Breech delivery in the all fours position: a prospective observational comparative study with classic assistance

Abstract

This is the first clinical evaluation of breech delivery in the all fours position. It is a feasible non-interventional obstetric delivery method. It seems to be safe for the fetus with reduced maternal morbidity. Vaginal delivery of fetal breech presentation, even in the all fours position, creates stress for the newborn.

Does breech delivery in an upright position instead of on the back improve outcomes and avoid cesareans?

“…Researchers in Salzburg, Austria, did a matched‐pair analysis limited to 41 breech deliveries with the mother on her hands and knees and a retrospective cohort of classic vaginal delivery, and concluded that upright delivery seemed to be “safe for the fetus with reduced maternal morbidity.” In an Australian study of 243 planned vaginal upright births, morbidity was low and short term, indicating good outcomes. However, there was no dorsal comparison group.…”

Expertise in physiological breech birth: A mixed‐methods study

“…The opposing belief among a portion of participants that identification of specialists would limit, rather than expand, availability of breech births requires careful consideration in any setting intending to trial a breech team. A further limitation is that the participants in the research were all oriented to physiological breech birth, involving upright maternal positioning . Although many of the participants developed experience within settings where this practice was not normative, the social clinical roles may not function in the same way in maternity care contexts where women and/or their attendants are not able to use upright birthing positions.…”

The art of vaginal breech birth at term on all fours

“…It is estimated that 8% to 35% remain undetected until labor . From the literature to date, we could only identify one case‐control study on the effectiveness of the all‐fours position for vaginal breech birth . This study showed that vaginal breech birth in the all‐fours position was accomplished spontaneously in 70.7% ( n = 29/41).…”

“…However, infants had a lower umbilical cord pH (pH of 7.19; 95% confidence interval (CI): 7.16–7.22) compared with the matched controls (pH of 7.24; 95% CI: 7.21–7.27). This is indicative of increased prenatal hypoxic stress, albeit clinically irrelevant .…”

“…Management of vaginal breech birth in the all‐fours position resembles the Bracht maneuver which is used in many Western countries for spontaneous vaginal breech birth in supine or lithotomy position . With the all‐fours position, the fetal body is allowed to descend spontaneously through the pelvis, that is, without any (exogenous) physical force from the attending clinician or midwife (Figs ).…”