![]() ![]() They bring the baby to the mother and wait, rather than cutting the cord and removing the baby. She's learning as much about resuscitation in Frankfurt as about breech birth.When you're doing Frank's nudge (aka the shoulder press), be sure the baby's head is turned to the front, rather than facing to the side.They noted that women would often spontaneously fall over onto hands & knees when the baby was breech or had a (cephalic) shoulder dystocia. Traditional midwives taught her to have the laboring woman grab a rope, sit and squat.For example, at her first solo breech birth at her hospital (where she was able to do the birth on her own, rather than transferring care to an obstetrician), the woman was on H&K on the bed and not much progress happened until she got on the birth stool. She has also never seen a cervix clamp down over the baby's head, because once the baby is descending, the head comes right out. She also noted that the Frankfurt team has never had to use forceps to date, nor Andrew Bisit's unit in Sydney. For midwives who are not trained or not allowed to use forceps, using one's hand is a way out of feeling like you *have* to have forceps. Her hypothesis is that hand size/width might be an important consideration for the birth attendant, and hands might be a better replacement for forceps. She wondered why obstetricians in the past have not done this and theorized that perhaps their hands were too large. ![]() She suggested trying first with the cheekbone, and if that doesn't work, you can go up further and try on the parietal bone. She went up inside the mother with one hand, all the way along the side of the baby's head to the parietal bone, and she was able to then flex the head and bring it down. The most fascinating part of Betty-Anne's lecture was a description (including videos and reconstructions using a doll and pelvis) of a technique she calls the "crowning touch." She attended a birth where the head became hyperextended after the arms were born. I won't summarize the cardinal movements here, so I suggest you visit Jane Evan's video demonstrating the cardinal movements of the breech baby (from the 2nd International Breech Conference in Washington, DC 2012). Both the posterior or anterior arms can become caught in various locations: on or under the sacral promontory or on the symphysis pubis. For example, if the baby stays right lateral and doesn't descend, that probably means a vaginal birth won't happen. ![]() She briefly reviewed the cardinal movements of a breech baby through the maternal pelvis, noting instances that indicate a vaginal breech birth will not happen or will be problematic. After some introductory remarks, Canadian midwife and researcher Betty-Anne Daviss noted that the term cardinal movements is a bit of a misnomer, because there are more variations in the descent of a breech breech than of a vertex baby. ![]()
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