VAVB

**VAVB (Vaginal Apical Vaginal Birth)**

VAVB, or vaginal apical vaginal birth, is a rare and controversial obstetric procedure involving the delivery of a fetus through the vagina by manipulating the cervix and uterus to reach the apical region of the vagina. This technique is primarily associated with cases of breech presentation, where the baby’s feet or buttocks are positioned at the cervix rather than the head. The procedure was popularized in the 1970s by obstetrician Dr. John A. McCall, who developed a method to assist in vaginal births of breech-presenting infants.

The technique involves inserting a specialized instrument, often a vaginal dilator or a small surgical tool, to gently guide the baby’s head through the cervix and vagina. While some early studies suggested improved outcomes for certain high-risk breech presentations, the procedure has faced significant criticism. Critics argue that VAVB increases the risk of complications such as uterine rupture, fetal injury, and prolonged labor. Additionally, it is not universally applicable and may not be suitable for all breech presentations, particularly those involving severe malpresentation or high-risk factors.

The use of VAVB has declined over time due to advancements in medical imaging, such as ultrasound, which allows for better assessment of fetal positioning. Modern obstetric practices often favor planned cesarean section for breech births, especially in cases where the baby’s head is not engaged or there are other complications. However, VAVB remains a topic of debate among medical professionals, with ongoing discussions about its efficacy, risks, and appropriate indications.

Ethical and legal considerations also play a role, as the procedure involves invasive techniques and may raise questions about patient consent and medical liability. While some practitioners continue to use VAVB in select cases, its role in contemporary obstetrics is limited, and it is generally reserved for specialized settings where alternative methods may not be feasible.