Practical insight into upright breech birth from birth videos: A structured analysis

Anke Reitter, Alexandra Halliday, Shawn Walker*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

14 Citations (Scopus)
16 Downloads (Pure)


Background: We aimed to identify common features of upright vaginal breech births with good outcomes to refine a physiological approach to teaching breech birth. Methods: We performed a structured analysis of 42 videos of successful upright breech births (eg, kneeling, hand/knees), facilitated by obstetricians (n = 34) and midwives (n = 8) in nine different countries. Precise timings and relevant clinical details were recorded on an Excel spreadsheet. Each video was analyzed twice by at least two members of the research team. Time-to-event intervals, frequencies of interventions, and descriptive statistics were calculated using SPSS. Results: A completely spontaneous (labor mechanisms and maternal effort only) birth occurred in 14/42 (33%) cases. The median time between the birth of the fetal pelvis and the head in all births was 1:52 (IQR 1:05,2:46; min:sec). Lack of spontaneous rotation to a sacro-anterior position by the time the fetus had emerged to the nipple line was strongly associated with fetal arm entrapment. The following maneuvers were used: shoulder press to flex the aftercoming head in midpelvis or outlet (n = 24), sweeping down arm/s (n = 12), buttock lift to assist shoulder press (n = 6), modified Mauriceau (n = 6), rotational maneuvers to release an entrapped arm (n = 6), elevate and rotate fetal head to assist engagement (n = 2), and conversion into supine maternal position (n = 2). Conclusions: Most upright breech births occur within 3 minutes of the birth of the fetal pelvis. Upright breech birth attendants use variations of traditional maneuvers. We introduce a physiological breech algorithm as an initial timekeeping framework for teaching, research, and practice.

Original languageEnglish
Pages (from-to)211-219
Number of pages9
JournalBirth (Berkeley, Calif.)
Issue number2
Publication statusPublished - 1 Jun 2020
EventBritish Intrapartum Care Society Annual Conference - National Space Centre, Leicester, United Kingdom
Duration: 7 Nov 20198 Nov 2019


  • Breech Presentation
  • birth videos
  • Intrapartum care
  • mechanisms
  • algorithm


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