Long-term childhood outcomes of breech presentation by intended mode of delivery: a population record linkage study

Abstract

Introduction: There is a lack of information on childhood outcomes by mode of delivery for term breech presentation. We aimed to compare childhood mortality, cerebral palsy, hospitalizations, development, and educational outcomes associated with intended vaginal breech birth (VBB) compared to planned cesarean section (CS). Materials and Methods: Population birth and hospital records from New South Wales, Australia were used to identify women with non-anomalous pregnancies eligible for VBB from 2001 to 2012. Intended mode of delivery was inferred from labor onset and management. Death, hospital, and education records were used for follow-up until 2014. Cox proportional hazards regression and modified Poisson regression were used for analysis. Results: Of 15,340 women considered eligible for VBB, 7.8% intended VBB, 74.2% planned CS, and intention was uncertain for 18.1%. Intended VBB did not differ from planned CS on infant mortality (Fisher’s exact p=0.55), childhood mortality (Fisher’s exact p=0.50), cerebral palsy (Fisher’s exact p=1.00), hospitalization in the first year of life (adjusted HR 1.04; 95% CI 0.90 – 1.20), hospitalization between the first and sixth birthdays (0.92; 0.82 – 1.04), being developmentally vulnerable (adjusted RR 1.22; 95% CI 0.48 – 1.88) or having special needs status (0.95; 0.48 – 1.88) when aged 4 – 6, scoring more than 1 standard deviation below the mean on tests of reading (1.10; 0.87 – 1.40) and numeracy (1.04; 0.81 – 1.34) when aged 7 – 9. Conclusions: Planned vaginal breech birth confers no additional risks for child health, development, or educational achievement compared to planned cesarean section.