Discovered a breech baby for 1st time

Specialties Ob/Gyn

Published

Specializes in LDRP.

g1, 39 weeks. To triage for r/o SROM and labor. Hooked her up, ctx q2-3min. Nitrazine swab of perineum equivocal, but ferns seen and then large amounts of fluid. All good. SO we know she'll be an admit.

I go to do a SVE. I don't feel a firm head-I feel nubs. 3 small nubs(for lack of a better term). My first thought, literally, was "What the fudge is that? That is NOT a head!" WHen I spread my fingers apart to assess dilation (she was 7, btw) it was so strange b/c I could feel 2 things (legs, i assume)moving back and forth. and there was so much room inside the cervix without the head right there.

I had never felt a breech before, much less been the one to discover it first. This pt thought she was vertex, and had been 2 weeks before when she had an SVE.

Totally wild.

Up Vote Up Vote ×

Yes! It is shocking! My first lady partsl exam I ever did was at a home birth and the CNM precepting me asked me what I thought. I felt little nubs too--toes! I didn't want to alarm the woman (or myself,LOL) so I just kept saying, "Not what I expected!" because I wasn't even sure what I was supposed to be feeling! She got a little cross with me so I turned my back to the mom and tapped my fingers. The CNM turned pale(green), did a vag exam, as I went and got the phone. She was immediately transported to the hospital for a CS. And she had been cleared by an MD 3 days earlier for a home birth!!!

Up Vote Up Vote ×
Specializes in LDRP.

Hey Happy Nurse,

Isn't it amazing , your story reminded me of my first too.

All I could think of is "what the H---", it was either one soft head or OMG. I called the doc on duty and she was not happy. My patient was an unknown to us, came in at 9cm and was hoping to go ahead with a lady partsl delivery (her own doc would not). I felt used!

We did get her off to the OR STAT and had a healthy baby. I wasn't very happy with this Mom trying to pull a fast one on us and let her know the risk she placed her baby in by not being forth coming with us.

It's one of those lady partsl exams that will remain fresh in my memory for a very long time.

Kay

Up Vote Up Vote ×

let her know the risk she placed her baby in by not being forth coming with us.

Actually the risks of delivering a frank or complete breech baby lady partslly with a skilled provider are about the same as the risks of a c-section in an otherwise healthy mom/baby. I would not have a section solely for that presentation. Did a quick google search and found one summary, but there's a lot more out there.

http://www.lamaze.org/Research/WhenResearchisFlawed/lady partslBreechBirth/tabid/167/Default.aspx

Up Vote Up Vote ×
Specializes in Community, OB, Nursery.

It seems that MDs are not learning how to deliver vag breeches anymore. The ones that happen at our place happen by accident more often than not. My question is, if it happens by accident and everybody's always fine, why can't it happen on purpose?? (I know, liability etc, which is disheartening.)

We had a lady come in the other day (think she was a G5) come in laboring. Got up to go to BR and as she sat down, out come feet....so they delivered her breech.

To the OP - good on you for recognizing what you were feeling!:yeah:

Up Vote Up Vote ×
Specializes in LDRP.

If the doctor was more experienced and or had training in the delivery of a breech newborn the situation would have been different for us. Although we do have family doc's who have delivered breech newborns this particular physician on call did not. With an experienced doctor it can be done safely, although I have heard of experienced doctors having poor outcomes.

I would love to hear from others who have assisted with breech delivery's and their personal experiences. This is an interesting topic, thank you for the informative read.

Do you work with OB/Gyn's or Family doctors? A lot of small community hospitals in our area are staffed entirely with Family doc's and not all of them are capable of doing c-sections.

Kay

Up Vote Up Vote ×
Specializes in L&D telephone triage.

After 9 years, I found my first breech. I did vag exam and felt toes moving against my fingers. I felt movement and followed it up to know it was a foot. Even after that nursing that long, it was kind of freaky. To OR for C/S Happy mom and baby.

Up Vote Up Vote ×
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

We have one MD who is very comfortable delivering breech babies but will only do this when there is a twin gestation and baby A is vertex. He will deliver baby B breech, no problem. He is also handy with forceps and has a great tolerance for some scary situations. He has about 30 years' OB experience and is "the man", but you can see he is getting tired of the current BS he has to deal with. We have one newer physician who is a master with forceps also, having done her residency at a major university hospital, seeing so much. She is amazing. Her practice style is much like the older OBs, just more "modern". She is not quite as comfortable with breech babies, however. But then, she is newer to this.

Up Vote Up Vote ×
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

I found my first breech by accidentally sticking my finger in a very ummmm, delicate spot. I asked my preceptor, "what on earth is that??" She checked behind me and said, "that would be a butt!"......so THAT's what it's like....ok.

THe freakiest check, however, was on a face presentation; baby sucked my finger. It was just the weirdest thing ever. It was years back when I was in my first year as a nurse. WILD.

Anyhow kudos to you!!!

Up Vote Up Vote ×
Specializes in LDRP.
The friekiest check, however, was on a face presentation; baby sucked my finger. It was just the weirdest thing ever. It was years back when I was in my first year as a nurse. WILD.

Ohhh my, I don't know what I would have done in that situation. Thanks for the heads up, makes doing lady partsl exams a little scary (good thing that little one didn't have teeth).

Kay

Up Vote Up Vote ×
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

It was the weirdest thing ever. It was all I could do not to pull back and squeal. I had to remember, this mama would be freaked out if I had. And, also she was about to get some bad news.....

A csection was needed to get the baby out.

Live and learn.

Up Vote Up Vote ×
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

I also agree with Elvish; the skill of most people to safely deliver breech babies is waning. The risk for most is not worth it. And breech birth, in skilled hands, can be safe. But it's still risky if the baby somehow gets "stuck" and seconds/minutes count there. A number of maneuvers to help baby out safely are at the skilled practioner's disposal, for sure. But like already mentioned, this is an almost lost art. It's a complicated issue, medically and so much litigation is out there, hanging over the heads of drs and midwives as it is. Cannot blame them for refusing to "go there".

Personally, I had a breech baby girl. I elected for c/s (had experienced lady partsl delivery with my daughter). I elected NOT to undergo version and the reason was, I felt she was a lot bigger than my son and was fearful it would wind up a failure or, worse, the need for an immediate c/s was not out of the question. It was not worth risking to me. Any time I even tried to move her, she would go wild in there, kicking and thrashing. I could not get her to move her head from under my right breast for anything!

I was glad. At 38 weeks, she was 9 lb, a full 3 lb bigger than my preemie son. It would very likely have failed, and as big as her head was, I am very glad no one would have attempted to deliver her in this position. The baby was my number one consideration, not the way she was born.

IMO anyhow.

Up Vote Up Vote ×
+ Add a Comment