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1. Give the mother lots of reassurance during prodomal (early) or latent labor.
2. Stay with her all of the time, even in early labor and take heart tones regularly as the cord may be compromised at any time.
3. To help prevent cord prolapse in a footling breech do not encourage the mother to walk or stand in an upright position. Having her sit in the "tailor" position in a comfortable chair with her back well supported will assist the buttocks of the baby to move down (more into a squatting position) and will enhance application to the cervix, thus guarding against possible cord prolapse.
4. Very warm baths are always a welcome labor assistance. Try placing a hot water bottle against the mother's lower back in the tub, if she is uncomfortable.
5. Hands and knees position or knee-chest will help when the mother has an uncontrollable urge to push prematurely.
6. In footling breech presentation, try to keep the feet within the vagina as long as possible. If the mother can't stand it any more, and they slip out, be sure to keep them covered and warm to prevent premature respiratory stimulation. DO NOT RUSH THE BIRTH! When the feet emerge, be sure to check for cord.
7. Let mom sleep if she wants to. No harm will be done if the cervix has a chance to further disappear. Remember that correct assessment of dilation is difficult in breeches, especially footlings. Choosing to opt for an "hour of patience", for optimum assurance of complete dilation... GO FOR 12 CENTIMETERS! If you can feel the cervix, she is not complete.
REMEMBER: The predominant reason for breech delivery failures, i.e., stuck heads, is due to premature pushing or incorrect assessment of complete dilation.
8. Give oxygen generously as needed during second stage, especially when mother begins continuous pushing.
9. Keep mother well hydrated. It is not unusual for the breech mother to refuse food, as the continuous pressure of the baby's head in the upper abdomen may make her feel nauseous.
10. The midwife must be expert in performing newborn resuscitation! She must have oxygen on hand and a pair of Blunt/Sharp scissors on hand in the event of emergency episiotomy.
MoonDragon's Birthing Guidelines - The Unexpected Breech
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