Jaimie's motherhood story - My breech birth.
I went in to see my midwife for my routine 38 week check up. I was in a midwife based program where I had my own appointed midwife for my whole pregnancy and birth. I got along well with a midwife and we shared the same interests and aspirations for my birth. I had a drug free natural labour with my son and planned to have the same this time. My midwife measured me and took my blood pressure.I then laid on the table and my midwife examined me to check if baby's head was head down and engaged. After poking and prodding for a while, my midwife wasn't convinced what she was feeling in my pelvis was a head. Two other midwives examined me and came to the same conclusion. The body part in my pelvis seemed less firm then the body part near my ribs. We were sent to an ultrasound to confirm the baby's position. She was in fact frank breech, bum first with her legs up at her head.
My midwife discussed what our options were and we both insisted we would try and still have the natural birth I wanted. Our obstacle for that breech births were not recommended and many obstetricians refuse to delivery a breech baby naturally. This was mostly due to a journal article which was published approximately 20 years ago stating breech births were dangerous and had a high infant mortality rate. After some research and phone calls, my midwife found four obstetricians who were willing to try for a breech birth. At this point it would all come down to timing if I went into labour before my due date. As I was in the public system, if I went into labour early I would get the obstetrician who was on that day/night. We couldn't guarantee that obstetrician would be one of the four who were willing to birth a breech baby. I may still have a cesarean if one of those doctors weren't on call.
Between 38 to 40 weeks I did everything I could to try and turn the baby. We were fighting an uphill battle as most babies at this gestation are happy where they are and don't have a lot of room to move around. I read and used the exercises on Spinning Babies website to tilt baby and crawled around on all fours. I tried Moxibustion and acupuncture which also didn't move baby. I then had a procedure called External Cephalic Version which is the process where a obstetrician manually tries to tun baby from the outside using his/her hands. I found this procedure more painful than a contraction. We had two failed attempts. Baby girl was very much happy where she was!
I was fortunate enough to stay pregnant for my due date examination at the women's heath clinic. I was seen by my midwife and a female obstetrician who was willing to attempt a breech birth. She had spoken about my case to her colleague who was also interested. They both wanted to induce me two days later, which was Thursday May 19th. I'd be 40+2 weeks in the morning. The OB's colleague would be the one delivering the baby that day if all went to plan. Theatre would be put on standby and a number of health professionals would need to be present in the room for safety of both myself and baby. I had my cervix checked and I was already 4cm dilated. The OB could feel my baby's bottom. She was down and ready to go. If I went into labour before Thursday morning it wasn't an issue as the two covering doctors were for the breech birth. We went home and started to pack!
We arrived at the maternity ward at 6:30am Thursday morning to be admitted for the induction.We were met by my midwfie and were taken to a large labouring room. After a cannula was inserted and CTG monitoring attached I was allowed to roam freely until my OB arrived. My OB arrived at 7:45am to rupture my membranes and then the syntocin infusion was commenced. My water was broken and there was a lot of fluid. Every time I stood up, I'd get a gush which would fill up a pad instantly. My OB explained the process of the drip, explained there was a chance I'd need forceps or an episiotomy to get baby out if her head got stuck during delivery. I'd need to lie on my back with legs on the stirrups to push and I needed to have this baby by 5pm as the OB on call was not an advocate for vaginal breech and I would end up with a cesarean, regardless of how my labour was progressing. Pretty much everything he described was NOT what my husband and I wanted in terms of interventions. I was starting to panic thinking this birth was going to be too medically focused. My midwife assured me she wouldn't let any of these interventions happens unless necessary. I started to feel tightening and mild contractions around 9:00am. I was standing, holding on to an IV pole and still able to walk and talk through the contractions.
My OB wanted me to have an epidural inserted just in case I needed an emergency cesarean or if Vaida got stuck; he would need to numb me quickly to get her out by ANY means possible. There was no infusion/drugs run through the epidural by my request. I still wanted the drug free labour, even though I needed to have the syntocin to keep my contractions regular. I didn't want to be numb throughout my labour so we made the compromise. The insertion of the epidural was fine but when the anaesthetist put through a test dose to ensure he was in the right space my BP dropped at 80/50 and I felt lousy! I was sitting on the side of the bed at this stage and had to be lowered by Nathaniel so that I didn't faint.
At the exact same time my contractions picked up dramatically and I hated that I was stuck on the bed while they gave me a bolus of IV fluid to bring my BP up. The contractions didn't feel like others I had felt with Hunter; I had the contraction pain in the pelvis but as my body relaxed and I breathed through the surge I could actually feel everything opening up. This continued for every contraction. I told my midwife about the sensation and she didn't make a big deal about it (although she told me afterwards that she was fully well aware that these sensations meant I was fully dilated).
My midwife stepped outside the room to speak to my OB about my wishes to push either on all fours or standing up (these positions in the literature show they are the most effective with a breech birth as they allow gravity to help baby turn). She also wanted to discuss the other interventions (forceps, manually helping baby out and an episiotomy) which had Nate and I nervous. This is when I started to hear my OB raise his voice and start yelling at my midwife. My midwife remained calm and stated all these interventions were not supported in literature etc. which he didn't like hearing. He stormed off and the conversation abruptly ended. My midwife came back into the room so composed like nothing had happened. I told her that I had heard the whole thing and she started to laugh! According to my midwife, my OB was not comfortable with me birthing any way other than on my back and that was something he wouldn't budge on.
We ended up having the head of maternity services come in to see me and discuss my concerns and my OB's wishes. We came to a compromise that I would birth on my back if he wouldn't touch Vaida as she came out. The literature states that during a breech birth, the OB should not assist baby coming out. It's what they called 'hands off'. It means that it was up to only myself to push and for baby to manually turn herself into the optimal position so her head would come out successfully. We also agreed to not use forceps or an episiotomy unless as a last resort.
My OB came back in the room and seemed much more calm since we were all on the same page. He proceeded to check me but didn't need to, Vaida's bottom was on show. I was not just fully dilated but ready to push! Breech babies must have their bottom in the vagina before pushing may begin, so baby made it very clear that she was ready to be born. I had been feeling so lousy that I had been working through the contractions like normal, without noticing she was right there.
My OB asked for all practitioners, to be in the room ASAP. This included my OB, another OB, a paediatric consultant, another paediatric consultant waiting outside, my midwife, a midwifery student and the head midwife of maternity to help my midwife as her "second person" and to make sure no sticky beaks came into the room for a look... A breech baby has not been born naturally in this hospital for many years according to my midwife. She didn't tell me the exact number, however she said it was closer to decades. Many people wanted to see what was happening, however the midwives were excellent in keeping the traffic down to only the necessary people for the birth and delivery. The anaesthetist was also on call outside in case I needed the epidural activated. My legs were put in the stirrups and it was up to me to let everyone know when I was having a contractions. My midwife had her hand on my stomach to help with picking up the contractions also.
Pushing out her bottom was such a different experience! There was no pain, just an opening feeling like I'd had with the contractions. My OB remained hands off and once Vaida's legs were out to her shins, they automatically slipped out and hung. She proceeded to wee and poo all over the place, all over the OBs! The pushing of the torso was similar to the feeling of crowning; the burning ring of fire lasted much longer as the torso was so long. That was the most painful part and I remember just panting and singing the "Burning Ring of Fire" son by Johhny Cash in my head! At this stage my midwife removed all the sheets so I could watch her come out. It was amazing to watch myself push her out slowly. Once she got to her elbows her arms also automatically slipped down by her sides. I then gave one more large push to get her out to her neck as she rotated herself to face the floor. It was now my OB's job to lightly lift her body as I gave one more push and her head popped out; I say popped because it actually made a popping sound! I had pushed her out in 13 minutes. Vaida Jean Orchard was as born at 12:07pm.
Unfortunately we didn't get to delay cord clamping as she needed to be checked out straight away by the paediatric consultant. Nate followed over and cut the cord in had resuscitation crib. Within 30 seconds of being born Vaida let out a loud cry and all was well. She required no oxygen or suctioning. She lay in the crib, with her legs up by her head!
Jaimie says: I'm a nurse at the local hospital. Mummy blogger (Raising wildlings). Coffee obsessed. Love to be outdoors. Love a glass of wine!
Hood: Regional Victoria
Children: 2: kids - 2.5 year old son, 9 month old daughter
Motherhood in 5 words: Joyful. Challenging. Instinctive. Loving. Rewarding.
Fav family friendly place: Botanical Gardens.
Coffee order: LARGE Flat white, no sugar.
Blog: Raising wildlings
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