Presentation of initial findings
The study’s initial conclusions read “Planned caesarean section is better than planned vaginal birth for the term fetus in the breech presentation; serious maternal complications are similar between the groups” (Hannah, et al. 2000:1375) However, when the data were analyzed comparing outcomes for countries with low perinatal mortality rates and high perinatal mortality rates this finding held only for countries with low mortality rates (i.e. the industrialized world). For the developing world (perinatal mortality rate >20/1000) there is no statistical difference between morbidity and mortality outcomes for cesarean babies and vaginally delivered babies (RR=0.66, 95% CI 0.35-1.24, p=0.13).
Thus, there are two competing findings in this study although this is glossed over. The reasons for the difference in response to delivery methods in the developed world and in the developing world are not hypothesized. Are clinicians in the developing world inexpert at cesarean sections? Are clinicians in the developed world insufficiently competent at vaginal breech deliveries? Why is there a difference?
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