How to Deliver a Frank Breech Baby

In frank breech presentation, the baby is aligned vertically within the uterus with the buttocks facing down. The hips are flexed with legs extending up toward the head. Most breech babies must be delivered by experienced medical professionals, and a cesarean section is often performed. However, vaginal delivery is sometimes possible.

Instructions

Difficulty: Challenging

1. Allow delivery to occur spontaneously until the anterior buttock appears in the vulva. The buttocks will distend the vaginal outlet to make room for the head. As the baby's body moves down the birth canal, it will rotate so that the shoulders can pass through the mother's pelvis.
2. Watch the baby's buttocks for advancement through the next few contractions. If there is no progress, consider performing an episiotomy. Insert two fingers from each hand into the vaginal opening around the baby's buttocks and pull gently on the baby's lower body until the lower body is born up to the knees. Episiotomies should never be performed by anyone but experienced medical professionals.
3. Slip one hand along the anterior leg of the baby and grasp the upper thigh. Flex the baby's thigh back toward its body and slightly outward so that the leg bends at the knee, delivering the remainder of the leg. Repeat with the other leg.
4. 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 spontaneously. 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 to avoid harming baby or mother.
5. Feel for the baby's arms inside the opening of the birth canal to determine position. Pull the arms down individually if they are accessible.
6. 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.
7. Rest the baby's body on your hand and forearm and 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.
8. Hook two fingers of your free hand on either side of the baby's neck. Gently pull down on the shoulders until the back of the baby's head appears under the mother's pubic bone.
9. 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. Go slowly to avoid overextending the baby's neck and head.

Tips & Warnings

• IMPORTANT: Do not attempt to deliver a frank 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.
• At Step 4, allow the mother to attempt to deliver the baby spontaneously. It's best not to apply traction to the baby's buttocks to aid delivery as this may cause extension of the baby's head or entrapment of an arm behind the head, making the head more difficult to deliver.