Doctors should no longer automatically opt for caesarean sections for breech births, advise new Canadian guidelines that note that vaginal births can be safe.

The Society of Obstetricians and Gynaecologists of Canada issued the guidelines Wednesday after reviewing research and clinical evidence on the safety of vaginal breech births compared with those of caesarean sections.

"What we've found is that, in some cases, vaginal breech birth is a safe option, and obstetricians should be able to offer women the choice to attempt a traditional delivery," said Dr. Robert Gagnon, a principal author of the new guidelines and chair of the SOGC's Maternal Fetal Medicine Committee.

About three to four per cent of pregnancies are considered breech. In these births, the baby has not moved into the head-down position towards the birthing canal but has its feet or buttocks positioned downwards.

In some of these pregnancies, the baby can be manipulated externally to turn head down, but many cannot.

Women carrying breech babies are typically not considered as candidates for a vaginal childbirth. In fact, breech pregnancies are almost always delivered using caesarean section, "to the point where the practice has become somewhat automatic," said Gagnon.

For years, doctors were told that vaginal breech delivery was not safe for the baby. But his committee reviewed the recent data and concluded that a vaginal breech birth is a safe option for many healthy-term (after 37 weeks) pregnancies.

"The evidence is clear that attempting a vaginal delivery is a legitimate option in some breech pregnancies," said Dr. André Lalonde, SOGC Executive Vice-President.

C-sections now make up about 25 per cent of births in Canada and can carry risks like any other major surgery, such as increased bleeding, pain, or infection. Vaginal childbirth is seen as safer, since it offers a faster recovery for the mother, as well as a better chance of having a vaginal childbirth in the future.

The problem now is that because C-sections have become almost the rule in such deliveries, many Canadian obstetricians don't know how to perform a vaginal breech birth.

"The onus is now on us as a profession to ensure that Canadian obstetricians have the necessary training to offer women the choice to deliver vaginally when possible," said Lalonde.

Health professionals, universities, and hospitals need to work together to help ensure that Canadian health centres are prepared to accommodate women who choose to attempt a trial of breech vaginal delivery, the guidelines advise.

In situations where a vaginal delivery is an option, the delivery should take place in a hospital setting, the guidelines advise. An experienced obstetrician should attend the delivery and offer a C- section if the labour doesn't progress smoothly.

"Some women with a breech presentation elect to deliver at home because they believe they will be refused a breech vaginal delivery at the hospital. It is urgent that we take on this responsibility and that every hospital in Canada offer safe breech vaginal delivery," Lalonde writes in an editorial accompanying the guidelines in the Journal of Obstetrics and Gynaecology Canada.

The society cautions that a vaginal birth is not recommended for some types of breech positions -- in particular, when the baby is positioned feet first. It's also not recommended if:

• The baby is expected to weigh less than 2500g (5.5 lbs.) or more than 4000g (8.8 lbs.)
• The mother has a narrow or small pelvis, which could make vaginal delivery difficult
• The baby's umbilical cord is positioned in such a way that it is likely to become entangled or compressed during delivery
• The head of the baby is in hyperextension (overly stretched)
• Other maternal conditions exist so that a C-section would be recommended even if the baby weren't in breech position.