While I’m in the UK at the international confederation of midwives, I will be spending the day with Jane Evans and Mary Cronk at their world renowned breech study. The importance of keeping up to date, continuously learning from others and re evaluating and reflecting on our own practice can’t be stated enough. Even though I do attend women with a breech you can never get too much input and experience from others to keep it as safe as possible.

I understand the need for information and making it available, I also know only too well not everyone agrees. Like Maggie Banks opinion that you should break the membranes, I don’t agree, I am of the opinion that the baby is likely to rotate and remain safer if the membranes are left intact during decent of the baby . This seems to be quite a British opinion and is backed up by Jane Evans.

We were unsure why a midwife would find it advisable to break the amniotic sac. If the membranes had been left intact the baby may have rotated earlier and the buttocks may have come down more before the legs were born

I think the best way to help the woman is to keep the atmosphere calm and create as little stress as possible.

I also agree with this:

Some practitioners advise waiting for an hour after full dilatation before active pushing is ‘allowed’. This is thought to ensure the cervix is *completely* dilated. This is particularly important for premature births as the bottom of a pre-term or growth restricted infant is generally smaller than their head but is questionable when the baby is full term and well grown as the bi-trochanteric diameter is the same as the bi-parietal diameter (the bottom is the same size as the head). By carefully observing the progress of the labour and the external signs of full dilatation the midwife rarely has need for an internal examination. Active pushing only starts when the urge is overwhelming and impossible to stop and then progress is usually smooth. If there is an urge to push before the signs of full dilatation are apparent the usual strategy of asking the woman to adopt a knee chest position is usually effective until spontaneous descent occurs. There is also a school of thought that if the birth is delayed the uterine contractions compress the baby into a more favourable, more flexed position thus facilitating a smoother birth.

A woman’s perineum is best left untouched as discussed above. A woman’s perineum is remarkable as it is designed to stretch and expand to facilitate the birth of the baby by gently adjusting the position of the baby as it progresses down the birth canal. It does not require support.

All breech babies technically have a cord prolapse. The head comes after the body. There is of course risk of compression between the bony pelvis and the baby. This cord does not appear to be unduly compressed and the compression would be transient as the baby was rotating. It should be remembered that a full term baby can tolerate a short period of anoxia during the birth and that the cord, at this stage is unlikely (and appears not) to be occluded totally. The cord is not between two bones but the maternal symphysis pubis and the baby’s abdomen. There is also the danger of causing the cord to go into spasm, thus exacerbating any problem.

When the baby is born to the umbilicus there is no need to rush. Steady progress and no delay is required at this time. The cord is unlikely to be occluded until the head comes into the pelvis, which is as the shoulders are being born. With natural manoeuvres, plus gravity, the shoulders and arms are usually born without help.

The baby rotates through the pelvis in a spiral in order to bring its’ arms down spontaneously – by handling the baby and hurrying the natural mechanism problems could occur’

I couldn’t say it any better than this. Lots of these thoughts apply to all labours, the mechanism may be slightly different but the spontaneity and normality of it shouldn’t be interfered with unless there are signs that things aren’t moving along naturally. Then the breech skills that are taught over and over come into play.

Here are a few pictures of a breech birth. I wasn’t this woman’s midwife but was called after the breech was confirmed as the woman was pushing and she declined a transfer to hospital. I don’t mind helping out other midwives and women at short notice.

This was the woman’s second baby as her first had been a section for breech. It had been a planned homebirth through the government funded homebirth system. Part of their policy was to transfer and section breech baby’s.

This pregnancy had been fine and she had an independent midwife. The woman laboured and when fully and pushing the midwife had found the baby to be breech.

We just waited for the baby to arrive, carefully timing the minutes to ourselves while keeping the atmosphere calm and stress free.

beautiful baby and placenta still attached

I did some resus on the baby in the water. We did in fact all step out shortly after. The placenta was born as she stood up.

Here are more breech pictures and a breech video from some of my previous posts.

Related posts:

1. Birth Video Of A Breech Baby
2. Breech A Variation Of Normal
3. The Baby Is In The Bag – Placenta Pics
4. Posterior Position
5. Artificial Rupturing Of Membranes