Managing Nuchal Arm and Footling Breech Presentations

Breech Xray

Breech birth, though relatively uncommon, presents a unique set of challenges for both healthcare providers and expectant mothers.

Accounting for only 3 to 4% of all term pregnancies, these situations demand careful management to ensure the safety of both the mother and the baby.

When dealing with breech birth, it is important to approach the complication with care and precision.  Before proceeding with any interventions, it is essential to assess the situation thoroughly.

This involves evaluating the position of the baby within the birth canal. This can help determine whether there is a nuchal arm (where the baby’s arm is positioned across the neck) or footling breech (where one or both of the baby’s feet are positioned to emerge first.)

Nuchal Arm

A nuchal arm arises during childbirth when the baby’s arm is positioned across its neck. This can potentially cause complications during delivery, such as difficulty in progressing through the birth canal or compromising the baby’s oxygen supply.

When a nuchal arm occurs, healthcare providers must carefully manager the situation to prevent harm to both the mother and baby:

healthcare professional putting model baby with nuchal arm into simulator

Gentle Assessment: Approach the situation with gentle manoeuvres to free the arm without casing injury.

Careful Guidance: Safely guide the arm downward alongside the baby’s body to ensure it can progress through the birth canal.

Avoid Force: Refrain from applying excessive force or pulling on the arm, which could lead to complications such as shoulder dystocia.

Close Monitoring: Continuously monitor the mother and baby for any signs of distress of complications during the process.

Prompt Intervention: Be prepared to intervene further if necessary, including considering a caesarean section depending on the situation and other factors.

Effective Communication: Maintain open communication with the healthcare team and the mother to ensure informed decision-making.

Footling Breech

A footling breech presentation occurs when a baby is positioned within the womb for birth with one or both feet pointing downward; ready to emerge first during delivery, instead of the typical head-first position.

Managing a footling breech birth requires careful consideration and often involves skilled obstetric care:

Proper Assessment: Proper assessment of the baby’s position is crucial. This can be done through prenatal ultrasound examinations and clinical assessments by healthcare providers.

Monitoring: Continuous monitoring of the mother and baby during labour and delivery is essential to detect any signs of distress or complications promptly.

Positioning: The mother’s position during labour can influence the progression of a footling breech birth. Certain positions, such as hands-and-knees or a forward-leaning position, may help facilitate the delivery.

Delivery techniques: Healthcare providers skilled in managing breech births may employ specific techniques to assist in the safe delivery of a footling breech baby. These techniques may include gentle manipulation of the baby’s legs and body to guide them through the birth canal.

Informed Decision-Making: It’s essential for healthcare providers to communicate with the mother and her family about the risks and benefits of various delivery options, including vaginal birth and caesarean section, and involve them in the decision-making process.

Breech Birth

Simulating Breech Births with MODEL-med Birth Simulators

Simulation training offers a valuable tool for healthcare providers to practice and perfect the manoeuvres required managing breech births effectively. By simulating various scenarios, providers can enhance their skills and confidence in handling these complex situations.

The MODEL-med® Sophie and Sophie’s Mum Birth Simulator is designed for the simulation of cephalic birth, breech birth and shoulder dystocia. It is made from a highly realistic flesh-like material that creates an extremely realistic tactile experience when simulating birth. It can be used in the assessment and management of nuchal arm and footling breech.

In managing nuchal arm and footling breech presentations, healthcare providers navigate through intricate challenges with precision and care.

While these situations may be relatively uncommon, their potential complications underscore the importance of thorough assessment and effective communication.

charlie and his mum

Accurate assessment of cervical dilatation is essential for safe and effective management of labour and delivery. It allows healthcare providers to monitor progress, detect complications, and make informed decisions that promote the well being of both the mother and the baby.