How to Deliver a Footling Breech Baby

Footling breech presentation, when one or both of the baby's feet present to the birth canal, is a rare complication that requires extreme care during delivery. Whenever possible, footling breech deliveries should be performed by experienced medical professionals in a hospital, as a Cesarean section is often necessary. Occasionally, footling breech babies can be delivered vaginally as follows.

Instructions

Difficulty: Challenging

1. To ensure that the head will be able to pass through, check that the mother's cervix is fully dilated and effaced before attempting to deliver a baby past the umbilicus.
2. Allow the fetus to descend down the birth canal on its own, unless there are signs of fetal distress. In cases of fetal distress when cesarean delivery is impossible, insert your hand into the vagina and grasp the feet. Place a finger between the legs and pull gently.
3. Support the baby's legs as the mother pushes its body out. Allow the mother to deliver the baby spontaneously. If the baby's emergence does not progreess, or there is a danger that the umbilical cord will compress, full manual extraction may be indicated. Determine whether an episiotomy is necessary before grasping the baby's legs and pulling gently. Episiotomies should never be performed by anyone but experienced medical professionals.
4. To prevent the baby's legs or head from getting stuck, apply pressure above the mother's pubic bone if the baby turns posterior while emerging.
5. If the baby does not deliver spontaneously, pull gently downward to deliver the hips and then the buttocks . Grasp the baby's hips with the thumbs over the sacrum and continue pulling down gently. Rotate the baby laterally if it does not do so on its own. At this point, the baby is delivered past the umbilicus, so possible pressure on the cord makes it necessary to complete the delivery as fast as possible without harming baby or mother.
6. Feel for the baby's arms inside the opening of the birth canal to determine position. Pull the arms down one at a time if they are accessible.
7. Rotate the baby's trunk until the front arm and shoulder are delivered, if they do not come out on their own. Rotate the body in the reverse direction to deliver the other shoulder and arm.
8. Rest the baby's body on your hand and forearm. Insert your index and middle fingers into the vagina, resting upon the baby's upper jaw. Do not place your fingers in the baby's mouth or push hard on the neck.
9. Hook two fingers of your free hand on either side of the baby's neck and gently pull down on the shoulders until the back of the baby's head appears under the mother's pubic bone.
10. Elevate the baby's body gently toward the mother's abdomen to deliver the mouth, nose, brow and crown of the head beyond the mother's perineum.

Tips & Warnings

• IMPORTANT: Due to high maternal and fetal morbidity rates, cesarean sections are usually performed in cases of footling breech presentation. Do not attempt to deliver a footling breech baby unless you're an experienced medical professional or are in an emergency situation where transport to a hospital is impossible.
• This bears repeating: Episiotomies should never be performed by anyone but experienced medical professionals.