Footling breech delivery — delivery protocol at Genesis Dnepr, Dnipro

What is a breech delivery — a delivery in which the fetus is positioned feet- or buttocks-first toward the birth canal; it requires special attention during planning.

This can be relevant for women in late pregnancy when the fetal position has not changed and a vaginal delivery is being considered.

It is important to discuss in advance with the care team the possible delivery options, necessary examinations, the birth plan, and pain-relief options — with the involvement of the obstetrician and midwife.

The decision is made individually and may change during labor in the interest of the mother’s and baby’s safety.

What this type of delivery means

Breech birth is a situation in which the fetus is positioned with the buttocks or feet toward the birth canal, and such a position requires a special approach when planning and managing labor. This presentation may be discussed late in pregnancy and requires additional examinations and risk assessment. Before delivery, it is important to discuss with your doctor and obstetrician the possible management options, a plan of action for different scenarios, and pain relief. The decision on the mode of delivery is always individualized and may change during labor.

Practical meaning: the fetus presents with the buttocks or feet first.
Difference from cephalic presentation: different management techniques and increased monitoring.
Preliminary assessment: examinations of the mother and fetus to inform the decision.
Planning: discussing options and scenarios with the doctor and obstetrician in advance.
Limitations: vaginal delivery is not always possible; a cesarean section may be required.

It is important to understand that the final decision is made in favor of the safety of the mother and baby and may be adjusted during labor.

Who this mode of delivery may be suitable for

In births with a breech presentation this approach may be appropriate in certain situations, but the final decision is always individualized. The choice is based on examination results and clinical assessment, not solely on the patient's wishes. It is advisable to discuss the birth plan, the partner’s involvement, and pain management with the care team in advance.

A woman who wants to discuss the birth scenario and possible options ahead of time.
A pregnancy without serious complications according to examination results (as assessed by the physician).
Having a partner or close person whose presence has been arranged and discussed in advance.
A patient for whom a pain management plan and an anesthesiologist consultation are important.
A woman who wishes to remain active during labor, provided the risk is low.
Previous childbirth experience that physicians take into account when making the decision.
A need for a calm, clear delivery plan with explicit criteria.

The decision is made with priority given to the safety of the mother and baby and may change during labor.

When the planned approach may be inappropriate or require restrictions

Labor with a breech presentation cannot always proceed according to the originally intended plan — in some situations the approach is limited or changed in the interest of safety. The decision is based on the progress of labor, the condition of the mother and fetus, and the resources available at the clinic. Below are typical reasons why a change of tactics or additional restrictions may be discussed.

Obstetric complications requiring urgent intervention.
Signs of fetal distress detected on monitoring.
The need for urgent operative delivery because of bleeding or other complications.
Contraindications to a particular type of anesthesia identified by the anesthesiologist.
Infectious or organizational restrictions affecting the presence of a birth partner.
Previous uterine surgery that alters the management plan for labor.
Severe maternal condition in which the speed and safety of care are paramount.

The delivery plan can be adjusted at any time — the priority is always the safety of the mother and baby.

Who and how decides on the mode of delivery

The decision about the mode of delivery is made jointly and is based on clinical data, the patient's wishes, and the team's readiness for different scenarios. In deliveries with breech presentation the approach is particularly cautious: fetal position, test results, and potential risks are taken into account. The patient can state her preferences, and the team explains which options are safe. The plan is not fixed permanently and can be adjusted during labor.

Patient: states her preferences and expectations regarding the mode of delivery.
Obstetrician and midwife: assess the pregnancy, lab tests, ultrasound, and fetal condition.
Anesthesiologist: participates in discussions about analgesia/anesthesia methods and contraindications.
Neonatologist: becomes involved when there is a risk of complications or to plan neonatal care at delivery.
Team assessment: matches the clinical picture with possible delivery scenarios.
Documentation and informed consent: record the agreed plan and alternatives.
Decision during labor: may change if indications arise for the safety of the mother and baby.

The final decision is made jointly by the medical team and the patient with priority given to safety.

Discuss your preferences and possible scenarios in advance so the team can prepare.

What to discuss with your doctor before childbirth

Prepare for the conversation in advance so you and your obstetrician/midwife can form a clear plan of action. If you are discussing delivery with a breech presentation, clarify the key questions that will affect the choice of approach. Write down the answers to these questions so it’s easier to navigate possible scenarios later.

What mode of delivery do you recommend for a breech presentation in my pregnancy?
Which examinations and ultrasound findings are important for making the decision?
Should we discuss the presence of a birth partner, and are there any restrictions?
What pain relief/anesthesia options are available and are there any contraindications?
How do previous deliveries, a cesarean section, or past complications affect the decision?
Which chronic conditions and medications should I mention in advance?
What is the plan of action if the situation changes during labor?
When should I go to the hospital if contractions or other symptoms occur?
What documents and items should I bring with me to the maternity hospital?
What are the hospital’s conditions for the postpartum stay and the care provided after delivery?

Bring your notes and ask clarifying questions — this will help agree on a realistic plan. Remember that the plan may be adjusted in the interest of your and the baby’s safety.

How preparation for delivery in breech (footling) presentation takes place

Preparation for this type of delivery is a step-by-step process carried out with the medical team, involving examinations and agreement on a plan of action. The process usually includes clarifying test results, discussing possible scenarios, and preparing the partner if needed. Assessment of the mother’s and fetus’s condition and targeted consultations with specialists — including an anesthesiologist if analgesia is planned — are also important.

Preparation helps reduce uncertainty but does not guarantee the plan will remain unchanged.

Consultation with the obstetrician and midwife to assess the current state of the pregnancy.
Review of the maternity/prenatal record and up-to-date test results.
Discussing the birth plan and possible alternatives in advance.
Gestational-age–appropriate examinations to clarify risks and indications.
Consultation with an anesthesiologist if pain relief during labor is being considered.
Preparing the partner: their role, limitations, and procedures for presence.
Familiarization with the clinic’s documents and the hospitalization protocol.
Making a short checklist of items and necessary documents for the maternity hospital.

Preparation makes the plan clearer and allows the team to respond more quickly to changes. At the end, discuss with your doctor which signs will require immediate hospitalization or a change of strategy.

How labor typically proceeds with breech presentation

In labor with breech presentation, the process is organized to ensure maximum safety and readiness for different scenarios. The scenario follows a sequence of stages: admission to the clinic, assessment of condition, monitoring and, if necessary, adjustment of the plan. The team discusses possible management options in advance, including monitoring and pain relief. A multidisciplinary team participates in the delivery, ready to coordinate actions promptly.

Admission to the clinic: intake, registration, and a brief assessment of condition.
Examination and assessment: measurement of vital signs, cervical exam, and confirmation of fetal presentation.
Monitoring contractions: tracking their frequency and strength.
Fetal monitoring: regular assessment of the fetal heart rate.
Team involvement: the physician and midwife are present during key stages of labor.
Discussion of analgesia/anesthesia: an anesthesiologist is involved if necessary.
Pushing stage (second stage of labor): coordination of actions, support, and instructions for the patient.
Birth of the baby: delivery and provision of initial care if needed.
Initial newborn examination and basic admission-care procedures.
The first hours after birth: monitoring of mother and baby, and establishing contact.

This is a general sequence of actions; the specific plan is discussed in advance and may change during labor for the safety of the mother and baby.

Analgesia for this type of delivery

Discussion of pain management is held in advance and upon admission to the maternity hospital, especially for deliveries with a breech presentation. At the consultation the indications, contraindications and possible options are assessed taking into account the current condition. The decision is made jointly with the anesthesiologist and the labor care team.

Discuss pain management at the prenatal visit and upon hospital admission.
An anesthesiologist consultation to assess indications and contraindications.
Options in the clinic may include epidural or systemic analgesia.
The choice of method depends on the condition of the mother and fetus and on the progress of labor.
Contraindications or the clinical situation may rule out certain methods.
The decision to administer analgesia can be adjusted during labor.
In emergency situations, priority is given to timely and safe medical care.

Complete predictability of the pain experience cannot be guaranteed, but a plan discussed in advance helps the team act more quickly. Discuss your preferences and any questions with the anesthesiologist before delivery.

How safety and monitoring are ensured during deliveries in footling breech presentation

During deliveries in footling breech presentation, the team closely monitors the condition of the mother and baby so they can respond promptly to changes. Monitoring consists of a series of simple measurements and assessments that help make a safe decision at the right time. Most often these are routine procedures that do not indicate a problem but give the team information to choose a management approach. The care plan may be adjusted based on the data obtained.

Regular assessment of the mother’s condition by the physician and midwife.
Fetal heart rate monitoring with cardiotocography (CTG) when indicated.
Observation of the frequency and strength of contractions and the progress of cervical dilation.
Assessment of signs of bleeding and the mother’s overall vital parameters.
Prompt consultation with an anesthesiologist if pain relief/anesthesia is needed.
The team’s readiness to change management and to perform operative intervention.
Informing the patient about findings and possible options during the process.

Monitoring is a routine and important part of labor aimed at the safety of mother and baby. If the situation changes, the team will discuss the next steps with you.

What happens if labor doesn't go according to plan

A good birth plan is a flexible strategy, not a rigid instruction. During breech labor the team is ready to change tactics if new information or risks appear. All changes are aimed at providing quick and safe care for the mother and baby. Whenever possible, you will be informed and involved in decision‑making.

Revising the plan if the mother’s or baby’s condition worsens.
Converting a partner‑attended birth to one without a partner if medically necessary.
Transitioning from natural labor to augmentation/stimulation or to a cesarean section when indicated.
Stopping or not using an epidural if it is contraindicated or if emergency surgery is required.
Switching from an upright or alternative position to another position while managing the progress of labor.
Increasing monitoring and involving a neonatologist if complications are suspected.
Immediate operative intervention or transfer to the operating room if there is a life‑threatening situation.
Discussing options and making joint decisions with the obstetrician and midwife whenever possible.

Changing the plan is a normal medical response to new information, not a sign of failure.

The team will explain why an adjustment is needed and what steps will be taken next.

Risks and limitations when choosing the mode of delivery

When delivering a baby in breech presentation it’s important to honestly assess possible limitations and related risks. This is not a reason for alarm, but information for making a balanced decision together with your care team. Specific risks depend on the condition of the mother and fetus, test results, and how labor progresses.

Limitation of the planned approach: a vaginal birth may become impossible during labor.
Risks depend on the condition of the mother, the fetus, and the course of pregnancy.
Possible need for operative delivery (cesarean section) if indicated.
Need for additional interventions or monitoring during labor.
Limitations on pain-relief/anesthesia options if there are contraindications.
The plan may be revised by the obstetrician and midwife in response to new clinical information.
Do not rely solely on other people’s experiences when choosing a management approach.

Discuss possible limitations and the criteria for changing the plan with your team in advance. The safety of the mother and baby always takes precedence over the initial plan.

What happens right after birth

The first minutes and hours after birth are focused on checking the condition of the mother and baby and ensuring a comfortable start to their time together. In the clinic, standard procedures are carried out quickly and according to protocol so the team can make timely decisions if necessary. Many actions are aimed at establishing initial contact and assessing the newborn’s condition. The specific scenario may vary depending on how labor went and the condition of the mother and baby.

Immediate skin-to-skin contact if the mother and baby are stable.
CTG (cardiotocography) and examination of the newborn by a neonatologist are performed according to the clinic’s standard.
Assessment of blood loss and uterine tone by the physician and the midwife/obstetrician.
Assistance with the first latch and breastfeeding support.
Monitoring of the mother’s blood pressure, pulse, and overall condition.
If necessary — additional support or transfer of the newborn to neonatal intensive care (NICU).
Transfer to the postpartum ward when the mother and baby are stable.

The first hours are devoted to observation and recovery; the team will explain all procedures performed and answer your questions.

If additional help is needed, you will be informed in advance about the next steps.

Role of the doctor and the team

Childbirth is managed by a coordinated team of specialists, each responsible for their part of care and safety. During labor, including in breech presentation, the team assesses the situation, informs you of options, and quickly changes tactics if necessary. It’s important to understand who does what so you can feel calmer and be involved in decisions about the birth.

Obstetrician-gynecologist — assesses risks and makes clinical decisions.
Doctor and midwife — monitor the progress of labor and provide direct assistance.
Anesthesiologist — advises on pain relief/anesthesia and addresses safety issues.
Neonatologist — receives and examines the newborn at birth.
Operating room team — prepares for surgical intervention if indicated.
Coordination of actions — joint discussions and rapid information transfer.
Informing the patient — explaining the current situation and the proposed steps.

The team works in the interest of your and your baby’s safety and is ready to change tactics as needed. Discuss in advance the roles of the specialists and any questions or concerns you have.

Why this format is convenient for the patient

This format allows you to discuss delivery options in advance and receive a clear action plan from the team. It helps reduce uncertainty and better prepare emotionally and organizationally. Your preferences, the team's readiness, and the medical indications are taken into account. The convenience depends on prior preparation and agreed decisions.

A clear plan for delivery, with clarification of possible alternatives during the process.
The ability to discuss personal preferences and expectations in advance.
Less uncertainty due to monitoring and pre-agreed criteria.
The option to choose and agree on the presence of a specific physician.
Partner participation, provided medical and organizational requirements are met.
Availability of pain-relief options after consultation with an anesthesiologist.
Monitoring of the mother and baby during labor and in the first hours after birth.
The team's readiness to promptly switch to a safe alternative if necessary.

These elements make the process more predictable and convenient for the patient; however, the final decision always depends on the clinical situation.

What happens at a pre-delivery consultation

A pre-delivery consultation is a structured discussion about your pregnancy, associated risks, and the preferences of both the care team and the patient. At the appointment the maternity record, test results, and your medical history are reviewed to determine which delivery options are safe. The discussion may cover available options, limitations, and procedures for breech presentation, as well as the need for additional consultations. One visit may be enough to address some issues, but sometimes follow-up appointments or additional tests are required.

- Medical history taking: previous deliveries, surgeries, chronic conditions, and current complaints.
- Review of the maternity record and current ultrasound and lab results.
- Assessment of pregnancy parameters and discussion of possible risks.
- Stating your preferences regarding the mode of delivery and partner presence.
- Explanation of possible limitations and the criteria for changing management during labor.
- Discussion of the need for consultation with an anesthesiologist or neonatologist.
- Information about signs that warrant hospitalization and the steps to take during labor.

Come to the consultation with your maternity record and a list of questions — this will help you make an informed decision. Remember that the plan is agreed upon jointly and may be adjusted during labor.

Please note that online consultations are available for patients from other cities. We often receive requests from Zaporizhzhia, Pavlohrad, Kamenskoye (Dniprodzerzhinsk), Novomoskovsk (Samar), Kryvyi Rih, Nikopol, Marganets, Sinelnikovo, Pokrov, Zhovti Vody, and other cities.

Preparing for admission for childbirth

Before admission, it is helpful to gather the essential documents in advance and discuss the plan with the maternity team.

If a breech delivery is being considered, clarify in advance which examinations are required and any possible organizational requirements.

Make a short checklist of items and prepare information about any chronic medications. This will help reduce stress at hospitalization and speed up the admission process.

Identification and personal documents.
Maternity record (prenatal chart) with notes from antenatal care.
Current test results and investigations important for planning.
Items for the mother — a basic kit agreed upon with the maternity ward.
Items for the newborn — the basic necessary supplies.
Items for the partner, if their presence during labor is planned.
Regular medications — a list and discussion of administration with the doctor.

Check with the maternity ward for current requirements and the list of documents before arriving. If you have questions, contact your pregnancy care team in advance.

Genesis Dnepr Maternity Unit — conditions

Below is a brief description of how the maternity unit is organized and what to expect upon admission. The overview presents the main services and procedures without excessive detail. When planning your delivery, discuss specific arrangements with your care team in advance.

Delivery rooms equipped for monitoring and rapid response when necessary.
Recovery rooms with rooming-in options for mother and baby.
Monitoring in the first hours: maternal vital signs and assistance with breastfeeding/latching.
Neonatologist available for the initial examination and emergency care if needed.
Anesthesiologist available for consultation and safe selection of pain-relief methods.
Partner births possible, subject to medical and organizational requirements.
Individual support from the team: doctor and midwife inform and assist the patient.

These arrangements are intended to provide clear organization and prioritize safety; confirm details at your prenatal visit.

When to seek urgent medical attention

During pregnancy and while preparing for delivery — including when considering delivery with a breech presentation — it is important to recognize warning signs in a timely manner. Below are signs for which you should not delay contacting the maternity hospital or your doctor. If any item on the list worries you, it’s better to get a professional assessment.

Bloody or heavy vaginal discharge that is different from your usual discharge.
Waters have broken — sudden or gradual leakage of amniotic fluid.
Regular, increasingly strong contractions with a consistent interval — it’s time to go.
Decreased or absent fetal movements compared with normal.
Severe, ongoing abdominal or pelvic pain that does not feel like contractions.
High blood pressure, severe headache, or worsening vision.
Marked weakness, dizziness, fainting, or difficulty breathing.
Fever of 38°C (100.4°F) or higher with chills or general weakness.
Any sudden change in how you feel that causes you serious concern.
Bleeding or severe pain after previous uterine surgery.

When in doubt, have it checked — this reduces risk and will reassure you. In emergencies, seek immediate medical care.

Frequently asked questions

Question: Can the mode of delivery be chosen in advance for a breech presentation?

Answer: The issue is often discussed in advance, but the final decision depends on examinations and the clinical assessment at the time of delivery.

Question: Is this type of delivery suitable for everyone?

Answer: No, it is not suitable for everyone; appropriateness is assessed by the physician based on the condition of the mother, the fetus, and examination results.

Question: Can the birth format be discussed before labor starts?

Answer: Yes, discussing the delivery format and possible scenarios is recommended at prenatal visits and during scheduled consultations.

Question: Can the plan be changed during labor?

Answer: Yes, the plan may change if new indications appear; the team will explain the reasons and propose a safe alternative.

Question: Can I give birth with my partner present?

Answer: In most cases partner presence is possible if medical and organizational requirements are met; this should be discussed in advance.

Question: How should I prepare my partner for participation in the birth?

Answer: It is useful to explain the partner’s role, review the delivery room rules, and agree on any limitations with the team during consultation.

Question: What pain relief options are available with this delivery format?

Answer: Options are discussed with the anesthesiologist; the clinic may offer epidural and systemic (intravenous) methods, and the choice depends on indications and contraindications.

Question: Who decides which analgesia to use?

Answer: The decision is made jointly: you state your wishes and the anesthesiologist evaluates indications and safety for you and the baby.

Question: What if the chosen analgesia method is not suitable?

Answer: In that case the anesthesiologist will propose an alternative method or adjust the plan taking into account safety and the current situation.

Question: When should I go to the maternity hospital — what signs should I watch for?

Answer: Go when you have regular contractions, rupture of membranes, bloody discharge, or any worrying changes in how you feel; clarify specific criteria at your consultation.

Question: What should I bring to the hospital?

Answer: Bring your main documents, maternity record, and a minimal set of personal items for you and the baby; it’s best to agree on details with the hospital in advance.

Question: Are documents and the maternity record required?

Answer: Yes, the maternity record and identification documents are usually required on admission; bring all up-to-date records and test results.

Question: Can I come with already completed examinations?

Answer: Yes, bring current ultrasound reports and lab results — this helps to make decisions about the delivery strategy more quickly.

Question: What happens if a cesarean section is needed during labor?

Answer: If indicated, you will be promptly prepared for a cesarean, the reason and next steps will be explained, and the priority is the safety of the mother and baby.

Question: What if the chosen delivery format no longer seems possible?

Answer: The team will discuss changing the approach, explain the reasons, and offer a safe alternative; this is a common course of action in labor.

Question: What should I discuss if I had previous labor or a cesarean?

Answer: Tell the doctor details of past deliveries, surgeries, and complications — this is important for assessing risks and choosing the approach for the current pregnancy.

Question: Can I discuss conditions of stay and the organization of the birth in advance?

Answer: Yes, conditions of stay, partner attendance, and other organizational matters should be discussed in advance at an appointment or when planning hospitalization.

Question: How can I get a second opinion or review the management plan if I have doubts?

Answer: Request discussion with another on-duty team or a referral for a colleague’s consultation; if necessary, the clinic will arrange an additional evaluation.