Cervical head entrapment at term


By Cynthia Caillagh, LM, CPM

Cynthia is one of North America's most experienced breech providers, having attended around 600 vaginal breech births and over 500 sets of twins. Her transport rate over the past decade for vaginal breech labors is 3%, compared to her usual transport rate of 2% for cephalic labors, indicating that most breech babies can be born vaginally, given motivated parents and a skilled, experienced provider. 

She has seen two cases of cervical head entrapment in a term breech baby over her career, both times due to the mother pushing before her body was signaling to do so.

I had a cervical head entrapment three months ago. It was the first one I've had in almost 30 years. The issue was with the mom pushing: I mean violently, aggressively, unrelentingly. Everything told me she was not fully dilated, and I kept begging her to stop pushing, and she wouldn't. It took me four minutes to resolve the entrapment, which was not fun, and another four minutes to resuscitate the baby. Equally not fun.

I actually had to go in on one side and pull the cervix as friendly as I dared. I didn't want to rip it. At the same time, I was doing a "pull the baby's head down" maneuver. It was really not any fun at all. 

She had had a section for her first birth, which was breech, and so this was a leap of faith for her. And I think all the pushing was just total fear. She had had five other babies, she was Amish, and she was determined to get this one out. But her determination became her undoing. She simply could not listen to advice. 

I am of the thought that women should not be pushing until we can see the buttock. And I know that not everybody agrees with that, but that's my position. I now feel very strongly, after 30 years, "If I can't see the butt cheek, you are not pushing."

In both cases where I've seen cervical head entrapment, it's been exactly the same. It didn't matter the size of the baby. It mattered that the mother was not listening. She wanted to push because she wanted to push. In both cases, helping women follow what their body is actually saying is probably one of the hardest, but most important, parts of our job.