A 37-year-old pregnant woman with identical twins is in labor. The second neonate's buttock is delivering. What is the appropriate action?

• A. Apply gentle traction on the neonate and turn him counterclockwise as his head delivers.
• B. Insert two fingers between the neonate and the vaginal wall.
• C. Place her in the knee-chest position and transport immediately.
• D. Support the neonate and assist with the delivery.

Answer: (D)

When the presenting part is breech, the priority in a twin birth is to support the baby and assist with the delivery rather than try to reposition or aggressively pull. In this scenario, the second neonate’s buttocks are delivering, so you cradle and support the infant as the mother pushes, guiding the body gently through the birth canal and protecting the perineum. This preserves the natural delivery process and minimizes the risk of injury to the baby or mother from traction or forceful manipulation.

Traction on a breech baby can cause serious harm, including limb injury or cord compression, and turning the baby during a breech delivery is not indicated as a first-line maneuver. Placing fingers between the baby and vaginal wall or placing the mother in a knee-chest position would not be the appropriate initial step in this context and could interfere with a safe delivery. Supporting the neonate and assisting with the delivery aligns with letting gravity and maternal effort complete the birth while you provide controlled, gentle guidance and perineal protection.