It is of great importance when considering a vaginal breech delivery that the mother has emotional stability, a high degree of confidence in her body as well as in her midwife, and a high degree of motivation. In attempting breech delivery, excellent communication and cooperation between the mother and her birth attendant are important. Make extra time to carefully go over the following material with the parents so that they will know what to expect.

COMPLICATIONS OF BREECH LABOR & DELIVERY:

1. Greater incidence of cord prolapse, particularly with footlings.
2. Pressure on the cord in first stage.
3. Increased incidence of premature placental separation.
4. Head entrapment due to pushing before, or misdiagnosis of complete dilation.
5. Injury to the neck or head.
6. Increased danger of nerve damage if arms are swept up over the head.

NO ATTEMPT AT VAGINAL DELIVERY SHOULD BE MADE UNDER THE FOLLOWING CONDITIONS!

1. Suspected cephalo-pelvic disproportion (CPD).
2. Possibility of baby weighing over 8 lbs or under 5 lbs.
3. Post-term infant (over 40 weeks).
4. Pre-term infant (before 36 weeks).
5. Prior history of CPD or NECESSITY for forceps delivery.
6. Previous NEED for pitocin induction or augmentation.
7. Previous shoulder dystocia.
8. Previous history of protracted or obstructed labor in the first or second stage, except posterior (face up) position.
9. Possible intra-uterine growth retardation (IUGR).
10. Any evidence of fetal distress.

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BREECH SCORING INDEX

When a decision is to be made as the feasibility of attempting a breech delivery, this scoring index is of great help. However it remains important that the midwife uses her own judgment as well, and never attempts a delivery for which she has neither the skill or experience. Even when you have determined that there are no predisposing factors against the delivery, if your heart shouts "NO!" do not do it!

BREECH INDEX SCORING SYSTEM

Points Assigned	0	1	2
Parity	Primagravida	Multigravida
Gestational Age	39 weeks or more	37-38 weeks	36-37 weeks
Estimated Fetal Weight	Over 8 lbs	7-8 lbs	5-7 lbs
Dilation	2 cm	3 cm	4 cm or more
Station	-3	-2	-1 or lower
Previous Breech	None	One	2 or more

This assessment is designed to be made at the onset of labor. A score of less than three would indicate the need for a cesarean section. A score of 4-5 would indicate that a careful review be made and would suggest that one should proceed with caution. A score of five or better would indicate a reasonable chance for a successful vaginal delivery. There are of course some moderating factors. If a multipara has had two nine pound babies vaginally, and this baby is of similar size, she should do fine as long as the baby does not go post dates. One point should be subtracted for footling breeches, as they are somewhat difficult to manage. In general, this is a very reliable system for predicting outcome.

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BREECH BIRTH LINKS

MoonDragon's Birthing Guidelines - The Unexpected Breech

MoonDragon's Vaginal Breech Pictorial - Hospital with Episiotomy & Forceps

Vaginal Breech Pictorial - Hospital without Pain Medication, Episiotomy & Forceps

Performing External Version

MoonDragon's Pregnancy Information: Breech Turning Ideas

MoonDragon's Pregnancy Information: Breech Labor - What to Expect

MoonDragon's Pregnancy Information: Breech Labor - How the Attendant May Assist

MoonDragon's Pregnancy Information: The Breech Delivery at Home

The Website: "Heads Up! All About Breech Babies"

MoonDragon's Pregnancy Information: Breech Presentation Information

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PREGNANCY RELATED LINKS

MoonDragon's Pregnancy Information & Survival Tips

MoonDragon's Pregnancy Information Index

MoonDragon's Pediatric Information Index

MoonDragon's Parenting Information Index

MoonDragon's Nutrition Information Index

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