Welcome to
Understanding Birth Better
Curated by Betty-Anne Daviss RM, MA
Understanding Birth Better is your online resource for vaginal breech birth, and to learn more about birth in general.
Breech Videos
Upright Position Breech Delivery in Frankfurt
Although many women have agreed to have their births videoed for our teaching purposes, it took us some time before we were able to find a woman willing to have a video of her birth actually put up on the web to accompany the IJGO article, "Does breech delivery in an upright position instead of on the back improve outcomes and avoid cesareans?" published online Nov. 5, 2016. Threatened that we might have to use a video of a birth from Ottawa instead of from Frankfurt, Frank finally found a willing mother in Germany. When I received the video, I told him, "I like the socks." He said, "You can tell it's a midwife from the socks."
The “Frank Nudge” (adulterated name “shoulder press”) and earliest video of a Frank Nudge and chest press together.
One of my favourite centres in Ecuador was run by Dr. Diego Alarcon, a dear obstetrician who took photos of the women who come to see him with every visit and then videod their birth. This is a video of a breech birth done there. They did ALL births in water and this was one of the earliest. Note that the cord is around the baby's neck several times and causes no problems. In the Frankfurt data, the cord is around the neck, some part of the body or in a knot 18.6% of the time -- with only 1.8% of those babies being admitted to the Neonatal Intensive Care Unit (and not necessarily admitted just because of the cord.) Also note that this obstetrician uses here a version of what I coined the "Frank nudge," i.e., pushing the shoulders back up against the pubic bone so that the neck will flex to allow the head to emerge. See the full article at https://obgyn.onlinelibrary.wiley.com/doi/10.1002/ijgo.12033
And the algorithm for how the baby follows the mechanisms of labour that I mapped out in Frankfurt, following Bracht (1935) and UK midwife Jane Evan’s lead can be found here along with the Frankfurt protocols:
ijgo12033-sup-0003-AppendixS1.docxapplication/docx, 33.2 KBAppendix S1. Protocols for breech delivery at the Johann Wolfgang Goethe University Hospital in Frankfurt, Germany.
Diego did not learn to push on the baby’s chest and shoulders from Frankfurt; it was an intuitive response to facilitating the baby coming out. However, we have taught the Frank Nudge,* and chest press since 2007 across Europe., North and South America, and China.
*(Name changed by trainers unwilling or unaware from where it came ——from Frank Louwen— to “shoulder press”)
Fundal Pressure
Fundal pressure (sometimes known as "Kristeller") has been a controversial topic in cephalic (head down) presentations, but it has been used in Frankfurt in vaginal breeches at least since Eric Bracht, the German obstetrician, used it as part of the Bracht manoeuvre for breeches in the 1930s and 1940s. It was simply continued and adjusted when the Frankfurt team converted their manoeuvres to upright positioning of the mother in 2004.
Betty-Anne has adjusted the way Frank Louwen does it because she found that neither she nor the other female obstetricians in Frankfurt could do it as effectively (with as much force) with their smaller frames. See the video for this solution and the Rethinking the Physiology of Vaginal Breech Birth for the description of the controversies about it. Basically, we do not advocate for the use of fundal pressure in cephalic births, but in breeches it works well because the smaller parts often emerge with this "pressure from above," considered superior to pulling from below. It is used all the time with cesarean breeches but it is far superior to use it without a cesarean once the mother is fully dilated.
This manoeuvre is used in Ottawa at the midwife-attended vaginal breeches and the Emergency Skills Workbook (ESW) of the Association of Midwives adopted it in their 7th edition that came out in 2023. ESW has also adopted the Frank Nudge (from Frankfurt), the Crowning Touch (created and developed by Betty-Anne, both manoeuvres for retrieving the after-coming head), and the rotations required for the arms. The ESW book will be published November 1, 2024.