Textbook spontaneous frank breech birth

The expectant mother was a 30 year old G2P1 who had had a prior vaginal birth of a baby given up by adoption ten years previously. She was now happily married and she and her husband were expecting their first girl with a medically uncomplicated pregnancy. 

She was surprised to find out at 36 weeks that her baby was frank breech. We attempted an external version, which was unsuccessful, and after she considered her options and risks, she ultimately chose to "refuse" the hospital-recommended cesarean and to attempt a vaginal breech birth with me as her continuity provider (I having recently attended the Madison Breech Conference), confident in her body and ability to have a physiologic birth. 

At 39 weeks and 3 days, her water broke at home at 1 a.m., and she presented to the hospital an hour later with regular painful contractions. Admission exam showed that she was 4 cm with buttocks presenting, and ultrasound showed a baby in frank breech presentation, with low amniotic fluid as expected after ROM and a possible nuchal cord. 

Labor progressed spontaneously and by 5 a.m., she was 8 cm dilated and give her multiparous status with advanced dilation, was moved to the PACU to prepare for delivery closer to the OR. She pushed actively for 2 hours in different with steady descent of the buttocks and was in the supported squatting position for birth. 

Rumping occurred at 0855 with the baby left sacrum transverse, and legs/torso rotated nearly immediately to sacrum anterior. Legs released spontaneously, nearly simultaneously from the frank breech position, and infant's abdomen and chest delivered spontaneously. Chest crease was visible, arms released spontaneously, and head delivered with the shoulder press at 0858 in a truly spontaneous and hands-off breech birth. 

The baby girl was passed to mother to go skin-to-skin, and had Apgars of 8 & 9 despite a mid-cord (loose) umbilical cord knot seen (!). No lacerations were noted, and baby nursed in the first hour. The baby weighted 7#13 oz (3540g). The couplet were discharged together on postpartum day one and were doing extremely well at two and six weeks!

Written by a physician who attended the 2019 Madison Breech Conference.