- To minimise complications during transportation of a potential breech birth and facilitate delivery only when inevitable.
- Patient is male
- Cord prolapse (7.4%)
- Foetal head entrapment in (0-8.5%)
- Perinatal mortality
- Postpartum haemorrhage
- Premature placental separation
- Prolonged compression of cord
- Trauma:
- Brachial plexus
- Brain/skull
- Fractured humerus, femur or clavicle
- All relevant infection control methods to be utilised.
- Prepare equipment required:
- Adult and infant BVM
- Baby mucus extractor
- Oxygen
- Placenta bucket
- Small combine
- Space blanket
- Sterile gauze pad
- Sterile scissors
- Towel
- Umbilical clamps
- Place in the lithotomy position[1] and move buttocks to end of bed.
- Administer high flow oxygen.
- Insert IV cannula.
- Consider appropriate analgesia.
- If foetus’ buttocks are presenting[2] on the perineum encourage the mother to actively push during contractions.
- Allow the legs, abdomen and trunk to deliver by maternal effort. Once the buttock is born external rotation of buttocks is seen whereby the baby’s back becomes uppermost[3].
- If legs are extended slide two fingers along the anterior leg and apply gentle pressure in the popliteal fossa.
- Deliver the legs by flexion and abduction[4].
- Gently bring down a loose loop of cord (approximately 15cm).
- If the shoulders do not spontaneously deliver place a single layer towel over the hips and buttocks and grasp the pelvic girdle with thumbs on the sacrum and index and mid fingers on the hips[5].
- Once the tip of the scapula comes into view gently rotate the posterior shoulder anteriorly into the oblique by rotating the baby through 180°. The sacrum is kept anterior at all times.
- With the next contraction and maternal effort apply gentle downward traction to deliver the shoulder[6].
- Gently rotate through 180° in the opposite direction to bring the anterior shoulder into the other oblique plane.
- Deliver the anterior shoulder by using gentle downward traction. Keep the sacrum anterior.
- If an arm is extended and obstructs progress slide two fingers along the anterior arm and apply gentle pressure in the cubical fossa. Flex the arm and swept across the chest and out of the vagina. Rotate the baby to original position with back facing uppermost.
- Place forearm under the baby for support.
- Commence delivery of the head with the next contraction. Maintain foetal head in a flexed position to allow passage.
- Perform Mauriceau Smellie Veit manoeuvre: place index and middle fingers on the foetal maxillary prominences[7], raise upwards[8]
- Note and record time of birth.
- Proceed with normal neonatal care.
- If the baby’s head does not deliver within 3 minutes transport the mother in an exaggerated Simms position[9]. Apply a V hold on the baby’s face if practical[7].
- Maintain a warm environmental temperature using blankets/towels.
- Advise receiving hospital.
- Monitor and record mother’s blood loss.
Frank
Complete
Footling
- Continue with Childbirth clinical skill.
- If the baby’s head does not deliver within 3 minutes, transport the mother Priority 1 to the nearest obstetric hospital in an exaggerated Simms position[9].
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