Enrollment in the Term Breech Trial was stopped on April 21 with 2088 enrollments out of a desired 2800

Enrollment in the Term Breech Trial was stopped on April 21, 2000 with 2088 enrollments out of the proposed trial of 2800. The Data Safety Monitoring Committee reported “the results were clearly in favour of planned Caesarian section”.[1] When data was excluded from analysis for those women who had prolonged labour, induction/ augmentation of labour with oxytocin/prostaglandins, epidural anaesthesia, footling/ uncertain type of presentation or no skilled/experienced clinician at birth, the findings were similar. The report [2] notes reduced benefit of Caesarian section in countries that have a high perinatal mortality rate the authors postulate “possibly because of higher levels of experience with vaginal breech delivery in those countries”. However these countries did not reflect the same reduction in serious neonatal morbidity. The 1994 Canadian Consensus on Breech Management at Term [3] gave a clear and comprehensive guide to the medical literature to set the Protocols [4] for the trial. It augured well that the Protocols proposed care that was less interventionist than many of the breech births that are ‘managed’ in New Zealand’s hospitals. There would be no mandatory epidural anaesthesia. Continuous foetal heart rate monitoring would be subject to the same criteria as cephalic presentations. Breech extraction would have no place in the labour and birth care. There would be no fixed time limits for the duration of first stage of labour as long as there was continual and progressive dilation of the cervix. There was acknowledgement of physiological pushing rather than simply a time limit on the second stage of labour, irrespective of pushing efforts. However, as an avid watcher of the Term Breech Trial [5] the findings come as no surprise. It did not take long for concerns to be raised when reading the Term Breech Trial Newsletters. These provided commentary, handy hints and progress on enrollments.