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Understanding Birth Better

Curated by Betty-Anne Daviss RM, MA

Understanding Birth Better is your online resource for vaginal breech birth, and to learn more about birth in general.

Breech Videos

Upright Position Breech Delivery

Although many women have agreed to have their births videoed for our teaching purposes, it took us some time before we were able to find a woman willing to have a video of her birth actually put up on the web to accompany the IJGO article, "Does breech delivery in an upright position instead of on the back improve outcomes and avoid cesareans?" published online Nov. 5, 2016. Threatened that we might have to use a video of a birth from Ottawa instead of from Frankfurt, Frank finally found a willing mother in Germany. When I received the video, I told him, "I like the socks." He said, "You can tell it's a midwife from the socks."


Podalic birth

One of my favourite centres in Ecuador is run by Diego Alarcon, a dear obstetrician who takes photos of the women who come to see him with every visit and then videos their birth. This is a video of a breech birth done there. They do ALL births in water now, but this was an early one: Note that the cord is around the baby's neck several times and causes no problems. In the Frankfurt data, the cord is around the neck, some part of the body or in a knot 18.6% of the time -- with only 1.8% of those babies being admitted to the Neonatal Intensive Care Unit (and not necessarily admitted just because of the cord.) Also note that this obstetrician uses a version of what I have named the "Frank nudge," i.e., bending the shoulders slightly back so that the head will flex as it emerges. He did not learn it from Frankfurt; it was an intuitive response to facilitating the baby coming out. He keeps the baby far too long in his arms, instead of giving the baby to the mother, which I have told him already is so last century, but he is human, like anybody else.

Fundal Pressure

Fundal pressure (sometimes known as "Kristeller") has been a controversial topic in cephalic (head down) presentations, but it has been used in Frankfurt in vaginal breeches at least since Eric Bracht, the German obstetrician, used it as part of the Bracht manoeuvre for breeches in the 1930s and 1940s. It was simply continued and adjusted when the Frankfurt team converted their manoeuvres to upright positioning of the mother in 2004. 

Betty-Anne has adjusted the way Frank Louwen does it because she found that neither she nor the other female obstetricians in Frankfurt could do it as effectively (with as much force) with their smaller frames. See the video for this solution and the Rethinking the Physiology of Vaginal Breech Birth for the description of the controversies about it. Basically, we do not advocate for the use of fundal pressure in cephalic births, but in breeches it works well because the smaller parts often emerge with this "pressure from above," considered superior to pulling from below. It is used all the time with cesarean breeches but it is far superior to use it without a cesarean once the mother is fully dilated. 

This manoeuvre is used in Ottawa at the midwife-attended vaginal breeches and the Emergency Skills Workbook (ESW) of the Association of Midwives adopted it in their 7th edition that came out in 2023. ESW has also adopted the Frank Nudge (from Frankfurt), the Crowning Touch (created and developed by Betty-Anne, both manoeuvres for retrieving the after-coming head), and the rotations required for the arms. The ESW book will be published November 1, 2024.

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