Footling Breech Birth, Attended by Two Midwives

Content from: http://www.birthingway.com/

These are pictures of a planned breech homebirth. Every effort was made to change the position of the baby and a hospital delivery was considered. The parents, understanding the risks involved, decided to continue with the plan to birth at home rather than have a cesarean in the hospital. It was only after labor had started that it was discovered that a foot was the presenting part rather than the baby’s bottom. Two midwives attended the mom during delivery, another was present and unless otherwise needed was free to take pictures. All three were experienced in breech delivery and in maternal and newborn resuscitation.

The mother labored very well for around 17 hours. At that point she wanted to push and no cervix could be felt in an exam. To ensure that the cervix was fully dilated, the midwives had the mom breathe through her contractions for 1 hour before pushing. Note: One of the reasons breech births are considered too dangerous is that the cervix is said to “clamp down” before the delivery of the head. It is possible that in these situations the cervix was never fully dilated. The baby’s body could work it’s way through a cervix that was not completely open. The practice of waiting an hour helps to ensure that this doesn’t happen. A hands and knees or kneeling position is chosen as this is the best position for breech delivery.

While unusual for a breech birth, the amniotic sac did not break during labor. Once the mom began pushing it ballooned out of her as shown in the first picture below. The midwife broke the sac to reveal tiny little toes. After a few pushes it became apparent that both feet were presenting.

In the second picture you can see the other leg is coming through. At this point the baby has its back to the mother’s right side (RST). Watch as she spirals herself out. The little mini skirt is the remnant of the amniotic sac.

Some midwives believe that it is best not to touch the baby during the delivery because the touch may cause the baby to startle and raise its arms. Others believe that a little support would help to reassure the baby that it was being pushed into a loving place. Most agree that under no circumstances should the baby be pulled.

By the last picture the baby has turned to a posterior position with her back to her mother’s back and left (LSP). This is not an optimal position for a breech (or any) delivery.

While the baby is in a posterior position the assistant midwife applies some pressure above the mother’s pubic bone to help prevent the baby’s arms or head from getting hung up there. She also keeps nearly constant assessment of the baby’s heartbeat with a doppler. In the pictures below she is seen applying some support to the mother’s perineum as the baby comes down.

Some meconium is usually squeezed out during a breech birth. It is not seen as the sign of possible distress as it is in a vertex birth. This is actually a very small amount. When the butt comes out first there is a lot more meconium pushed out. The baby continues to rotate. (What cute chubby little legs!)

Because the baby has been rotating to the right the cord is now between the baby and the mother’s pubic bone. This is a problem because it is almost completely compressed. In the first picture below, the midwife is supporting the baby with her right hand while she attempts to shift the cord away from the pubic bone to the baby’s belly to relieve the pressure.

The baby has turned to the opposite side she was on when she first presented. Her back is now (almost) to her mother’s left side (LST).

In the second picture the midwife is feeling for an arm. She can’t feel either arm meaning they are not against the baby’s chest under her chin as hoped. She is not pulling on the baby or applying any force. She waits for the arms to become accessible.

The baby needs to be delivered quickly once born to the umbilicus because of the pressure on the cord. To assist the descent, the midwife is reaching for the baby’s right arm in the first picture and pulls it down. She then reaches for the left arm and frees it as well.

The baby was born after about 30 minutes of pushing.