Breech Delivery Techniques and Considerations

Breech Delivery Methods

The American College of Obstetricians and Gynecologists recommends the Reverse Breech Extraction (Pull Technique) for breech deliveries, which involves grasping one or both feet, applying traction toward the woman's feet to deliver the legs and abdomen, rotating the body in the midline to deliver each arm in turn, and applying traction toward the woman's head to deliver the baby's head 1, 2
The Patwardhan Method is a modification of reverse breech extraction where an assistant introduces their whole hand into the vagina to cup the baby's head with the woman's legs supported in semilithotomy, as described by the American College of Obstetricians and Gynecologists 1, 2

Proper technique is crucial as errors in performing breech extractions may increase the risk of femoral and humeral fractures, according to the American College of Obstetricians and Gynecologists 2
The use of a single forceps blade or ventouse as a lever to disimpact the fetal head is considered dangerous and should be avoided, as stated by the American College of Obstetricians and Gynecologists 3
Vacuum-assisted delivery has been described for frank breech presentations, though it carries potential risks, as noted by the American College of Obstetricians and Gynecologists 4

Specialist training is required for breech delivery techniques, and many obstetricians may not be familiar with how to perform them properly, according to the American College of Obstetricians and Gynecologists 1, 3
A wide variation in practice exists due to the paucity of evidence-based guidelines and lack of multiprofessional training, as stated by the American College of Obstetricians and Gynecologists 3

The American College of Obstetricians and Gynecologists warns against using single forceps blade as a lever, vacuum extraction abdominally, and digital pressure with only 2-3 fingers, as these techniques can cause significant fetal injury, including intracranial and subgaleal hemorrhage, and maternal visceral injury 5
The American College of Obstetricians and Gynecologists recommends avoiding digital pressure with only 2-3 fingers, as it is less effective and may increase the risk of skull fractures 6

The American College of Obstetricians and Gynecology recommends high-fidelity simulation training with multiprofessional teams for proper technique in breech extractions, as many obstetricians lack adequate training in these techniques 5