Clinical Practice Procedures:

Obstetrics/Breech birth
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Date April, 2016

Purpose To ensure a consistent procedural approach for Breech birth.
Scope Applies to all QAS clinical staff.
Author Clinical Quality & Patient Safety Unit, QAS
Review date April, 2018
URL https://ambulance.qld.gov.au/clinical.html

This work is licensed under the Creative Commons

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International License. To view a copy of this license,
visit http://creativecommons.org/licenses/by-nc-nd/4.0/.
 Breech birth
April, 2016

A breech birth is the delivery of a baby from a breech presentation, where the foetus enters the birth canal with the buttocks or feet first,
as opposed to the normal head first presentation.

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Figure 3.71

The main categories of breech delivery include:[1]

Frank breech Footling breech

The foetuss buttocks presents first, One or both feet presents first, with
with the legs flexed at the hip and the buttocks at a higher position.
extended at the knees, placing This is rare at term, but relatively

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the feet near the ears. common with premature
Most breech babies, babies. Here the hips and
(6570%) are in the knees are flexed so that
Frank breech position. the foetus is sitting
cross-legged, with feet
beside the buttocks.
Increased risk of prolapsed
cord with a footling breech.

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Complete breech Kneeling breech

Here the hips and knees The foetus is in a kneeling position,

are flexed so that the with one or both legs extended
foetus is sitting at the hips and flexed at the
cross-legged, knees. This is extremely rare

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with feet beside and often grouped with
the buttocks. footling to form the
category incomplete breech.
Increased risk of prolapsed
cord with a kneeling breech.

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 Indications
To assist a labouring woman in the birth
of her child when the child presents in
a breech position
MANAGEMENT (Breech birth)
Preparation for newborn resuscitation should be made at the
earliest sign of breech presentation.[2]
Consideration should be sought for early CCP/obstetric retrieval
team backup.

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Contraindications
Ensure technique with appropriate infection control measures
to be taken at all times.

Nil in this setting

The following procedure has
been adapted from guidelines

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provided by the World Health
Complications
Organisation.[3]
Foetal distress and hypoxia
Failure to deliver
Pain

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Prolapsed cord
Shoulder dystocia
Head entrapment
Meconium aspiration
Post-partum haemorrhage
Inversion of the uterus

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NOTE: Perform all manoeuvres gently and without undue force.
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 Procedure Breech birth

1. Delivery of the buttocks and legs d) If the legs do not deliver spontaneously, deliver one leg at a time:

Buttock has - Push behind the knee to bend the leg;

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a) Once the buttocks entered the vagina - Grasp the ankle and deliver the foot and leg;
have entered the - Repeat for the
vagina tell the other leg.
woman she can
push with the
contractions.

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b) Let the buttocks
deliver until the
lower back and then
the shoulder blades are seen.
The legs
c) Gently hold the buttocks in one hand, have delivered

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but do not pull. spontaneously

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 Procedure Breech birth

2. Delivery of the arms

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Unassisted
e) Hold the baby by the hips with
(arms disengage spontaneously)
thumbs on the buttocks.

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Do not hold
the baby by
the flanks
or abdomen

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as this may
cause kidney
or liver
damage.
Assisted
(bend arm to bring hand over face)
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 Procedure Breech birth

Arms stretched above the head or folded around the neck b) Assist delivery of the arm by placing one or two fingers on the
upper part of the arm. Draw the arm down over the chest as
Use the Lovesets manoeuvre: the elbow is flexed, with the hand sweeping over the face.

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a) Hold the baby by the
c) To deliver the second arm, rotate the baby back 180,
hips and turn 180,
keeping the back uppermost and applying downward traction,
keeping the back
delivering the second arm in the same way under the pubic arch.
uppermost and
applying downward
traction at the same
time, so that the arm

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becomes anterior
and can be delivered
under the pubic arch.
Arm that was posterior
becomes anterior

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2nd arm that was posterior
now becomes anterior

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Lovesets manoeuvre 1 Lovesets manoeuvre 2
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 Procedure Breech birth

If the babys body cannot be turned to deliver the arm that is anterior c) Free the arm and hand.
first, deliver the shoulder that is posterior:
d) Lay the baby back down by the ankles. The shoulder

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a) Hold and lift the baby up by the ankles. that is anterior should now deliver.

b) Move the babys chest towards the womans inner leg. The shoulder
that is posterior should deliver.

Lovesets manoeuvre 3

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NOTE: This procedure is different to the Burns Marshall Manoeuvre
and once the arms are delivered the Adapted Mauriceau-Smellie-Veit
is then undertaken.
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 Procedure Breech birth

3. Delivery of the head

Deliver the head by the Adapted Mauriceau-Smellie-Veit (MSV) manoeuvre as follows:

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a) Lay the baby face down with the length of its body over your hand and arm.
b) Place the first and second fingers of this hand on
the babys cheek bones and flex the head.
c) Use the other hand to hook the
babys shoulders with the index
and ring fingers with the middle

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finger on the babys occiput.
d) Gently flex the babys head
towards the chest to bring
the babys head down
until the hairline is visible.

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e) Pull gently to deliver the head.
f) Raise the baby, still astride
the arm, until the mouth
and nose are free.
g) Deliver the baby onto the
mothers abdomen for

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skin to skin contact.

NOTE: Ask an assistant to push above the mothers

pubic bone (suprapubic pressure) as the head delivers.
This helps to keep the babys head flexed.
Adapted Mauriceau-Smellie-Veit (MSV) manoeuvre
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 Procedure Breech birth

4. Care of the newly born

a) Place the newborn on the mothers abdomen, providing

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skin to skin contact. Thoroughly dry the baby, wipe the
eyes and assess the newborns breathing.
b) If the newborn is crying or breathing (chest rising at least Clamping and cutting of
30 times per minute) leave the newborn with the mother.
the umbilical cord
c) If the newborn does not start breathing within
30 seconds, take steps to resuscitate the newborn.
Clamp cord at 10, 15

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d) Complete an APGAR score at 1 and 5 minutes
after birth.
e) Late cord clamping (performed approximately
and 20 centimetres
from the newborn
and cut between
15 and 20 centimetres.
35 minutes after birth) is recommended for
all births, while initiating simultaneous
essential neonatal care.[4,5,6]

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f) Clamp cord at 10, 15 and 20 centimetres
from the newborn and cut between
15 and 20 centimetres.
g) Ensure the newborn is kept warm en route to the
receiving facility. Maintain skin to skin with the
mother and cover the newborns head and back

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with a warm blanket.
h) Encourage suckling, if mother wishes.

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