Everything Is Just Breechy

mayas-birth-2I think the best way to help the woman is to keep the atmosphere calm and create as little stress as possible.

I also agree with this:

“Some practitioners advise waiting for an hour after full dilatation before active pushing is ‘allowed’. This is thought to ensure the cervix is *completely* dilated. This is particularly important for premature births as the bottom of a pre-term or growth restricted infant is generally smaller than their head but is questionable when the baby is full term and well grown as the bi-trochanteric diameter is the same as the bi-parietal diameter (the bottom is the same size as the head). By carefully observing the progress of the labour and the external signs of full dilatation the midwife rarely has need for an internal examination. Active pushing only starts when the urge is overwhelming and impossible to stop and then progress is usually smooth. If there is an urge to push before the signs of full dilatation are apparent the usual strategy of asking the woman to adopt a knee chest position is usually effective until spontaneous descent occurs. There is also a school of thought that if the birth is delayed the uterine contractions compress the baby into a more favourable, more flexed position thus facilitating a smoother birth.

A woman’s perineum is best left untouched as discussed above. A woman’s perineum is remarkable as it is designed to stretch and expand to facilitate the birth of the baby by gently adjusting the position of the baby as it progresses down the birth canal. It does not require support.

All breech babies technically have a cord prolapse. The head comes after the body. There is of course risk of compression between the bony pelvis and the baby. This cord does not appear to be unduly compressed and the compression would be transient as the baby was rotating. It should be remembered that a full term baby can tolerate a short period of anoxia during the birth and that the cord, at this stage is unlikely (and appears not) to be occluded totally. The cord is not between two bones but the maternal symphysis pubis and the baby’s abdomen. There is also the danger of causing the cord to go into spasm, thus exacerbating any problem.

When the baby is born to the umbilicus there is no need to rush. Steady progress and no delay is required at this time. The cord is unlikely to be occluded until the head comes into the pelvis, which is as the shoulders are being born. With natural manoeuvres, plus gravity, the shoulders and arms are usually born without help.

The baby rotates through the pelvis in a spiral in order to bring its’ arms down spontaneously – by handling the baby and hurrying the natural mechanism problems could occur’”

I couldn’t say it any better than this. Lots of these thoughts apply to all labours, the mechanism may be slightly different but the spontaneity and normality of it shouldn’t be interfered with unless there are signs that things aren’t moving along naturally. Then the breech skills that are taught over and over come into play.


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