BREECH DELIVERY
1. Pregnant patient in active labor with arm, foot, or buttocks presenting first
a. Attempt to establish contact with MCEP or OB for delivery instructions
b. The appearance of feet through the vulva does not require immediate delivery. Allow the feet, legs, and buttocks to advance through the vagina before intervening.
c. If imminent delivery
i. Begin transport to hospital with NICU capability and notify hospital asap.
ii. Encourage mother to push hard
iii. Support infant’s body until the upper back appears.
iv. Grasp the iliac wings and apply gentle downward traction
v. Guide the infant's body in the direction of least resistance and rotate infant “back up” and deliver scapulae
vi. Rotate 90 and deliver shoulder/arm
vii. Rotate 180 and deliver opposite shoulder/arm
viii. Gently rotate baby so face is down
ix. If unable to deliver place fingers on humerus and applying gentle traction with two fingers, the arms can be delivered.
x. Gentle abdominal compression of the mother's uterus will engage the infant's head. Swing the infant's head upwards until the body is in a vertical position.
xi. When the head delivers, suction and wrap the baby.
b. If non-imminent delivery
i. Ay apply gentle pressure to presenting part to prevent or slow delivery
1. Pregnant patient in active labor with arm, foot, or buttocks presenting first
a. Attempt to establish contact with MCEP or OB for delivery instructions
b. The appearance of feet through the vulva does not require immediate delivery. Allow the feet, legs, and buttocks to advance through the vagina before intervening.
c. If imminent delivery
i. Begin transport to hospital with NICU capability and notify hospital asap.
ii. Encourage mother to push hard
iii. Support infant’s body until the upper back appears.
iv. Grasp the iliac wings and apply gentle downward traction
v. Guide the infant's body in the direction of least resistance and rotate infant “back up” and deliver scapulae
vi. Rotate 90 and deliver shoulder/arm
vii. Rotate 180 and deliver opposite shoulder/arm
viii. Gently rotate baby so face is down
ix. If unable to deliver place fingers on humerus and applying gentle traction with two fingers, the arms can be delivered.
x. Gentle abdominal compression of the mother's uterus will engage the infant's head. Swing the infant's head upwards until the body is in a vertical position.
xi. When the head delivers, suction and wrap the baby.
b. If non-imminent delivery
i. Ay apply gentle pressure to presenting part to prevent or slow delivery