Complicated Breech Scenarios: Heads Up! Breech Conference

Day 3

Breech Birth Scenarios

Diane Goslin

Diane Goslin, who serves a large Amish & Mennonite population in Pennsylvania, described several complicated breech scenarios she has encountered. Gail Tully helped by illustrating the situations with a doll & pelvis. Diane then invited conference participants to share their own less-than-textbook breech births--this included footling and kneeling presentations, slow labors, long second stages, babies that did not rotate to anterior, and nuchal arms.

After learning from Jane Evans the signs of a normal, physiological breech birth, it was very enlightening to learn how to recognize and respond to abnormal breech situations. After all, that's really what breech attendants really need to know. Much of the time, breech babies emerge on their own. But what if they don't? That's when a cool head, skilled hands, and the ability to think on your feet can be lifesaving.

The main things Goslin has learned over the years:

• A lot of patience and a lot of monitoring. A breech is not the kind of birth where you go sleep on the couch. You need enough help in case the mom, dad, or midwives are exhausted. 
• Be able to picture your baby well and visualize how it's inside the mother. Become confident and competent with how the baby is positioned inside the pelvis. 
• Think outside the box. As much as we might love H&K, for example, we have to be willing to try whatever works to help get the baby out.  
• You have to be flexible and  see what's working. You can't just have one formula for getting these babies out. We don't like doing manipulations, but it there is trouble, it's better than a brain-damaged or dead baby. You need to know the maneuvers and know when & how to do them.

Jane Evans commented that British midwife Mary Cronk taught her a lesson about getting a stuck object out. Mary had a messy kitchen drawer that would often get stuck because some object was wedged and in the way. Mary's husband would shut the drawer a bit, wiggle the objects around, and then open the drawer easily. The same goes with breech birth. If you can resolve the obstruction, then the baby can descend easily.
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