North American Registry of Midwives (NARM) Practice Exam

During a breech delivery, when is a hands-off approach recommended until the baby is born?

1. At the shoulders

2. At the legs

3. At the umbilicus

4. At the head

The correct answer is: At the umbilicus

The hands-off approach during a breech delivery is recommended at the level of the umbilicus. This means that care providers should allow the baby to move down naturally through the birth canal without applying excessive traction or intervention until the umbilical cord is visible or the baby reaches this point. This technique respects the natural progress of the delivery and reduces the risk of trauma to the newborn. By waiting until the umbilicus, midwives can help ensure that the fetal body is fully delivered with minimal manipulation, allowing for the natural rotation of the shoulders and body, which can help prevent the arms from becoming trapped behind the mother's pelvic bone. This hands-off technique is vital for promoting safety and preserving the delicate balance during a breech birth. In contrast, intervening too early at the shoulders, legs, or head may lead to complications and is generally discouraged, as it can disrupt the physiological process of birth and increase the risk of injury to both the mother and the baby. Therefore, allowing the delivery to progress until the umbilicus offers a more favorable outcome in breech deliveries.