Frank breech or double footling with imminent delivery and long transport: what is the correct approach?

Frank breech or double footling with imminent delivery and long transport: what is the correct approach?

• A. Allow newborn to deliver to the waist without active assistance; When legs and buttocks delivered, assist head out keeping body parallel to the ground. If head does not deliver within 1-2 minutes, insert gloved hand into the vagina to create airway for newborn. Transport immediately if head undelivered
• B. Complete delivery on scene with full active assistance
• C. Call for cesarean section immediately
• D. Cut the cord and transport before head delivery

Answer: (A)

In this situation the priority is to manage a breech birth safely while a long transport time is ahead. Delivering the body first lowers the risk of the head becoming trapped and helps control the delivery so the airway can be managed more easily. By letting the legs and buttocks come out first and keeping the newborn’s body in line with the birth canal, you reduce traction and potential trauma, and you set up the head delivery for a smoother process. Once the trunk is delivered, you gently assist the head to deliver, keeping the baby’s body aligned and the airway accessible. If the head does not deliver within a short, reasonable window, you insert a gloved hand into the vagina to create space around the head and to provide an airway for the newborn. This internal maneuver buys time to improve ventilation and breathing for the infant and helps prevent airway obstruction. Transport should begin promptly if the head remains undelivered, because prolonged breech delivery increases risk for both mother and baby. Cesarean on scene isn’t feasible, and cutting the cord before the head is delivered isn’t appropriate.

In this situation the priority is to manage a breech birth safely while a long transport time is ahead. Delivering the body first lowers the risk of the head becoming trapped and helps control the delivery so the airway can be managed more easily. By letting the legs and buttocks come out first and keeping the newborn’s body in line with the birth canal, you reduce traction and potential trauma, and you set up the head delivery for a smoother process.

Once the trunk is delivered, you gently assist the head to deliver, keeping the baby’s body aligned and the airway accessible. If the head does not deliver within a short, reasonable window, you insert a gloved hand into the vagina to create space around the head and to provide an airway for the newborn. This internal maneuver buys time to improve ventilation and breathing for the infant and helps prevent airway obstruction.

Transport should begin promptly if the head remains undelivered, because prolonged breech delivery increases risk for both mother and baby. Cesarean on scene isn’t feasible, and cutting the cord before the head is delivered isn’t appropriate.