Collective Forgetting of American Vaginal Breech Delivery.

Abstract

When asked why nearly all doctors refer their breech cases to surgery, despite non-surgical breech birth being permitted throughout the United States, an obstetrician will likely cite the Term Breech Trial (TBT). This study, conducted in 2000, decisively concluded that planned cesarean delivery is safer than vaginal breech delivery. However, a review of the literature suggests that the decline of vaginal breech deliveries was a long time in the making. From the 1950s, once the perceived risks of breech births were accepted as a fact, numerous studies advocated more liberal use of cesarean delivery for breech babies and suggested strategies to limit vaginal breech births. By the late 1970s, as the majority of breech patients underwent surgery, a vicious cycle of collective forgetting began. Hospitals and medical training programs abandoned the non-surgical option, leaving younger generations of unskilled doctors reluctant to perform the complex procedure. As health organizations criticized the overuse of cesarean sections in the ensuing decades, obstetricians faced a growing dilemma in breech management, continuing to perform surgeries even while questioning their benefits. The 2000 study sanctioned this existing state of practice, which had been evolving over decades and in which collective forgetting played a crucial part.