Surprise breech

Recently, we had a surprise breech at home. I've been rolling around in my head the value of sharing this story publicly, both to share a positive breech story and to show to student midwives and midwives the variation of breech that fooled us, and so a few days ago I got up the nerve to ask the mama for permission to post about it here. She agreed, and has previewed and approved sharing these words and photos.

Prenatally, there was no suspicion that the baby was breech at any time in the third trimester by any one of the two midwives or two apprentices. When we palpated the baby at term, s/he felt like a vertex baby whose head had descended into the pelvis so far as to be unballottable. During the vaginal exam during labor, the presenting part was at +3 and felt round and slightly edematous, like a head descending with caput.

We suspected nothing until, while mom was pushing, when Mollie checked for descent and positioning, her glove got covered in what can only be described as breech meconium. (Vertex baby meconium is mixed with amniotic fluid before it can show itself and is more accurately named as meconium-stained fluid. Breech meconium doesn’t have much opportunity to mix and looks like newly born baby meconium.) Within a push after that, we were seeing the baby’s skin... the baby’s very very bald skin. Yet still, this was nothing like what a breech “should” look or feel like. Mollie and I both extensively checked all around in a circle as deep as we could, looking for a butt crack, an anus, or any sign of something that felt like buttocks, and neither of us found anything except this big round baby part, still feeling like a head with caput. Still, we prepared ourselves mentally for a breech birth given the completely undiluted meconium. Baby was descending quickly, and we knew we did not have time to transport.

Soon, we saw a small quarter-sphere baby part at the edge of the presenting part. It looked like the baby’s shoulder was presenting next to its head, but that being impossible, we now had absolutely no idea what we were seeing. A few minutes later everything became clear as that small round part grew in length and popped out - with toes. Breech!

We brought mom to the edge of the bed, so that the baby could be born hanging downward off the edge of the bed. (This is the classic way for breeches to be born, because it facilitates flexion of the baby’s head to navigate under the pubic bone; then the baby is lifted by a care provider to facilitate extension.) The round presenting part was the left hip, with the left knee pulled up and the left foot tucked up next to the bum. As the hip was born, the knee released and the leg was born. Only then did the asynclitism right itself, showing us first labia, then her right buttock and right foot. (Unlike most pictures of complete breech babies, her legs were not crossed. Tuck position rather than cannonball.) Then her right leg was born and her right hip, emerging to just below the waist. Mom’s pushes with the next contraction brought her out to her chest. I gently held a warm blanket over her, hands at her hips waiting to safely help lift her when needed. When the next contraction did not bring her arms, Mollie reached up inside for them and brought them out one at a time. A minute or so later, she flexed all her limbs; I’ll never forget the sensation of feeling this baby, not quite born, move like that in my hands as I held that blanket on her. With the next contraction, we could see the lower part of her skull, and Mollie asked me to raise her body as she helped deliver her head, but it wasn’t ready, so we moved her back into the hanging position. Before the next contraction, I could feel her body lose its tone, starting to become limp. She was still pink but I was now more than ready for her to be born. I’m not sure whether Mollie saw how limp she was getting but I know Mollie was more than ready for her head to be out as well! With the next contraction, her ear started showing, which revealed that her head was transverse. Mollie told me to lift her toward the side, and Mollie directed her head at that angle, and she was born.

She breathed immediately, and as I quickly got the stethoscope on her, I counted her heartrate at 140 bpm. She started rooting by the time she was a couple of minutes old, and latched and nursed vigorously at eight minutes old. The only sequelae we noted from her mode of arrival were the bruises on her left buttock and hip, left labia, and left foot, and her breech baby posture which confirmed for us that we’d missed her position prenatally.


Bruise and "caput" on left buttock from hip to labia, none on right side.


Bruised left foot.


Posture and head shape. This cutie was never vertex.


Many, many thanks to the parents for allowing me to share this.