If there are inadequate or no contractions after birth of first baby, escalate oxytocin infusion at a rapid rate (Table P-8) to produce good contractions (three contractions in 10 minutes, each lasting more than 40 seconds); 
- If the membranes are intact and the breech has descended, rupture the membranes with an amniotic hook or a Kocher clamp; 
- Check fetal heart rate between contractions. If there are fetal heart rate abnormalities (less than 100 or more than 180 beats per minute), deliver by breech extraction;