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Vaginal Breech Birth on the Central Coast

Posted by Selena Maoney

SELENA’S VAGINAL BREECH BIRTH STORY

I’ve been in awe of everything to do with pregnancy and childbirth since I was a little girl- I just couldn’t wait to experience it for myself… and I think my excitement about it (as opposed to fear), my respect for natural processes and trust in the human body is the reason why I’ve had two amazing intervention & drug-free natural birth experiences.

I had an obstetrician with my first, ‘just in case’, as I am quite a cautious person and it was unchartered territory.  That said though, I searched very hard for one who would respect and support my wishes for an intervention-free (unless absolutely necessary) natural birth.  I found one who delivered in a Birth Centre environment and even encouraged me to catch my baby - I reached down and lifted her out all by myself with my husband supporting me from behind, which was just incredible, beyond words.  So the birth was amazing, but I wasn’t expecting the routine jab of Syntocinon that came shortly afterwards, and my placenta actually had some trouble detaching.  I lost quite a bit of blood- not enough to require a transfusion, but enough for it to be classified as a post partum hemorrhage (PPH).

Fast forward a couple of years and we decided that we didn’t need an obstetrician for our second pregnancy, choosing instead to be cared for by a team of Community Midwives.  My pregnancy was, once again, easy and uneventful.  Sometime during my last trimester I informed them of my intention to have a physiological third stage – I didn’t want any interference this time, especially as the Syntocinon didn’t seem to work last time.  I trust my body.  We consequently discovered that, due to my previous PPH, hospital protocol dictated that I was going to have a cannula inserted upon my arrival (whilst in labour), as I was at risk of another post partum bleed.  To me, getting a cannula is actually much worse than giving birth.  And why assume that just because it happened once it was going to happen again? I’d have it if & when I needed it – but definitely not as a routine precaution in the middle of labour which would totally interrupt my focus.  Someone wise once advised me to “throw the road out ahead that I plan to travel on”… well there was no PPH on my road ahead, so why would I prepare myself to have one?!  The midwives were very understanding, but their hands were tied and they said the only way around it was to meet with the Head of Obstetrics at the hospital and have this protocol officially waived by him… so they made me an appointment to see him.

This Head Obstetrician didn’t hold back in letting me know that I was making a very irresponsible choice not to have the cannula or the Syntocinon, and he tried to talk me out of my decision.  He made me feel stupid and selfish for even contemplating a physiological third stage, given my history.  It turned into quite a heated debate, where I felt bullied as I asserted my right to make informed decisions about my birth and my body; and he kept reiterating all the risks involved.  I had done my homework and would never put myself or my baby in any danger.  I got the distinct impression that he was more concerned about looking after number 1… which wasn’t me by the way!  This was confirmed in my mind when he eventually asked me to assume full responsibility for my choices in writing.  I was happy to do so and was glad that the worst was over… or so I thought.

He then expressed concern that I looked very small for my dates (at 35 weeks) and after measuring me he wanted to do a scan.  I don’t like the idea of exposing my babies to too many ultrasound waves during pregnancy (I only have the morphology scan at 20 weeks), but I was passed the point of arguing with him at this stage, still reeling from our last debate, so I let him go ahead.  I wasn’t worried about my size- I carry small and have small babies.  The first thing he deduced from the scan was that my baby was in frank breech position.  He actually laughed as he told me “well there’s no point worrying about the third stage now because this baby will be born via caesarean section”.  I immediately thought back to one night that week when a massive movement from bubby actually woke me up- she must’ve done a 180, a little acrobat☺.  He then proceeded to tell me the following things with the most appalling bedside manner that plunged me straight into a pretty severe state of shock.
“Your baby is too small for dates, it has probably stopped growing.  There isn’t enough amniotic fluid surrounding it, a dangerously low level actually, hardly any… it is likely that your placenta has stopped working, so the baby is being deprived, hence the lack of growth, and will need to come out very soon – you will definitely be having a caesarean, most probably an emergency within the next few days”.  All as though he was telling me what he was going to order for lunch.

At that point I was floating above myself, looking down on the surreal scene, straining to hear what he was saying on the phone as he ordered more urgent, immediate scans, but barely hearing him over the sound of my pounding heart, and my screaming insides… trust your instincts, trust your body!

I remember the student midwife walking out with me, expressing concern and disbelief about how I had just been treated.  I remember collapsing into my car and sitting there for hours (I had to wait 3 for my appointment) stroking my belly, reassuring my baby, trying to digest it all, phoning my husband and my midwife, just not believing… how could anything be wrong when it felt so right, when it felt just the same as last time, when there had been no warning?
And finally… I remember the immense relief that flooded every cell in my body when I heard the magic words about four hours later that my baby was in fact OK… my instincts were right, everything this obstetrician had said was wrong… except for one thing: that my baby was in breech position at 35 weeks.

I trust my instincts, I trust my body.

So my midwife informed me that if she was still breech at term, a natural delivery was unfortunately not an option and they would have to hand me over for a caesarean, performed by whichever obstetrician was on duty at the time- perhaps the very one I never wanted to see again.  Suddenly I was invaded with every birthing mother’s worst enemy… fear.  Fear of having no choice at all in how I was going to birth my baby… fear that we would be forced to endure the polar opposite birth experience to the one we were excitedly anticipating… fear of unnecessary major abdominal surgery… fear of putting my body and my baby into the hands of someone I absolutely could not trust.

They said that if I laboured at home until the last minute I might get my natural birth, but it wasn’t a guarantee.  They had seen women presenting at hospital with buttocks on view and still being taken to theatre.  These were risks I was just not willing to take, so at this stage I thought I should just stay home for the whole thing… but with a breech on board I wasn’t so sure I should be going it alone.

Knowledge is an effective adversary to fear, so I spent hours researching everything to do with breech birth, and then hours on all fours with my bum in the air, doing handstands in the pool, waving moxa sticks at my toes, shining a torchlight and pressing my ipod earplugs down on my pelvis (serenading bub with Mozart), and road-testing countless other methods that google informed me might encourage my baby to turn.  That was Plan A.  However after learning that only 5% of breech babes turn back around after 37 weeks, I realised that I needed a Plan B, pronto.

We explored all options and decided to make use of our private health cover and try to find an obstetrician who would take me on at such a late stage, and who might even consider delivering a vaginal breech.  I knew it was rare, but in all my research I hadn’t found any reason to believe that this method would present a higher risk to my baby or to myself than a caesarean would.  I know a lot of people, including my husband, who were born breech naturally without any dramas.

One very pleasant local obstetrician agreed to meet with me straight away and take me on.  He also agreed to ‘attempt’ a vaginal delivery, having had some experience with it, but… well there were a lot of buts, which again all came back to risk.  I felt a dreaded sense of déjà vu.  He was very quick to quote the results of a big research study called the ‘Term Breech Trial’ of 2000, which concluded that there was a small percentage increase in the infant mortality rate with vaginal breech as opposed to planned caesarean section for term breech babies.  I had just read all about this study (AND its numerous flaws) and discovered that it has been solely responsible for most obstetricians worldwide deciding not to practice vaginal breech at all anymore.  He asked me if I was willing to put my baby’s life at risk, which made me feel again like an irresponsible and selfish mother… and yet he never disclosed the risks that I know are inherent in all caesarean operations.  My trusty inner voice was screaming again… trust your instincts, trust your body!… so needless to say, after yet another unnerving experience which made my hair stand on end, Plan B was quickly aborted.

Breeeeathe.

That night, in absolute desperation, I gave my friend Peter Jackson (founder of Calmbirth) a call.  His reassurance and words of wisdom instantly lifted my spirits and led me to the turning point I so desperately needed.  He kindly gave me the contact number of the Head of Obstetrics at John Hunter Hospital in Newcastle, Dr Andrew Bisits, who apparently was a bit of a guru on natural breech.  I left a message for him the following morning and was delighted when he personally returned my call and invited me straight up to meet with him.  Our conversation was brief but it left me with such a good feeling that I immediately binned all my private hospital admission forms and told my husband that our baby was a little Novacastrian.

Andrew is my hero.  He made me feel like a mother about to have a baby rather than a troublesome patient with a life-threatening disease.  He respected both my desire and my ability to birth my baby naturally, and he answered all my questions and addressed all my concerns with a wealth of knowledge and vast experience.  He cared about me and my instincts and what I wanted, because it was my experience and I was at the centre of it.  I knew instantly that I was in the right place, and I didn’t care anymore whether bubby was going to turn back around or not – I was actually secretly hopeful that she wouldn’t so we could remain in his care… but that said, he did attempt an ECV at 37½ weeks, and I wasn’t disappointed when it was unsuccessful.

Vaginal breech deliveries occur so often up there that all staff on the labour ward are very experienced, confident & positive about it - which is a much better situation to be in when giving birth than if your caregivers are inexperienced, anxious or negative.  At John Hunter they measure & manage risk by adhering to a strict set of criteria which must be met in order to qualify for a vaginal breech.  Some of these include: size & position of baby, size & shape of mother, attitude of mother etc.  I got ticks in all boxes and had the added advantage of having given birth before, so Andrew told me that he expected my birth to be very straightforward- ‘textbook’ even.  He said he could picture me just breathing her out – what a vote of confidence! ☺
He gave me an internal exam at 39 weeks (which was when my first daughter was born) and found that I was already 1cm dilated.  It was two days before my husband’s birthday and we were predicting that bubby would probably arrive then, considering how much she already took after him!

During the early hours of the next morning I felt the familiar tightenings which I immediately recognised as the probable onset of labour… such an exciting feeling!!!  Even though they had subsided once I got up, we organised for our 2½ year old to be picked up by her grandparents, and David & I spent the day quietly getting ready (all the drama of the recent weeks had distracted me from even packing a bag yet!). It was a Thursday, late night shopping at Erina Fair, so we went down there at about 5pm.  I hadn’t told him that the waves had started up again, and the whole time we were shopping I was calmly breathing through them.  When we got home at 7, I suggested that we go for a walk- I wanted to stay active to keep things moving, and also upright so that gravity would assist me this time (I laboured for a long time with my first because I was mostly horizontal).  Still David had absolutely no idea that it was happening, until we were quite some distance from home on our walk, and it dawned on me that we had almost an hour+½ drive to hospital and I didn’t really want to be giving birth to a breech baby on the F3!

So we got home at around 8pm and David started organising dinner in a mild panic while I called the hospital, still very calm & collected, to let them know that I’d “probably see them up there sometime during the night”, before getting in the shower.  Only a few minutes later Andrew himself rang and asked David to get me out of the shower.  After speaking to me and ascertaining that I was in established labour and extremely relaxed about it, he very calmly told me that he didn’t want to alarm me, but that I should get dressed now, hop in the car, and head straight up there.

We left home at 8:30, and David did the trip in only 1 hour… 10 minutes of which were spent sitting in roadworks at East Gosford.  He told me later that if it came to it, he was worried an ambulance might take me back to Gosford if we didn’t get far enough up the freeway.  Once we were passed halfway and on the home stretch towards John Hunter he relaxed a bit, but he was still determined to get pulled over by the police, believing that he had the best & only excuse for speeding- “my wife is in labour with a breech baby & we’ve got to get to Newcastle”.  I think he was disappointed that he was denied that little thrill ☺ However he was anticipating a much bigger thrill- his birthday was only 3 hours away now, and he was going to get the best pressie ever.

We walked into our Birth Centre room just after 9:30pm and our lovely midwife Christine took me through all the ‘check-in’ questions whilst I was rolling around on a fitball, still quietly breathing through my waves.  In for 4, out for 6, releeease.  She then busied herself getting things ready whilst David dimmed the lights, got the music set up and the aromatherapy oils burning, and I slipped off to the bathroom. Once again I found the toilet the most comfortable place to sit.  By this stage my exhalations were audible- I sighed as I surrendered to the strength of each wave and visualised the muscles of my uterus doing their job so well, bringing my precious baby closer to me and our much anticipated first cuddle.

It’s protocol up there to have a CTG machine strapped around the belly to monitor the baby’s progress during a vaginal breech delivery.  Chris kept popping her head in to check it and commented that bubs heartbeat was consistently strong so she was happy to remove it.  Shortly afterwards, I leaned over and vomited into the shower, which I celebrated as a sign that I was fully open and transitioning now… not long to go bubby, we’re doing so well.  Chris seemed quite shocked to hear a subtle change in my sighing, which obviously indicated to her that I had started to push.  I remember the incredulous look on her face when she asked me if I thought my labour had progressed any since we arrived- she apparently hadn’t realised how far along I was, perhaps because I was so calm.  She asked me to hop up on the bed so she could examine me, but then David announced that he could see a water sac emerging, so she got a bit of a fright and rushed out of the room to call Andrew.

When she returned and helped me onto the bed on all fours, my waters broke and a little bottom was crowning, so there was no need for an examination.  I was moved straight onto the birthing stool and was vaguely aware of more people entering our sanctuary… the registrar on duty assumed catching position (Andrew wasn’t there yet), another midwife and a paediatrician stood by (another protocol for vaginal breech)… and then Andrew appeared just in time to quietly talk the registrar through the birth, which was a very “hands off” experience that unfolded seamlessly.  One hand supported the little bottom as it descended and I think a finger may have swept one shoulder through, but it was really just all my baby and me… just as we had intended☺.

Our precious Sophie Grace was born at 11:45pm, just 15 minutes shy of her Daddy’s birthday (she clearly wanted her own day!) and only a little over 2 hours since we had entered the room.  She was lifted straight up onto my chest and let out a little cry which sent the paediatrician away with a big smile. Everyone was smiling, it was such a joyful event… who would’ve thought that it could be so uncomplicated in the end?  Even the third stage was easy- my placenta fell spontaneously to the floor within minutes, before the chord was cut… no Syntocinon, no hemorrhage.

The irony that I even achieved a physiological third stage after everything that had happened, after being told that I would need the highest form of intervention to birth this baby, still floors me.  Andrew subsequently told me that it all unfolded exactly as he knew it would, and Christine thanked me for “restoring her faith in birth”.  Aside from a little bruise on her left butt-cheek, Sophie was perfect in every way, gorgeous, alert & content.  She latched straight onto the boob and hasn’t looked back (19 months later it’s still her favourite place ☺).

I count my lucky stars that I found Andrew and had the fortitude to strive for a Plan C… however it wasn’t really luck, it was all about preparation:

•    Doing lots of homework so I was fully informed every step of the way;
•    Creating a private, safe & sacred space to birth in, with caregivers who supported me 110% (settling for nothing less);
•    Using visualisation, affirmations & meditation to help maintain my positive mindset;
•    Listening to my instincts & letting them guide me through the obstacles;
•    Connecting with my baby throughout;
•    Practicing my calm breathing and using it consistently;
& lastly, but perhaps most importantly -
•    Trusting implicitly in my body to do the job that it was so magnificently designed to do.
…………………………………………………………………………………………………………………

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3 Comments on “Vaginal Breech Birth on the Central Coast”

  1. Joan Arc says:

    Thank You for your inspirational story. It has taught me to hope.

    I did all my research for my first birth and wanted a physiological third stage and a natural childbirth. I handed over my birth plan to the ob in the second half of my pregnancy and was then treated to lectures on what was wrong with my choices at every appointment. This led to crying bursts after every appointment and anxiety whenever the next appointment was coming. He even had the gall to tell me that although the baby and I were healthy I was overdue and should be induced because he thought I would come on Christmas Day and didn’t want to work!

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