Fetal Presentation – Passenger (Nursing)

00:00 The last piece of information we want to think about in terms of the passenger is perhaps the most complicated. So, what I recommend for this part is if you have access to some sort of baby doll which you may not have which is okay, but it does help so you can borrow one and that will make this so much easier. So if you've got one or can access one, go grab it but if not, just stick with me and we'll work through this. So now we're going to look specifically at the presentation. So, fetal presentation is the relationship of the presenting parts of the fetus to the quadrants of the maternal pelvis. So we're going to kind of put all of these elements together and see what that looks like. Now, there are several options for presentation.

00:49 We can have a vertex or cephalic presentation meaning the head is coming first, we can have a breech where the bottom is coming first, or we could have a shoulder presentation where the shoulder is coming first. So, thinking about a vertex presentation, this is a situation where the head is coming first. This is the most ideal. Remember we've already talked about attitude and the importance of flexion. That's going to create the smallest diameter for the baby to make its way through the pelvis and through the vagina. So this is ideal. What happens, however, if we're in a breech presentation? So, now we have a wider diameter because the bottom and the legs and everything else takes up much more space than the head. There are 3 different types of breeches, however. This is a frank breech. In the frank breech position, what I want you to pay attention to is the flexion of the hips and the flexion of the knee joints. So in a frank breech, the hip joints are flexed, the knee joints are actually extended. That's what creates that pike position for the baby, which is great if you're going to deal with dive off of a high dive but not so great in labor. But this is a frank breech presentation. This is a complete breech. So again, look at the hips. They're flexed, but this time the knee joints are also flexed which means the feet are tucked up underneath the bottom. We finally have a footling breech. This one's the easiest to remember because they're feet involved and it's in the title. So we could have a single footling or a double footling. So I want to show you on my pelvis why this might be a problem. So, now I have the pelvis and the baby. Now I have to tell you a little story. One of my favorite colleagues has named my baby here Clitus. So for henceforth we'll refer to him as Clitus the fetus. So, Clitus the fetus is now in a frank breech position. So, as we put Clitus in to the pelvis, you can begin to see how tight the fit is. So what's the concern? Well, the concern is is that as the baby moves through the pelvis, all of the soft tissue are going to form around the baby which is great until the legs come out and then we get to the neck. So now we're on the neck, and what's going to happen to the soft tissue? Well the soft tissue actually could contract and end up contracting around the baby's neck. And so this is why a breech position for a vaginal delivery is not ideal. So in a vertex position when the baby comes through, the neck comes through pretty quickly right after the head and so there is less of a chance of any constriction around the neck. In a complete breech, this time, the hips are flexed but so are the knees.

03:47 So now we have a situation that looks sort of like this? And what that does is it actually creates space for guess what? The cord. So our concern about a complete breech is that there's room for the cord to actually slip through. Now remember, the cord is the source of oxygen for the fetus until it's delivered. So, having the cord come through and then be subjected to compression may actually cut off the oxygen supply to the baby before it comes out, which is not ideal. Even worse, if we have a footling bridge, so whether it's a double footling with 2 feet or a single footling this way, there is lots of room in the pelvis for the cord to slip through. So this is the number 1 reason why. Breech presentations are not ideal for vaginal deliveries and you may find that when some patients come in and it's known they're in the breech position, they will not be offered a vaginal delivery, they will proceed straight to a Caesarean birth.