Because at least one doesn’t seem prepared to acknowledge that foetal presentation makes any difference to birthing outcomes.
Lauredhel has been astonishingly civil at Andrew’s blog in pointing out that his much-hyped position paper on the perils of increasing the Baby Bonus (the dreaded “overcooked” baby syndrome) was “purely a hypothesis-generating paper, not a paper with any data in it”, and even as such was confounded by his ignorance of obstetrics: full term births and emergency interventions are not delayed, only pre-term elective interventions can be delayed, and there is little to no evidence that delivering a baby at a lower weight at 38 weeks gestation makes any long term difference if its weight at the equivalent to 40 weeks gestation is still more than the allegedly crucial 4kg.
Andrew has ignored every single cite she has offered regarding the unnecessary rate of caesarean (and induction) intervention in Australia and elsewhere (see her previous posts, with cites), claiming that obstetricians wouldn’t possibly systematically perform unneeded procedures (no, not even though such practice is to their direct financial benefit). The kicker is that he also claimed that all her cited studies were contaminated by selection bias, and then with no sense of irony offered as his coup-de-grace a study which only looked at breech presentation births1.
Lauredhel attempted (twice) to point out that breech presentations are abnormal situations, and was ignored (quite a pattern). So let’s just make it crystal clear, shall we? The fetal malpresentation described as breech position accounts for slightly less than 3% of births. Breech births are also regarded as much more dangerous births with a higher rate of complications than cephalic/vertex births, no matter whether the birth is vaginal or c-section.
To use figures comparing outcomes for breech births for predicting outcomes for the normal range of births is flawed extrapolation in the extreme.
1. Hannah ME, Hannah WJ, Hewson SA, Hodnett ED, Saigal S, Willan AR. Term Breech Trial Collaborative Group. Planned caesarean section versus planned vaginal birth for breech presentation at term: a randomised multicentre trial. Lancet 2000;356(9239):1375-83.[link hub][Medline]