Bottoms up down under a Case Report of Emergency Vaginal Breech Delivery using Telehealth in Australian Remote Community

Abstract

This report describes the use of Telehealth in outback Australia. In this case, an obstetrician could reach out and guide a primary health care worker to successfully resolve an obstructed delivery during the vaginal breech birth of an indigenous woman in a remote regional community. The events occurred in a small community health centre, approximately 300 km from the nearest obstetric service. The mother presented unexpectedly with contractions of active preterm labour leading to precipitant delivery. At the time of the video link, the Obstetrician saw a young aboriginal woman lying supine on a table, her skirt raised and her legs parted. A baby's lower limbs and body lay prone and unmoving, the head and neck still within the vagina. The woman was exhausted, and her care attendants were uncertain what to do. The situation was highly critical. After a moment of summation, the Obstetrician garnered the resources available, including the woman's sister, who was standing by her side, and the primary health care worker and coached them through the required steps of delivery to allow extraction and immediate neonatal resuscitation. The outcome was excellent, a testament to the mother's resilience and the support of her team. The case highlights inequalities faced by regional Australians; the isolation of profound distance, the scarcity of resources and opportunity, the proclivity of disease and risk, and the insatiable attrition of healthcare services inexorably stretched beyond their means. In this setting, it offers hope by acknowledging the success of innovative technologies such as Telehealth which can broaden the reach of virtual, face-to-face communication and allow us to connect in real-time to areas not otherwise accessible.