Management of the client with a singleton Breech Presentation in labour

The Breech delivery is considered an abnormal delivery; the management plan for the client with a breech presentation is aimed at ensuring an uneventful delivery of a healthy infant with little or no adverse life-threatening conditions. Close monitoring is very important; once vaginal delivery is confirmed, progress is monitored with two (2) hourly vaginal examinations.

Each Obstetric/Midwifery Unit will develop individual Guidelines for Management of the Breech delivery

PROCEDURE 

The Midwife shall:- 

5.1 Conduct an abdominal examination and document findings in the client’s health record. 

5.2 Perform a sterile vaginal examination to (a) assess cervical dilation (b) confirm the presenting part and (c) exclude cord presentation/ prolapse. 

5.3 Inform the on-call Obstetrician of the findings of the abdominal and vaginal examination. 

 5.4 Inform the Operating theatre, Anesthetist, and Neonatologist/Pediatrician of the pending delivery.

 5.5 Discuss the plan of care with the client to facilitate her active participation. 

5.6 Employ pain management in accordance with written protocols and procedures. 

5.7 Conduct continuous electronic fetal monitoring during labour.

5.8 Collaborate with the Obstetrician to determine the appropriate mode of delivery after confirming the presentation. 

 5.9 Provide support and guidance to the client throughout the delivery process. 

5.10 In the absence of the obstetrician, the midwife shall perform the breech delivery. 

5.11 Ensure that the Obstetrician and Neonatologist/Pediatrician are present at breech delivery. 

5.12 Follow established infection prevention and control guidelines according to IPC manual.

 The Obstetrician shall:- 

5.13 Respond to the call from the Midwife in a timely manner 

5.14 Perform the breech delivery if requested.