Each month we will bring you a feature on current issues and an update on the research that is going on. Drop us an email if you'd like us to cover a particular topic!

A.Breech presentation is where the baby’s bottom or feet are leading the way down the birth canal. Around 3% of babies are in the breech position at term. Many obstetricians have favoured caesarean section for breech deliveries as they have considered this safer than a vaginal delivery for the baby. This is because the largest part of the baby is its head. In a vaginal breech delivery the body is delivered before the head, so there is a possibility that there could be difficulty delivering the head. This is especially true if the feet are coming first as they can slip through the neck of the womb (the cervix) before it opens wide enough to let the head through. There can also be a greater risk of the baby becoming distressed during labour due to a shortage of oxygen supply. Sometimes this can be because the cord gets tangled in the legs and comes down into the vagina before the baby is ready to be born. Others obstetricians with experience of vaginal breech delivery have considered that caesarean section is no better than vaginal breech delivery in selected cases. The controversy over the best way to deliver a breech baby has arisen due to a lack of good evidence to determine what form of delivery is best.

Researchers in the Term Breech Trial Collaborative Group recently reported their study involving 2088 women with a breech presentation at term in 26 countries. Women with large babies or with other contraindications to a vaginal breech delivery were not included. The 2088 women were randomly assigned to have either a caesarean section or a planned vaginal breech delivery. They found that around 43% of the women with a planned vaginal breech delivery were delivered by caesarean section, mostly because of complications in labour. There were a lower number of baby deaths and serious problems in those delivered by caesarean section, with 5% of babies born vaginally having such problems compared to only 1.6% delivered by caesarean section. The authors calculated that for every additional 14 caesareans carried out that one baby death or serious problem would be avoided. There was no overall difference in complications for the mother in the first 6 weeks after delivery between the two groups. So caesarean section appears to be the best way to deliver a breech baby.

Prenatal growth linked to marriage in men

It is well known that married men live longer than unmarried men and have a lower rate of vascular disease such as heart attacks. The intriguing question is why? Do healthier men tend to marry? Does the care and companionship of marriage offer protection through reduced stress? Do men who are more likely to suffer from heart disease tend not to marry? No one knows the answer but another dimension has recently been added to the intriguing relationship…….. birthweight.

In the last 10 years or so it has become clear that growth in the womb is linked to problems like heart disease and diabetes in adulthood. Babies that are small at birth have a higher risk of these problems. Could it be that these small babies also tend not to marry. Researchers in Helsinki and Southampton have recently studied this question in over 3500 Finnish men born between 1924 and 1933 and over 1600 men from Hertfordshire, England born in the 1920’s. Using information such as birth records, school health records and census data they found that smaller babies in both countries were more likely to have never married. Between 15 and 20% of men whose birthweight was under 2.25kg never married compared to well under 10% in those whose birthweight was 3.5kg or more. In Finland they found that these men were on average 2cm shorter and 2.4kg lighter than the other men when they were aged 15. In England they found that the men who had never married were on average 2.1cm smaller and about 1kg heavier when aged 61-71.

Just how low birthweight might impact on factors that could influence marriage, such as personality, emotions, social factors and sexuality, is not clear. Nor do we know why married men have a lower risk of heart disease. However, these data show that a baby’s prenatal growth may be important not only with regard to adult health but also in predicting whether men marry.

*Reference: Phillips DIW et al (2001) BMJ 322, 721.