I read in the June 23 issue of the Vancouver Sun that yet another nail has been driven into the coffin of the art of obstetrics. (“Hospitals adopt cesareans for breech babies,” and “Natural breech births abandoned by Vancouver hospitals because of higher risk.”)
Did the reported study compare cesarean section to vaginal delivery of only properly selected cases of breech presentation managed by skilled and experienced obstetricians? If not, the results have little meaning.
At this point the argument is really academic since so few obstetricians are being trained in vaginal breech delivery and those capable of doing the training are disappearing rapidly. Many obstetricians, including some in high places, have found it easier to condemn the procedure than to learn it. But in case a few such skilled and experienced obstetricians remain, their prospective patients have been warned from the pulpit that the method is contraindicated and dangerous. Perhaps now that we all have calculators, mental arithmetic should be banned.
I feel very sad and I suspect that my late mentors are turning over in their graves.
—A.M. Krisman, MD
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Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.
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