This frank breech little girl is born with a partial breech extraction. The hips are born and then the doctor manipulates the baby the rest of the way out. Its not the low risk approach. The doctor did the best she could given her training and the custom of using a non-physiological birth position. Its tough to watch this birth, but the doctor is competent. She has to retry the Brant maneuver after repositioning the baby to let the nape of the neck out (hairline at the back of the head at the top of the neck). The setting is not what we might consider mother or baby friendly, but others may think this was the safe way for the baby to be born! The funny think is the comment that the baby may have been born in the street if the birth had been just ten minutes earlier. And that have been any worse, why??
A physiological breech birth involves a birthing position in sync with the pelvic design. I'll emphasize the kneeling position with the mother leaning forward, perhaps on hands and knees, perhaps knee-elbow. The baby enters the pelvis in active labor in whatever active birth positions the mother is drawn to use. When the first bit of baby only first appears, the mother may be asked to be kneeling if she isn't already. It is a typical position for women to get into spontaneously.
Now gravity helps pull the baby to the anterior sacrum position by the time that the abdomen appears. The baby faces the back and as the helper is behind the mother, the helper sees the baby's cord easily. The arms come spontaneously and then the baby seems to be sitting on the towels between the mother's knees. The chin appears and then the mouth and nose. With the next contraction the head comes out and now the helper can touch the baby!
All this time no one touches the baby or the mother. UK Midwife Jane Evans reports 1 in 100 physiological breech births needed help with arms. Germany physicians Frank Louwen and Anke Rietter report 2 needing help among 300 knee-elbow breech births.
We're at a breech birth today. Mom laboring slowly but encouragingly. We are in the hospital and anticipating a hands-off breech birth in hands and knees position if the baby continues to come down so nicely. Don't expect a clip, though. ;)