# Footling Breech Delivery in an Emergency Department Without Obstetrical Services: A Case Report

## TL;DR

This case report describes a breech delivery managed in an emergency department without obstetrical services, emphasizing the need for training and protocols in such settings.

## Contribution

The paper contributes a real-world example of managing a breech delivery in an ED without obstetric support and advocates for structured training and protocols.

## Key findings

- A successful footling breech delivery was managed in an ED without obstetrical services.
- Emergency physicians may need to handle complicated deliveries due to lack of specialized services.
- Annual simulation training and structured protocols can improve outcomes in such cases.

## Abstract

Hospitals without formal obstetric services place the emergency physician in the position of managing potentially complicated precipitous labor and delivery such as breech presentations. Breech deliveries pose an increased risk of significant morbidity and mortality to both the mother and fetus. Recent emphasis on cesarean section as the optimal delivery method for breech presentation has decreased education and comfort levels with breech vaginal deliveries. This case study highlights a patient who presented to a suburban emergency department (ED) in active labor with a footling breech presentation. No obstetrical services were available. The delivery was successful, and the neonate was resuscitated. Though emergency medicine residents receive training in standard vaginal deliveries, most residents do not receive firsthand experience with difficult deliveries. This case highlights the need for policy and procedure and annual competency training for physicians and allied staff in ED facilities without obstetrical services. Structured protocols and annual simulation training will improve outcomes for imminent deliveries with potential complications.