Hesperian Health Guides
Baby is breech
There are 3 breech (bottom down) positions:
| frank breech (straight legs) |
complete breech (folded legs) |
footling breech (feet first) |
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A frank breech is the easiest and safest kind of breech to deliver.
Dangers of breech births
Breech births can go well, but they are often dangerous for the baby. They are especially dangerous for a first baby, because no one knows if the mother’s pelvis is big enough for birth.
There are serious dangers of breech birth:
- The cord can more easily prolapse when the waters break.
- The baby’s head can get stuck at the cervix. This can happen if the baby’s body, which is usually smaller than the head, comes through the cervix before the cervix is fully open.
- The baby’s head can get stuck at the mother’s pelvis after his body has slipped through. If the cord gets pinched between the baby’s head and the mother’s pelvis, the baby can die or be brain damaged from lack of air.
If possible, breech babies should be born in a medical center, especially footling breech. If medical help is too far, or if a birth in a medical center is not possible, make sure a midwife who is experienced with breech is there to help at the birth.
Delivering a frank or complete breech
Do not let the mother push until you are sure that her cervix is completely open. Even after she has a strong urge to push, she should wait through a few more contractions to be sure.
When the cervix is open, encourage the mother to push in a way that feels right to her. Encourage her to give good, strong pushes. The baby’s bottom and belly will usually be born without any help.
The legs usually come out by themselves. If they are not coming, put your fingers inside the mother and gently pull down the legs. Do not pull on the baby.
Loosen the cord a little by gently pulling a bit of it out of the vagina. In general, do not touch the cord much.
Wrap the baby in a clean blanket or cloth to keep her warm. If the baby gets cold, she may try to take a breath inside the mother, and her lungs will fill with fluid. Keep the blanket on the baby for the rest of the delivery. (The rest of the drawings in this section do not show the blanket so you can see the baby's position better.)
You may want to have a helper put pressure on the mother’s pubic bone (not her belly). This is to keep the baby’s head tucked in, not to push the baby out. Carefully move the baby’s body down to deliver the top shoulder. Hold the baby by the hips or below.
Be careful. Pressure on the baby's back or belly can injure her insides.
If the top shoulder does not come out, you may need to put your fingers inside the mother’s vagina to bring the arm out. Try to grasp the arm by feeling the shoulder, and then following it down. Pull the arm across the chest by pulling gently on the elbow. Deliver the top shoulder.
Lift the baby gently to deliver the bottom shoulder and then gently deliver the bottom arm.
The baby must now turn to face the mother’s bottom. Hold the baby with your arm, and put one finger in the baby’s mouth. Put your other hand on the baby’s shoulders, with one finger on the back of the baby’s head to keep it tucked in. The baby’s chin should stay close to her chest so it can fit easily through the mother’s pelvis.
Lower the baby until you see the hair on the back of her head. Do not pull hard! Do not bend the neck — it can break!
Keep the baby’s head tucked in while you raise the body to deliver the face. Let the back of the head stay inside the mother.
The mother must relax, stop pushing, and blow (blowing will help her stop pushing). Let the head come out as slowly as possible.
The back of the head should be born slowly. If it comes too fast, the baby could bleed in the brain and be brain damaged or die.
Delivering a footling breech
A footling breech is more dangerous than the frank or complete breech. Footling breech babies have a very high chance of prolapsed cord (the cord coming out before the baby).
It is much safer for a footling breech to be born in a medical center. Try to slow the labor. Put the mother in a knee-chest position and get medical help.
If you cannot get to a hospital, keep the mother from pushing until you are sure that the cervix is fully open. Ask the mother to lie down — the cord may be less likely to prolapse. Use the instructions for delivering a frank or complete breech.