Face-to-pubes Rotational Maneuver for Bilateral Nuchal Arms in a Vaginal Breech Birth, Resolved in an Upright Maternal Position: A Case Report

TY - JOUR

T1 - Face-to-pubes Rotational Maneuver for Bilateral Nuchal Arms in a Vaginal Breech Birth, Resolved in an Upright Maternal Position: A Case Report

AU - Walker, Shawn Lynn

PY - 2020/6/1

Y1 - 2020/6/1

N2 - Background: A physiological breech birth is one in which the woman is encouraged to remain active throughout her labor and able to assume the position of her choice for the birth. Use of this strategy within the United Kingdom National Health Service has led to the use of innovative maneuvers to relieve obstruction when women give birth in upright positions, for example, kneeling or standing. This includes use of the face-to-pubes rotational maneuver to relieve extended nuchal arm(s). In this paper, we report a case where the face-to-pubes rotational maneuver was used to relieve bilateral nuchal arm entrapment in a breech birth. Methods: Single-case study. We aimed to generate an in-depth understanding of how this maneuver works and how professionals decide to use it by exploring its use in a real-life context. Results: The face-to-pubes rotational maneuver appears to be an effective method of relieving nuchal arm entrapment when used by experienced hands. In cases of bilateral nuchal arm entrapment, elevation to a higher station may be necessary to dis-impact the arms above the pelvic inlet before the fetus can be rotated. After face-to-pubes rotation and release of arms, the head should be realigned in an occiput anterior position for delivery. Conclusion: The face-to-pubes rotational maneuver can be taught for resolution of nuchal arms in an upright position. Parents should be informed of the availability or not of a specialist midwife trained in physiological breech birth, as this may be important to their decision-making.

AB - Background: A physiological breech birth is one in which the woman is encouraged to remain active throughout her labor and able to assume the position of her choice for the birth. Use of this strategy within the United Kingdom National Health Service has led to the use of innovative maneuvers to relieve obstruction when women give birth in upright positions, for example, kneeling or standing. This includes use of the face-to-pubes rotational maneuver to relieve extended nuchal arm(s). In this paper, we report a case where the face-to-pubes rotational maneuver was used to relieve bilateral nuchal arm entrapment in a breech birth. Methods: Single-case study. We aimed to generate an in-depth understanding of how this maneuver works and how professionals decide to use it by exploring its use in a real-life context. Results: The face-to-pubes rotational maneuver appears to be an effective method of relieving nuchal arm entrapment when used by experienced hands. In cases of bilateral nuchal arm entrapment, elevation to a higher station may be necessary to dis-impact the arms above the pelvic inlet before the fetus can be rotated. After face-to-pubes rotation and release of arms, the head should be realigned in an occiput anterior position for delivery. Conclusion: The face-to-pubes rotational maneuver can be taught for resolution of nuchal arms in an upright position. Parents should be informed of the availability or not of a specialist midwife trained in physiological breech birth, as this may be important to their decision-making.

KW - bilateral nuchal arms

KW - breech presentation

KW - physiological breech birth

KW - rotational maneuvers

KW - upright breech birth

UR - http://www.scopus.com/inward/record.url?scp=85080984734&partnerID=8YFLogxK

U2 - 10.1111/birt.12486

DO - 10.1111/birt.12486

M3 - Article

SN - 0730-7659

VL - 47

SP - 246

EP - 252

JO - Birth (Berkeley, Calif.)

JF - Birth (Berkeley, Calif.)

IS - 2

ER -