Ok, the topic of breech is so daily in my life right now. I wish I was done with my other projects to travel somewhere for more training. Somethings up. At least we are working on a related project….more on that when its manifested. I got another call today from a birth educator, out of town, looking for a breech-skilled provider. Just what those skills are does need to be discussed.
Today, Teri’s Passion for Birth blog post with a couple of my midwife partner, Emme Corbeil’s photos of our other partner Clare Welter, CNM (the footling here) and Sylvia Kosloski, CPM (my own midwife!) with me at our Midwifery Now! (MN!) Breech Update showing the cardboard pelvis I made the day before the workshop. Teri said to friend me on Facebook and learn the Cardinal Movements of Breech … er, ah,
ok, I guess that’s an assignment for me. Didn’t mean to steal the honor, as other midwives are more qualified! Meanwhile, here’s Teri Shilling’s blog https://childbirtheducation.blogspot.com/2009/11/mega-pelvis.html
The person who really describes breech cardinal movements well is UK Midwife Jane Evans. She explained the best starting position for the breech is Right Sacral Lateral (Transverse in our country’s English). That’s just the opposite for a head down baby. Very enlightening!
The baby starts on the right.
When the hips enter the brim, they may be transverse then. Even if they’re coming in posterior, the baby will rotate around to the anterior by the ribs, if there is no touch, and no obstacles to the cardinal movements of the baby (such as lying on one’s back) during the movement through the pelvic floor.
The mother is on her hands and knees most often for safety. We show the pelvis as if the mom is standing simply because of the size of adults and showing a room full of midwives.
And the box wouldn’t support a person moving through it if it were on its side. So the pictures are not exactly how it’d go, but they show the general idea.
The baby turns to face a hip as the chest comes into the pelvic floor and the first bun appears. The first bun to appear is the anterior cheek. When the buns are one above the other, you see one before the other rather than both at once, its reassuring of success with the arms.
After the birth of the hips the umbilical cord appears. It is easy to see if the cord is happily pulsating. It is easy to see if the baby’s tone is good. But do not touch the cord to bring down a loop.
The baby rotates again and faces the spine as the shoulders enter the pelvic brim. The arms, often over the chest, drop out in this position. The baby is still not touched. The midwife may be going crazy with desire to touch the beautiful child or to check the cord by touch. She’ll get over it. Don’t touch.
The baby pulls the knees up to the belly and this brings the chin to the chest. The baby is likely to drop out now or with the next contraction. Remember, you are watching the umbilical cord and tone of the baby to assess health.
As the baby drops from the mother the midwife or doctor quickly catches the baby. This is the appropriate first touch.
In this way, the baby’s work to rotate through the pelvic floor is not interrupted. Disturbing the baby increases the likelihood of having to rescue the baby from extended arms.
Anyone hoping to catch a breech has to know the specific ways of releasing stuck arms or the extended head. Just because touching the breech is one common cause of extended arms or head, it is not the only cause. I’ll leave that information for another venue.
I have only had my hands on a few breech babies that needed help and am fortunate to have studied and studied, and practiced and practiced with dolls and pelvis and a very astute senior midwife before needing to put those lessons to action. We are fortunate to have some good breech How to’s in print:
B BREECH BIRTH, book by Benna Waites