Face‐to‐pubes rotational maneuver for bilateral nuchal arms in a vaginal breech birth, resolved in an upright maternal position: A case report

Abstract

Background A physiological breech birth is one in which the woman is encouraged to remain active throughout her labor and able to assume the position of her choice for the birth. Use of this strategy within the United Kingdom National Health Service has led to the use of innovative maneuvers to relieve obstruction when women give birth in upright positions, for example, kneeling or standing. This includes use of the face‐to‐pubes rotational maneuver to relieve extended nuchal arm(s). In this paper, we report a case where the face‐to‐pubes rotational maneuver was used to relieve bilateral nuchal arm entrapment in a breech birth. Methods Single‐case study. We aimed to generate an in‐depth understanding of how this maneuver works and how professionals decide to use it by exploring its use in a real‐life context. Results The face‐to‐pubes rotational maneuver appears to be an effective method of relieving nuchal arm entrapment when used by experienced hands. In cases of bilateral nuchal arm entrapment, elevation to a higher station may be necessary to dis‐impact the arms above the pelvic inlet before the fetus can be rotated. After face‐to‐pubes rotation and release of arms, the head should be realigned in an occiput anterior position for delivery. Conclusion The face‐to‐pubes rotational maneuver can be taught for resolution of nuchal arms in an upright position. Parents should be informed of the availability or not of a specialist midwife trained in physiological breech birth, as this may be important to their decision‐making.

State of the breech in 2020: Guidelines support maternal choice, but skills are lost….

“…A common limiting factor is the lack of a provider skilled and willing to offer vaginal breech delivery . In this issue, two papers address the physiological approach to vaginal breech delivery using an upright birthing position and describe the use of birth videos to teach the technique and the use of maneuvers to resolve complications occurring in the upright position …”

How safe is it to plan a vaginal breech birth with OptiBreech collaborative care?: analysis of cumulative data within the OptiBreech Multiple Trials Cohort

“…These results also do not apply to all planned VBBs. The OptiBreech teams follow a specific care algorithm 10 with manoeuvres specific to upright breech birth 37 , the presence of an OptiBreech team member increases the likelihood that this will be followed 2,18 , and their presence facilitates shared learning from each birth throughout the team. Outside of this model of care, the absence of one or more of these potential mechanisms may impact outcomes.…”

No More ‘Hands off the Breech’

“…The availability of a midwife skilled in physiological breech birth is important to women's decision-making process around mode of childbirth. 6 In a secondary analysis of the Term Breech Trial data, the presence of a skilled and experienced practitioner was also the only factor associated with a reduction in adverse outcomes for babies born vaginally (OR: 0.30 [95% CI: 0.13-0.68], P=.004). 18 This definition included midwives, and the reduction was similar to that achieved with caesarean section (OR: 0.33 [95% CI: 0.19-0.56], P=<0.0001).…”

“…For example, if the baby's pelvis remains sacrum transverse, shoulders in the anterior-posterior diameter, following descent to the nipple/scapula line, telling someone to push harder or to wait for the next contraction will waste valuable time. One or both arms are caught above the inlet to the pelvis, and rotational manoeuvres are very likely needed 1,6 (see figures 2 and 3). In our video study, women were assisted to convert to a supine position in two out of 42 births, and this also occurred in our case study.…”