• Adequate study of mother and fetus before the second stage of labor improves the chances for a successful delivery in cases of breech presentation. Normal labor is anticipated if the pelvis is adequate, the fetus of normal size, the cervix completely dilated, and the delivery proceeding spontaneously under light anesthesia. The delivery of choice is a spontaneous one with assistance offered for the delivery of shoulders and head. Obstacles that arise will generally be at the breech, the body, the shoulders, or the head. For each, certain procedures exist, and the obstetrician should be prepared to apply them as needed. The rule that the time allowed for delivery of the head after the umbilicus has reached the vulva should not exceed eight minutes needs reconsideration. A slow methodical delivery, extending the time to perhaps 15 minutes, is less likely to injure the fetus permanently than is the application of excessive pressure or undue haste in placing forceps. Post-partum examination of the maternal soft parts should extend to the interior of the uterus. Understanding, skill, patience, and consultation will save many lives.
Hughes EC. THE SECOND STAGE OF BREECH DELIVERY. JAMA. 1957;163(5):332–336. doi:10.1001/jama.1957.02970400004003
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