frank breech

In Physiological Breech Birth training, we teach breech practice according to the consensus statements developed with experienced professionals in Principles of Physiological Breech Birth Practice (Walker, Scamell & Parker, 2016), including:

Care providers should not disturb women’s spontaneous movements in an otherwise normally progressing breech birth.

Mother-led positioning offers the greatest physiological advantages.

Sometimes maternal-led positioning is most conducive; sometimes judicious guidance is appropriate, especially to help resolve delay.

When facilitating a physiological breech birth, care providers proactively use maternal position (or change in position) to promote normal descent.

The pictures below demonstrate asymmetrical maternal movement in a normal breech birth, in which the mother assumes an upright, kneeling position, with freedom to move her torso up and down as she feels the need. Study of effective, spontaneous maternal movements during successful breech births teaches professionals about all normal birth. Instinctive maternal movement can be read as purposeful and meaningful, in light of radiological evidence of changes in pelvic diameters (Reitter et al, 2014) — rather than counter-productive and needing professional interruption or guidance.

In this picture series, the mother spontaneously lifts one of her legs into an asymmetrical, ‘running start’ position. Often a change in maternal position, or rhythmic maternal movement (“give it a wiggle”) will prompt spontaneous descent to resume.

If a professional detects a slight delay in descent, it may be appropriate to suggest a change of position by raising one leg or the other, as a first-line intervention, a ‘maternal manoeuvre,’ before hands-on intervention. If you are using a ‘Running Start’ position, assist the mother to lift the leg on the side the baby faces, e.g. the same side as the legs & umbilicus. This will open the pelvis on that side, creating space for the pubic arm to descend past the ischial spine, and encouraging rotation in a sacrum-anterior direction. If you intervene by lifting the leg on the side of the baby’s back, this will encourage rotation in a sacro-posterior direction.

Thank you to the staff at the Royal Jubilee Maternity Services in Belfast for giving us the language, “Lift the leg on the side the baby faces.”

This mother is raising and lowering her torso with the aid of her partner’s thighs.

Dropping her torso, arching her back and tucking her hips under.

Moving her hips back towards her heels.

Squatting back onto her heels. This creates maximum space in the pelvic outlet as the breech passes through the ischial spines. The mother will not ‘sit’ on her baby, preventing the birth, but will instead raise her hips again when she instinctively feels the urge to do so.

Rising up again, arching her back. Creating space in the pelvic inlet as the shoulders and head enter.

Squatting back down. Spontaneous movements constantly change pelvic diameters as the baby rotates through.

Torso and hips rise up as baby rumps. Thrusting hips forward has a protective effect on the perineum and opens the inlet to assist engagement of shoulders/head. ‘Fetal ejection reflex.’

Pressure as baby descends. The mother drops her torso down again.

Moving into Running Start. The baby has not completely rotated to sacrum-anterior. The mother spontaneously lifts the leg on the side of the fetal legs, creating further space to assist rotation of the torso and descent of the pubic arm.

Significant descent occurs with the next contraction.

Running start continues to make space for gravity to do it work.

Almost there.

Straight to his mother’s arms.

The physiological process of welcome continues without interruption.

Thank you to the mother, who gave permission for her birth photos to be used for educational purposes; and to her family and midwives. One of these images appeared in the article, Unexpected Breech: What can midwives do?  in The Practising Midwife. Click here to download – PDF.