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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.
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!" don't 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.
MoonDragon's Birthing Guidelines - The Unexpected Breech
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