The debate over “The term breech: vaginal or cesarean delivery?” [January] should be moot. Although Alex Vidaeff, MD, and Edward Yeomans, MD, argue for vaginal delivery, no one in his or her right mind would opt for this mode of delivery unless forced to because the baby is falling out.
The only physicians willing to consider it either are academicians who practice in tertiary university settings with a cadre of residents or physicians with access to 24-hour, in-house anesthesia and cesarean section capabilities. Most important, they are supported by hefty liability insurance policies and a phalanx of hospital attorneys willing to wage war on their behalf when something goes wrong.
Change the tort system, and I might consider doing vaginal breeches again. Or maybe not. I can do a cesarean in 30 minutes and have a healthy baby and a happy mother with minimal morbidity.
The alternative: I can sweat for several hours waiting for the mother to deliver, tying up several other people in the delivery room, all the while realizing that any purported cost savings would be immediately wiped out by a multimillion-dollar judgment when something goes wrong.
I don’t care what the literature says. The only outcomes that matter are my own.
David Rivera, MD
DRS. Vidaeff and yeomans respond:
We appreciate Dr. Rivera’s comments, but unlike him, we do care what the literature says. Our article was prompted by what we perceive as a lack of debate following such an important study as the Term Breech Trial. Cognizant of the radical impact the trial’s results may have on the future of our specialty, we wanted to stimulate scientific and clinical dialogue concerning the practical applicability of its conclusions.