Written by MAMA mum, Jacqui
So my pregnancy was fairly easy and uncomplicated. I remember thinking (and probably saying) ‘When’s the hard stuff going to start?’
All my prenatal check ups were pretty uneventful – everything ok, off you go, see you in a bit. I had minimal monitoring, just the 20 week scan and the initial blood tests.
At about 28 weeks Kelly was able to feel the baby properly and said she was breech but that didn’t matter much at this point, still lots of time. I had done a lot of reading during my pregnancy and two books (Ina May Gaskin’s Spiritual Midwifery and Henci Goer’s Thinking Woman’s Guide to better birth) dealt quite a lot with vaginal delivery of breech births. I’d also seen Ina May’s documentary Birth Stories, which showed a breech delivery. This was all before I had much understanding of the birthing practices in Melbourne, so I took this knowledge of the baby being breech as nothing to worry about. Most likely baby would turn, if not, we’d work though that at the time.
This mindset continued through each check up as we found she was still breech. At about 32 weeks I started doing some exercises to try and turn her but I was starting to get the feeling that she wasn’t going to budge. As I got to 35 weeks and my last week of work (and the week before Christmas) I started thinking maybe I’d better try something a bit more productive. Even then, I only started to ‘worry’ because of other people’s comments on her position. It was only then that I started to feel like her being breech was a bad thing, rather than merely unconventional. So I had some acupuncture done and took the moxibustion sticks home to continue this treatment, although the feeling that she was happy where she was starting to become stronger.
Then, on the eve of my last day of work I had my 36 week check up at the hospital and everything changed. I walked in thinking the only thing I had to worry about was telling the obstetrician I wouldn’t be doing the GBS swab. We never even got to that. The doctor looked at my file and commented on the baby being breech. The day before I had started feeling quite different, like she had dropped, so I was keen to see if maybe she had turned. She had a feel of my tummy and said no, looked like she was still breech, we’ll go and do a scan to check. That confirmed things, so back to the room we go. At this stage I was still not particularly concerned, just wanted to know what the next step would be. I was certainly unprepared for her next words.
‘We don’t recommend vaginal birth for breech babies, so I can book you in for a caesarean for 39 weeks.’ What??!
I hadn’t even considered that as an option! I had been thinking I would be told that I couldn’t birth exactly the way I wanted (for example a water birth) but it never occurred to me that I couldn’t have a vaginal birth at all. She went on to explain why it wasn’t recommended, none of which sounded convincing to me. So when I meekly asked if it was possible to talk about a vaginal birth, she went on again about the risks, ending with the great line that ‘Of course, if something went wrong with the baby, you’d never say ‘at least I had a vaginal birth’.’ That left me flabbergasted and quite speechless – of course not but… isn’t there another option? Eventually we booked in for an ECV to try and turn her, but by then I was convinced she wasn’t moving and that it wouldn’t work.
We left in shock. Aaron had to go back to work and I went home. And cried. I was just devastated. It came out of nowhere, and was delivered so cruelly. Aaron suggested I call Kelly, but I didn’t want to hassle her (always the way with me) and also I was so upset I knew I would just be crying and it wouldn’t be a very productive conversation. I knew I was keen for a natural, vaginal birth and that a caesarean was way down on my list of what I wanted, but I was surprised at the depth of my feeling. I was completely devastated at the idea that I couldn’t give birth normally. I was already feeling like a failure at the prospect of it. Eventually I worked through it, and got to the point where I was ok if I had to have a caesarean, but I think I would still have had to deal with it after the birth if it had eventuated.
So then I had to go to school the next day for my last day – what a way to end the year! I was so distracted. Barb eventually convinced me to call Kelly, which I did, and as predicted, I cried a lot. But she was so reassuring and I was seeing her that night. Again, it was a lot of tears, but she had options – calling the hospital, seeing if there was someone there who would allow me to have a vaginal, or getting into contact with ‘Vaginal Lionel’ a private obstetrician (we were never going to be able to afford him but it was just good to have an option at that point) and talking to Jan, the other MAMA midwife, who had lots of experience in breech (though she couldn’t deliver it anymore, due to the insurance issues for independent midwives).
The other hugely beneficial thing Kelly did that day was telling me to sit down and think about what was really important for my birth experience. When I actually sat down and thought about this I realised that my ideal birth was based on a simple principle – that I was involved as possible, which meant being able to do as much I could as well as being informed about everything. It was the idea of a bunch of medical people extracting a baby out of me and me being nothing more than the vessel it needed to come out of that frightened me so much about having a caesarean.
We went in on Christmas Eve day for the ECV – the first of many hours spent hooked up to the CTG machine. And sure enough she wouldn’t budge. I don’t know if my belief that she wouldn’t move influenced it, but she just did not budge one bit.
By then, Kelly had worked her magic and got me the name of a obstetrician at the hospital who delivers breech babies, so when it didn’t work and they again suggested a caesarean, I had a name to ask for – Kobus Dupleissis. They were able to make me an appointment with him for the next week. He became my light at the end of the tunnel. I was already feeling so much calmer about everything because I was being given options. If Kobus had assessed me and my baby and said that we couldn’t have a vaginal birth for reasons related to us I felt I would have been ok with that. It was just the blanket no from the first obstetrician that made no sense to me.
Through all this the feeling that I could have a vaginal birth without problems never left me – I just couldn’t believe my body wouldn’t be able to do it. Nothing felt wrong, I never felt uneasy, I was never frightened at the prospect of her coming out bum first, even despite people around me projecting their anxieties on to me (yet they all seemed to know someone who had delivered a breech baby naturally, although most were before older generations).
Finally we had our appointment with Kobus. He had no problem with allowing me to try for a vaginal birth as I fit all the criteria (smallish baby, frank presentation), the only area to be discussed was whether or not I should wait to go into labour naturally and run the risk of not having a obstetrician on duty who was skilled in delivery breech baby. In the end I decided to be induced so that I could ensure I had a chance.
This meant going in a week before her due date (of course Kobus was going on holidays the following week!) and being induced. I had acupuncture and an induction massage to try and get things started, as well as an attempt at a stretch and sweep, though I was nowhere near ready for that to be of any benefit. Unsurprisingly I spent the whole day being hooked up to the Syntocinon drip to no effect. By the end of the day I was sure I was going to be told ‘We had a try, time to go in for a caesarean’. But Kobus walked in at 5, had a look and said ‘have a rest, we’ll try again tomorrow’. What a relief!
The next day I started it all again, but thankfully it all kicked into gear pretty quickly and by midday I was in established labour. My memory of the actual labour and birth is quite calm compared to the stress of the preceding weeks. It was hard work, and annoying to be hooked up to monitors (thankfully Kelly had made sure I had access to wireless ones, otherwise I would have been tethered to the bedside, which would have driven me mad). But for the most part I just felt an overwhelming need to push through and finish it. I never wanted to ‘stop’ the pain, I just wanted it to be over. Once I reached transition, Faris arrived, along with the paediatrician, an extra midwife and a few students who had asked if they could observe. I was happy enough to have people watching as I knew that observing a breech birth was the first step in changing the mentality of medical practioners.
One of the reasons people are reticent about vaginal breech births is that they can require some manipulation as they come out. As such I was on the bed with my legs in stirrups to allow for Faris to assist. I pushed out the bottom, which is roughly the size of a head, though a lot more alien looking! We didn’t know the sex, so when the bottom was out, Faris asked if we wanted to know the sex – it was rather apparent at that point that she was a girl!
Once the bottom was out, Faris released the feet, which were still up by her head inside the birth canal. Then he left her bottom and legs to ‘flop’ down – the weight of the dangling legs helps the body come out to the shoulders with another push. Then he helped release first one shoulder and then another with each subsequent push, leaving the whole body hanging out – they make rather interesting photos! Finally the head needed to come out. From memory I gave maybe two pushes, and she was still inside, so at that point Faris decided forceps were needed, and he helped get her head out.
Finally, here she was, our stubborn little bum first baby! The cord was cut immediately as she needed to be taken for air. All was good though and within a few minutes she was back with me, already hunting for the breast! (She continued to be a keen breast feeder until we weaned her at 20 months!)
I felt fantastic at this point – absolutely elated! The Syntocinon was put back up to max levels to get my placenta out, which was actually more painful than the birth – I was certainly over it by then and not happy to be having more painful contractions!
Over the next hour my husband and I enjoyed snuggles with our little Clementine and I had a shower (one fun fact about pushing a baby out bum first is that is pushes out all the meconium – not particularly pleasant, although at least we never had to change a meconium filled nappy!). I started to feel a bit faint at this point, and I was bleeding a bit more than expected. Over the next 5 or so hours, this faint feeling increased, and the bleeding continued. No one was sure what the problem was, as my placenta had been whole, I hadn’t had any tears, though there was a tiny nick on my vaginal wall from the forceps. After many very painful vaginal examinations, it was finally determined that the nick on my vaginal wall was the cause of the bleeding, and I was sent to surgery at about midnight to repair it. By this stage I was in a lot of pain and feeling very, very faint, so I was thankful for the general anaesthetic. It certainly put a dampner on what had otherwise been a pretty fantastic birth experience. Poor Aaron was left with the baby, feeling rather clueless! Thankfully, Jan had suggested expressing colostrum in the days leading up to the induction, so we had a fair bit on hand, which allowed him to feed her. Even before I went into surgery I had gotten to the point where I didn’t have the energy to feed her, so I am very thankful for that extra bit of advice – another way the MAMA midwives work their magic!
We left as soon as possible the next day, and I recovered at home with Kelly or another midwife visiting every day. This is by far one of the most beneficial services MAMA offer. To know that I had a friendly face popping in each day to just check in, check how I was recovering, offer advice when I wasn’t sure what to do, or just a comforting voice when it all got a bit overwhelming (I’m looking at you day 5 blues in the middle of a heatwave!!), was just indispensable.
So that’s my story! In the months that followed I felt like superwoman, I was just so proud of my body for achieving what it did, and my stubborn mind for sticking to my guns! I’m pleased to hear that there is now a Breech Clinic at the Royal Women’s hospital now, so that if someone like me turns up with a breech bub at 36 weeks, they will be transferred to a team of carers who will give them a range of options to choose from. Hooray!
