1010 members of the National Childbirth Trust focused on postnatal sexual health and showed high levels of morbidity up to two years after the birth.5 This was significantly associated with the mode of delivery: dyspareunia was most common in women who had had assisted vaginal deliveries and least common in those who had had a caesarean section (table 1). Nearly all the women who had an assisted delivery had an episiotomy (93%); this compared with a rate of episiotomy of 20% in those who had unassisted vaginal deliveries.

    Table 1

    Number (percentage) of women who had dyspareunia after childbirth by mode of delivery

    View this table:

    Vaginal deliveries of babies presenting by the breech are rarely straightforward and therefore may result in considerable maternal morbidity. Any evaluation that does not include long term follow up of the mother will give only a partial perspective on the effect of breech delivery on mothers and children.


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