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Breech
Delivery
Could be induced.
***
If slow or poor
progress, may be augmented.
***
Epidural
commonly strongly advised.
***
Membranes
commonly ruptured artificially to enable an electrode to be applied
to the buttocks to enable continuous electronic fetal monitoring. The
scrotum is to be avoided...
***
Food and fluid
restricted, therefore IV drip in situ.
***
therefore,
first stage immobility.
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When second
stage reached, patient put in lithotomy position (on her back).
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Contractions enhanced/controlled
by oxytocic drip.
***
When buttocks
on perineum, routine episiotomy.
***
Attending
practitioner applies traction to the buttocks gripping the hips.
***
Legs, if
extended are brought down with pressure from the attendants fingers
behind the knee. Further traction is applied to the trunk, the arms
are pushed up over the baby's
head by this manoeuvre.
***
The arms now
are required to be
delivered by Loveset's
manoeuvre. The baby is then lifted up by its feet, by a second
attendant and forceps are applied to deliver the head.
***
Third stage
managed actively by oxytocic injection and controlled cord traction. |
Breech
Birth
Spontaneous
onset anytime after about the 37th week.
***
No augmentation
if labour is slow or there is poor progress - caesarean section.
***
Membranes not
ruptured artificially.
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Vaginal
examinations restricted to avoid accidental rupturing of the membranes.
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Fetal heart
listened to frequently with a Pinard stethoscope or a hand held
Doppler Sonic aid using ultrasound.
***
Food and drink
encouraged, but remembering that women in strong progressing labour
rarely want to eat.
***
Mother
encouraged to assume positions of choice during the first stage.
***
If, and when
spontaneous rupture occurs conduct a vaginal examination as soon as possible.
***
Mother
encouraged to be in an all-fours position.
***
No routine episiotomy.
***
Second stage by
maternal propulsion and spontaneous expulsive efforts guided by the
attendant if judged appropriate.
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Third stage
without chemical or mechanical assistance, usually managed according
to woman's
wishes.
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