10 mechanisms of upright breech birth

This video shows excerpts from an upright frank breech birth in a Brazilian hospital. The birth is shown twice: first in slow-motion with the 10 mechanisms noted as they occur, then at normal speed.

The 10 mechanisms of an upright physiological breech birth are:

1. Buttocks/feet emerge sacrum-transverse
2. Body restitutes to sacrum-anterior as trunk is born
3. Legs release spontaneously
4. Chest crease ("cleavage”) means arms are not behind head
5. Baby does tummy crunches to release arms & flex head
6. Arms release spontaneously
7. Full perineum = head is flexed
8. Head releases spontaneously
9. Baby passed to mother
10. Cord remains intact even if resuscitation is needed

If these mechanisms are present and the baby has good color and tone, there is no need to provide hands-on assistance. Approximately 70% of upright breech births will proceed spontaneously without any need for maneuvers (see Louwen et al. 2017).