Dear Melinda: I think (someone please correct me if I am wrong) that that is one of the primary concerns with breech birth: there is no moulding. To come out the diameter of the baby's skull that presents to move onder the pubic arch and out of the pelvic outlet has to match the diameter of the presenting part which in a breech would be the bisacromial diameter (hip to hip). If the baby is at term and has grown symmetrically, and is well flexed so that the smallest diameter of the baby's head presents to be born then all should go well. This lack of moulding is evident on observation of the baby: the occiput area may even seem a little flat. Conversely the legs remain in a rather flexed position for a while after birth. I have been present at only 3 breech births: my second daughter's 24 years ago, and 2 in the last 2 years. At my daughter's birth the OB used "forceps to ach" (written on her identity card) which he explained as necessary to prevent too sudden expansion of her cranial bones as she moved so quickly through my pelvis (she was only 6lb 8oz, HC 34.5 cm), in any case he used then to guide her out, she came out screaming. The first breech I observed was here in Washington in the OR and was an attempted standing breech with a primip. The baby's head did get stuck and would not deliver, the mom got back onto the "delivery" table and the OB delivered the head with forceps (no epis and no tear!), all within 5 minutes although they were SUCH a long 5 minutes, baby's apgars were 3 then 8 then 9. Quite scarry, obviously the baby needed resucc at birth but recovered well. That baby was 6 lb 12 oz with a 14.5 inch head (37cm) and U/S had detected a large head, the labor had been a pretty typical primip labour long and slow with a 2-3 hour second stage. The third baby was an undiagnosed breech at home: mum's second baby, rapidly progressing labour (2 hours active), arrived to mum on all fours making pushing noises and thick mec coming from her vagina. Actually relieved to find the presentation was breech. By the time all was set up (10 minutes) she was pushing on de by birth stool and baby popped out in 3 to 4 pushes, Apgars 10/10 (no blue even on the toes), screaming and 9lb 2oz, don't have a record of the head circumference. This is probably more than you wanted, hope it helps. marilyn -- This mailing list is sponsored by ACE Graphics. Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe.
