Discovered a breech baby for 1st time

[HappyNurse2005]

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.

[justme1972]

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!!!

....and a great example of...everything is fine for home births, as long as everything goes textbook.

[morte, LPN, LVN]

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!!!

now this one should have come with beverage alert....lol

[cvssc]

We have had some residents who did very well with breech deliveries. My patient opted for a c/s. She was a G 3 or 4 I believe. She was given options and elected c/s. The only bad breech deliveries I remember were mothers coming in (home vitamin C inductions) with baby entrapped. Those are horrible.

Thank God people do have training to assist with these stuations. Hopefully, we can help prevent more bad outcomes with more education and preventive programs.

[cradlecrewer]

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

OMG!! One of the first breech deliveries I assisted in was a preterm (27weeks) TWINS!!! The first baby delivered just fine...the second was a nightmare. It was breech and the head got clamped down on. The doctor had me holding the little legs up while he tried to manually remove the head, pulling and tugging. It was horrifying. I thought the neck would surely be broke. Quite a frightening experience. That was 20 some years ago, and it still haunts me. This was a family practice doctor who refused to call in the OB (pride you know). Stupid Stupid mistake.

[Elvish, BSN, DNP, RN, NP]

Once we (before I went to work there) had a 33-weeker deliver on the toilet, breech. A mother-baby nurse delivered....and of course the resident comes strutting up a couple minutes later angry. "YOU DELIVERED A BREECH? EVEN WE DON'T DELIVER BREECHES!" Well, um it wasn't really a choice. She sat down on the toilet, a butt came out, and she had Mom push with everything she had, delievred in one push. Fortunately NICU was 10ft away, everybody was fine.

[HappyNurse2005, RN]

Okay, my breech lady partsl stories.

We have had IUFD's early on deliver breech.

THis pt I was not here for, but heard about, from the nurse and teh MD in question.

Pt came in , 5th baby, term. Was 5 or 6cm in triage, taken via stretcher to labor room just down hall. Was complete and ready to push by arrival to room. Assisted to labor bed, feet up, starts pushing with RN and the resident. (1st year resident). That was a butt coming out! The attending said though, that since it was her 5th baby, they would go ahead and finish the breech baby instead of doing a stat section. Baby was 8 pounds and fine.

Next was a lady with twins at 31 weeks. First baby was term, 8 pounds. She was in PTL, 5cm for several hours, epidural, procardia, intact BOW. Thought was, one more vag exam, and still 5cm, epidural off, keep up procardia. I was her nurse. After a short while in talking to her, I smelled poop. I knew she was complete. She was.

So they scanned her, baby A was vertex, baby b was breech. She wanted a lady partsl delivery, the 2 residents on call were supportive, the attending was not supportive of lady partsl breech 2nd twin. The risks were discussed with her, she elected to have the lady partsl breech twin.

She did fine! baby a delivered, they tried to do a version on baby b, didnt work, delivered lady partslly, breech. shot out like a rocket!

Generally, though, breech singletons get c/section. Breech twin b really depends on the doctor. More will go for c/s, but some will do it vag.

[Elvish, BSN, DNP, RN, NP]

I am really happy to say that where I am, we have more twins deliver lady partslly than via c/s, regardless of the presentation. Y'all know sometimes twin b will flip in utero, and sometimes he'll come out butt/feet first. Either way, I like it, and it's so much easier on moms.