Baby risks during natural breech birth 'very small'
The risks of a baby dying or suffering complications during a natural breech birth are "very small", experts have said.
The vast majority of babies are born head first, but of those that are breech (positioned feet first), most will be born by caesarean as is advised by midwives.
The study, published in BJOG: An International Journal of Obstetrics and Gynaecology, found that although this is safer, the risk brought by vaginal delivery was still very low.
The large-scale research analysed 27 articles with a total sample size of more than 250,000 women to determine the risks of mortality associated with planned vaginal breech delivery from delivery up to seven days after the birth.
It found the overall death rate from planned breech vaginal delivery was 0.3%, while for planned caesarean it was 0.05% - about one in 300 and one in 2,000 respectively.
This was lower than the rates in a World Health Organisation (WHO) study on babies born head first, which found the risk of foetal and neonatal deaths to be 0.39% and 0.38% respectively.
Co-author Yifru Berhan, professor of obstetrics and gynaecology at Hawassa University in Ethiopia, said: "Our results show that the relative risk of perinatal mortality and morbidity was between two and five times higher in planned vaginal breech delivery compared to planned caesarean section birth. However, the absolute risks were very small.
"Although the controversy is still unresolved, our study substantiates the practice of individualised decision making around delivering a breech baby. Future research should focus on a comparative study on vaginal breech and non-breech delivery."
Professor Alan Cameron, vice president of clinical quality for the Royal College of Obstetricians and Gynaecologists (RCOG), said: "This is a very interesting study which uses all of the existing data on breech delivery to determine the absolute risks of vaginal breech birth to the baby.
"The Royal College of Obstetricians and Gynaecologists currently recommends that caesarean delivery is the safest mode of delivery for the baby when in a breech position.
"However, there are benefits and risks associated with both caesarean delivery and vaginal breech birth and women are encouraged to discuss and weigh up the options with their obstetrician so they can choose the best plan for themselves and their baby."
Mervi Jokinen, practice and standards professional advisor at the Royal College of Midwives, said: "This is an interesting topic where some studies have had a significant impact in changing practice, reducing women's choice, and to some extent contributing to the rising numbers of caesarean sections globally.
"All births carry an element of risk, however small.
"The important issue here is that women are aware of the evidence around breech birth, including the risks and the benefits of either a vaginal delivery or caesarean, so that they can make a decision about how they want to give birth. It is important that they discuss this with their midwife or doctor who will offer advice and support."