Click the image to see more from Karyn Loftesness Photography
I was measuring consistently ahead in fundal height early on and just before the mid-point of my pregnancy my midwife referred me to an obstetrician to have an ultrasound (we’d not planned on having any) to rule out twins, fibroids, excess amniotic fluid, or any other complications. At the ultrasound, we were told there was one baby, no fibroids, and no excess fluid — the doctor said I simply had “a large uterus.” So we went with that as confirmation.
At about 2:30 one morning, I had a contraction that woke me from my sleep. This had happened before, so I waited and felt a few more before I grudgingly got up and decided I’d take a bath to help them stop so I could get some sleep. I went into the bathroom and turned on the light. I saw that a little blood was in the toilet from sometime earlier that night, and wiped to see if there was any more… there was.
I woke up my husband, Garrett, and he called our midwife to tell her what was happening. She said it was probably just my bloody show and to take it easy but to call her if anything else happened. I tried to sleep, bathe, and just relax to get the contractions to stop. I was struggling to concentrate on the book I was reading. This was at about 6:30.
I took another bath, a shower, and tried to lie down and listen to a Hypnobabies CD, but the contractions were too strong for me to really relax. I definitely thought they’d stop. In fact, I thought they’d better stop, since I’d just had the home visit from the midwives on Monday morning. I could have a home birth in 5 days at 37 weeks, but not a day sooner!
I was determined not to be in true labor yet. When Garrett got home from dropping off our son (at about 8:30) and saw me in the bed, he said we needed to call our midwife again and so he did — all while packing a bag. She asked some questions and then suggested we come and meet her to assess the situation and see if I was really in labor or see what we could do to slow or stop it.
We left and on the way stopped at the store to get more minutes for our cell phone. I was low moaning for a while, but then that stopped working. About 45 minutes into the trip, my moans got higher pitched and less controlled. We talked about passing a bank, and how we’d definitely make it a few more hours at least and then a couple of minutes later, my water broke — everywhere! I was finally able to accept that the baby would be born that day, and soon, but we talked and I figured we still had at least a few hours. Garrett called our midwife to keep her updated, and she announced a change of plan — she said to meet her directly at the hospital. She asked Garrett if it was me moaning that she was hearing, and he said it was.
As they were talking, my body gave a tiny involuntary push, and I felt something come up between my legs. My first thought was, “Oh, God, the cord.” But I knew what an emergency that would be, and thought that maybe, just maybe, I had somehow pooped. So I reached down (with much trepidation) and felt, and it was most definitely cord. I yelled, “The cord is out! The cord is out!” and my midwife heard me yelling over the phone. She told Garrett to pull over immediately and get me on all fours to take the pressure off the cord, and to call 911. There was, oddly enough, some traffic on the rural highway that morning, but after about a minute he managed to pull off the road. He got out and threw Bruin’s car seat in the grass (we were, luckily, in front of empty fields on both sides of the highway. It was actually quite a pretty spot) and got me into the back seat, talking with our midwife all the while. She told Garrett to get my chest down and my butt up in the air, and then he called 911.
Somehow Garrett managed to get my shoes and pants off. I could hear him on the phone with the operator and the guy was asking him what he saw, and asking him to feel for a pulse in the cord (he didn’t feel one), and telling him to hold the baby in. By now I was really in it… it was all happening so fast, but I truly was my primal self. The pushing and grunting was happening, whether the 911 operator told me to stop or not. I tried to be compliant, but I couldn’t stop it. There was literally nothing I could do but work with my body and my baby.
It was the most beautiful feeling I have ever experienced. I wasn’t scared — I was totally consumed, growling and pushing. At some point, Garrett touched what he said was just the cord, which I shouldn’t have felt, but it was excruciating. Whether or not the baby made a fluke movement at the exact same time or if for some reason I was able to feel it, I don’t know, but I did try to donkey-kick poor Garrett. I tried to kick him off again (while yelling, “GET OFF OF ME!!”) when the operator told him to flip me onto my back. That didn’t feel right at all, but I tried, and just absolutely could NOT make my body do anything differently than it was doing. It knew exactly what to do, and there was simply no stopping it. I occasionally lifted my head to look out of the window at the trees in the sunshine, and just let my mind feel “universal.”
To me breech is a variation of normal. Well not only to me, 4% of babies are breech so it must be pretty normal to them too. There is fear and unknown surrounding this which all circles around the “term breech trial” which was extremely flawed and commented on at the time by people like Maggie Banks. Practitioners with no concept of birth as part of the normal life cycle were involved.
In a nut shell the trial recommended that the practitioners were experienced, however 26% of them hadn’t been at a breech and it was even used as a learning tool on occasions. It was also recommended that the birth was totally hands off to at least the umbilicus and then only acted on in complications; but this was totally ignored. Of course it had to be cancelled the medicalisation of childbirth never works. Please read the critique by Maggie who followed it closely.
My experience with breech goes back to my training. The hospital had a 9% c/s rate so most babies birthed well. I was involved with both twin and breech births as part of my experience with normal. I have only seen one very traumatic breech which was an extraction done by a frightened Registrar. This is not something I would allow my clients to be subjected to EVER.
Over the past 12 months alone I have attended 4 breech born babies in a variety of positions. This included 2 frank 2 flexed and part of the end of the year before I attended a beautiful footling breech.
Women’s journey to a breech birth are often convoluted and very interesting. This really shouldn’t be needed but we are fed fear around breech even before pregnancy and unwinding the tangle to realising that it is just a birth, often takes lots of time and soul searching.
Breech birth seems to be widely searched on the Internet and information on a normal birth with a breech baby is getting more and more difficult to access.
Breech Baby? Normal Births Getting Scarce
Practitioners experienced in a birth with a woman who’s baby is breech are getting older and there is soon going to be nobody to pass on these skills. It seems the norm to pull out the baby using obstetric procedures that cause trauma and harm and then claim that the problems were incurred due to the breech birth instead of the care providers interventions. This was also part of the comments of the term breech trial.
Hospitals only offer a medicalized birth if you want to “attempt” this. Being active during your labour is really important and this is no different for breech births.
It’s important to know that your practitioner is experienced and confident and has the skills to remain hands off unless there is an extreme need to intervene.
I am lucky enough to have trained in a hospital in the UK where breech birth was seen as a variation of normal and at a time where midwives were considered the experts in normal midwifery practice (which of course they are).
I think the best way to help the woman is to keep the atmosphere calm and create as little stress as possible.
I also agree with this:
“Some practitioners advise waiting for an hour after full dilatation before active pushing is ‘allowed’. This is thought to ensure the cervix is *completely* dilated. This is particularly important for premature births as the bottom of a pre-term or growth restricted infant is generally smaller than their head but is questionable when the baby is full term and well grown as the bi-trochanteric diameter is the same as the bi-parietal diameter (the bottom is the same size as the head). By carefully observing the progress of the labour and the external signs of full dilatation the midwife rarely has need for an internal examination. Active pushing only starts when the urge is overwhelming and impossible to stop and then progress is usually smooth. If there is an urge to push before the signs of full dilatation are apparent the usual strategy of asking the woman to adopt a knee chest position is usually effective until spontaneous descent occurs. There is also a school of thought that if the birth is delayed the uterine contractions compress the baby into a more favourable, more flexed position thus facilitating a smoother birth.
A woman’s perineum is best left untouched as discussed above. A woman’s perineum is remarkable as it is designed to stretch and expand to facilitate the birth of the baby by gently adjusting the position of the baby as it progresses down the birth canal. It does not require support.
All breech babies technically have a cord prolapse. The head comes after the body. There is of course risk of compression between the bony pelvis and the baby. This cord does not appear to be unduly compressed and the compression would be transient as the baby was rotating. It should be remembered that a full term baby can tolerate a short period of anoxia during the birth and that the cord, at this stage is unlikely (and appears not) to be occluded totally. The cord is not between two bones but the maternal symphysis pubis and the baby’s abdomen. There is also the danger of causing the cord to go into spasm, thus exacerbating any problem.
When the baby is born to the umbilicus there is no need to rush. Steady progress and no delay is required at this time. The cord is unlikely to be occluded until the head comes into the pelvis, which is as the shoulders are being born. With natural manoeuvres, plus gravity, the shoulders and arms are usually born without help.
The baby rotates through the pelvis in a spiral in order to bring its’ arms down spontaneously – by handling the baby and hurrying the natural mechanism problems could occur’”
I couldn’t say it any better than this. Lots of these thoughts apply to all labours, the mechanism may be slightly different but the spontaneity and normality of it shouldn’t be interfered with unless there are signs that things aren’t moving along naturally. Then the breech skills that are taught over and over come into play.
New Canadian guidelines reverse the long held thought that all breech babies should get a section and are now confirming what we all know bum down babies can be born through vaginas.
Here is a fantastic video of a frank Breech taken last week.
This woman had an unusual journey into homebirth. She lives in rural Australia and had to come into the city to birth so had booked the birth centre. A few trips and hours driving each time for all the testing etc as the baby is breech. At 36 weeks the hospital attempted a cephalic version (which is successful about 30% of the time on primigravid women.) and it failed, so she was told that she had no choice but to book a ceasarian section. When she questioned this saying her choice would be to birth normally she was told that it would be fine if she wanted a brain damaged baby.
Having no home in the city but staying with her family she got in touch with me to help her with facilitating a normal birth at the hospital. The first thing we did was change hospitals and go and talk to the midwife in charge of labour ward and a sympathetic Ob. We negotiated clinic and made a birth plan and gave it to the ob. He was clear that he was very supportive to the woman’s request but if he wasn’t on duty he couldn’t guarantee the same reception from all, he even went as far as to say there were some you definitely wouldn’t want to be there.
Once she felt relaxed she went into labour. I don’t normally help women at hospital because of the awful atmosphere but I hadn’t had too much time to build up a relationship with this woman so I was happy with the plan. We went to the house to help her with labour until it was time to transfer to the hospital.
When that time came She didn’t want to move. We had a beautiful homebirth.
ETA someone suggested I had hands on this birth. I assure everyone that The only part of the baby I touched is the cord. Other than that it was only the mother that I touched while the baby was birthing. Oh and falling forward as being born is NORMAL.
Once more I am compelled to write about Breech. After the study proving vaginal breech to be as safe as a section you’d think the whole world would be back on board. After all it only took a matter of months after the flawed Hannah trial for almost every Obstetrician to be convincing women that a major operation was safer than a normal birth. But NO. In Australia at least it is worse than ever and with the NHMRC guides saying that only “singleton cephatic 37 to 42 weeks with no other complications” should stay home, they could not be trying any harder to stamp out normal, unhindered birth in all it’s variation of normal.
You can find lots of other breech posts on this blog but I would once again like to talk you through the mechanism of a Breech birth.
Most important rule is HANDS OFF THE BREECH no matter how tempting it is just to pull on that leg DON’T. It’s the easiest way to create nuchal arms and a completely deflexed head. When you pull on the leg you create a morro reflex in the baby.
“At 7am it was time to get in the birthing pool that was set up in the middle of the dining room. It felt amazing and just what I needed at that point. My midwife seemed to know what I needed before I did. My 4 year old daughter was present the entire time. She loved rubbing my back with frequent costume changes so her brothers could see all her pretty outfits.
Finally around Noon, it was time to push. It took a lot of work to get baby A down in his complete breech position. The midwife tickled his feet and he was able to switch to a more favorable frank breech position scrotum presenting first.”