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

Research output: Contribution to journalArticle

Shawn Lynn Walker, Anke Reitter, Alexandra Halliday

Original languageEnglish
JournalBirth (Berkeley, Calif.)
Accepted/In press23 Dec 2019
EventBritish Intrapartum Care Society Annual Conference - National Space Centre, Leicester, United Kingdom
Duration: 7 Nov 20198 Nov 2019

King's Authors


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 9 different countries. Precise timings and relevant clinical details were recorded on an Excel spreadsheet. Each video was analysed 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 (labour 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 manoeuvres were used: shoulder press to flex the aftercoming head in mid-pelvis or outlet (n=24), sweeping down arm/s (n=12), buttock lift to assist shoulder press (n=6), modified Mauriceau (n=6), rotational manoeuvres to release an entrapped arm (n=6), elevate & rotate fetal head to assist engagement (n=2), 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 manoeuvres. We introduce a physiological breech algorithm as an initial timekeeping framework for teaching, research and practice.

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