Shoulder Delivery by Breech Presentation*

Does breech delivery in an upright position instead of on the back improve outcomes and avoid cesareans?

“…Second, it introduces a new understanding of cardinal movements of the descending breech and maneuvers to rectify problems (Fig. ), avoiding traditional, potentially damaging maneuvers required in dorsal position and from which cesarean delivery does not necessarily escape . Third, unlike registry studies, the present investigation provides detailed clinical information about each birth for assessment and comparisons.…”

“…Practitioners are now performing cesarean deliveries for breech births rather than improving vaginal breech maneuvers designed for mothers on their backs that have changed little since the 1930s, and before that, had not changed since the 1700s . In 2004, we realized the Bracht maneuver for breech could be eliminated by turning the mother over onto her knees.…”

Vaginal delivery of breech presentation

“…The Løvset and Bickenbach manoeuvres are the best described [7,54]. Only the bony fetal pelvis and legs should be grasped to avoid damage to the fetal adrenal glands, which are disproportionately large.…”

“…After spontaneous delivery to the fetal umbilicus, expulsive delay despite power from above, with or without nuchal arms may require manoeuvres involving fetal manipulation. The Løvset and Bickenbach manoeuvres are the best described [7,54]. Only the bony fetal pelvis and legs should be grasped to avoid damage to the fetal adrenal glands, which are disproportionately large.…”

“…Improved safety with antibiotics, blood transfusion, and Kerr's lower segment incision prompted consideration of routine CS for breech presentation [2]. Concurrently, improvements in vaginal breech delivery technique markedly lowered the risk of a trial of labour in experienced hands, and breech perinatal mortality continued to fall, despite stabilization of the CS rate [1,[3][4][5][6][7][8]. The debate surrounding the optimal mode of delivery for the breech fetus focuses on a single clinical question: what is the magnitude of risk to the fetus of a TOL and how should we balance it against the increased immediate and future risk of CS to the mother and her future children?…”