“I spent the next 30 hours desperately trying to find an independent midwife with breech experience, and preferably Mary’s recommendation, who could take me on at short notice. Eventually, and having spoken to many wonderfully helpful – but unavailable – IMs, we found Lynn. Little did we realise how short this notice really was – following a few contractions which woke me up during the night, I was in established labour within about 9 hours of confirming our midwife. I was in denial for a while, I couldn’t believe it was such a close call, but eventually had to admit that the contractions had been regular for a couple of hours and we needed to phone Lynn and bring our meeting time forward to NOW!”
“He’s found his voice more now but is still usually a delightfully contented, but expressive, baby and I can’t help but attribute this to the calm and relaxed manner in which he entered the world.”
A story of many breeches, from the midwife’s own birth as a footling breech baby in WWII, to others she has attended during her career…
“The best part of the story is the old doctor’s instructions for when to call, i.e., how to tell when the time was right. His first instruction was to do nothing! and see if labor goes away. Then eat bread and butter (still my favorite food) and drink beer, and then do nothing! He instructed my mother that when the labor got so intense that she thought she couldn’t take it anymore, she should go for a walk in the garden or the hallways of the cloister with one of the nuns. He told her to do some slight breathing during contractions and lean on the wall, the fence or a nun. After that she should again do nothing!
He further advised that if she thought she couldn’t do anything anymore she should lie down on her left side with two pillows between her legs and do nothing! At this point he said she should tell the nuns to feed the donkey. When the donkey was full, they should hitch the wagon to the donkey and go get the doctor. He told her when he got to the cloister he would eat some food, have some beer and check in with her and that he would still have lots of time to prepare for the birth.”
“Today my beautiful baby boy is 5 weeks old! I can’t believe it’s going so quickly, he has grown so much already. Motherhood has so far been how I expected and totally not what I expected at the same time; but I’ll save that for another blog! ”
“A few pushes later and the bottom was out, a couple more then the legs and torso. I was nearly there, ready to meet our baby, I was still using the gas and air and had Paul holding my hand encouraging me the whole time. The contractions subsided a little with the head still not delivered so I had to have a small episiotomy. The baby was here. But no crying, Paul went to the midwives to check all was ok…Then there was the cry.”
The Birth of Piper Joy
Throughout my pregnancy, I was having 4-weekly growth scans due to a low PAPP-A detected in my 12 week bloods. All of these scans were followed by a consultant appointment. Up until the scan on 11th August, these scans had all been fine, but had always found my baby in the breech position. I had always planned to have a vaginal breech birth if Baby was still breech at term.
Monday 11th August 2014 – 40+1
I had a routine growth scan booked for 13:30, which confirmed my baby was still breech and also that growth was now stalling. Because of this, my consultant didn’t want me to go much further over term, as it could pose a risk to my baby. With the added complication that Baby was breech, she told me an induction was out of the question. Here was the plan – have a membrane sweep now, and if that didn’t work, have a scheduled Caesarian section on Wednesday 13th August… my 29th birthday! I agreed.
So, she checked my cervix and did a sweep, which wasn’t as uncomfortable as I’d anticipated; she told me I was 2cm dilated, and that my cervix was very favourable. At my last midwife appointment, my midwife had said the consultant would probably offer a sweep, and ever since she’d said that, I’d been a bit anxious about it.
Anyway, my consultant phoned around, and got me on the surgery list for Wednesday. She said I’d have to be pre-assessed now, so my husband and I made our way to the labour ward, where they’d pre-assess me for my scheduled C-section.
After the midwife on the ward had pre-assessed me, I used the loo and noticed a small amount of blood from the sweep. I then experienced some period-like cramps, which are common after a sweep.
We had to make our way to the pharmacy to pick up my pre-meds, and all the while we were there, I was getting these cramping pains with Braxton Hicks contractions. I was taking them with a pinch of salt, because I knew after a sweep, they were quite common and often a sign of false labour. I was convinced they’d go away as the day progressed.
By the time we left the hospital, it was 4pm – 1.5 hours after my sweep. I was still experiencing the pains, which were coming every 4 or 5 minutes, and lasting only about 10 seconds each time. I was able to talk through them, and if I changed position during one, the pain went away. These facts all indicated to me that this was false labour, so when my husband suggested we call the labour ward to see what their advice would be, I told him they’d only tell me to take paracetamol and have a bath, but I agreed to call them anyway.
When we got home, I phoned the labour ward at our preferred hospital and told them what was going on, and that I thought it was false labour. They told me to take some paracetamol and have a warm bath to see if the pains went away. While I did that, my husband sorted out my son with his dinner etc, and my mum left, under the impression that we didn’t need her to have our son should we leave for the hospital.
I took my Kindle into the bath and had a soak. The pains did go off while in the bath, so I got out hoping real labour would still happen before my scheduled C-section date. I noticed that I had lost a small amount of plug in the bath, so I put a pad on as well as my PJs, ready to settle down and relax for the evening.
The pains started up again almost as soon as I was out of the bath and dressed. This time, I decided to use my contraction timer app to see if they were regular, and to establish exactly how long the pains were lasting.
We put our son to bed and I showed my husband the timer app. Pains were now regularly coming 3-4 minutes apart, and lasting 30 seconds each time. He told me to ring the labour ward to let them know.
I phoned the ward, and explained everything – the breech situation, my history of a short labour with my son, and that I’d had a sweep earlier. The assistant on the other end of the phone told me she’d ask the advice of a senior midwife, then came back to me and told me to make my way in.
By this time, it was 7pm, and our son hadn’t yet settled in bed. My husband phoned his parents to meet us at the hospital to take our son back home and look after him overnight if I was going to be kept in. We spent some time getting the hospital bag topped up with last minute things like chargers and my toothbrush, and got him out of bed.
Here we go!
We piled into the car, and set off on our way at 7:30pm. Contractions continued to be around 30 seconds long, and 3-4 minutes apart. They were getting stronger, but were still very bearable.
At about 8pm, we met my in-laws just outside the hospital, and dropped our son with them. I was still unconvinced that the ward would keep me over night, but at least our son was being taken care of if we needed to stay. My mum had just got home, and I phoned to tell her what was going on.
We parked in the hospital car park, and remarked that, this time, things hadn’t been such a rush as they had been with our first. We got to the labour ward, and were shown to our room. I was admitted onto the labour ward at 8:15pm, and put on the CTG monitor to monitor Baby. Everyone knew our baby was breech, and the midwife told us she had volunteered to look after me, after hearing I wanted a vaginal breech birth.
The registrar came into the room and introduced himself. He then asked a fair few questions (“Your first labour was how long?!” – 4 hours from show to birth!), and went through the risks of a vaginal breech birth, and cited the only available piece of research out there at the moment. However, the first thing he was sure to specify was that he is an advocate of vaginal breech birth. That put me at ease straight away. He explained that he suspected I was in early labour, and that the birth would be very controlled and monitored, and that, when it came to the second stage of labour, they would transfer me to theatre to push, just in case they had any need to delivery by emergency Caesarian section. At least we would all be in the right place should things go awry at this point. I agreed – that seemed sensible enough.
He did a vaginal examination, and told me I was 3cm dilated. He had a good rummage to confirm that Baby’s feet would not be the presenting part, and told me he’d be back to check me in a couple of hours to see how we were progressing. The midwife told me to have a walk around, and that she’d go and get a ball for me to bounce on. I asked about gas and air, because straight after the registrar had checked me, my pains had become stronger. She said that I couldn’t have the gas and air just yet, because I wasn’t in established labour. “Okay, no probs.” I remember saying. We would see how I was after our little walk.
So off my husband and I went. He planned to get my hospital bag from the car, so we walked to the main entrance of the hospital, all the while having strong contractions every 2 minutes now. We phoned our parents, and I spoke to my mum while my husband went to the car. She told me she had just started watching ‘Long Lost Family’ on TV, which was making her cry. Going by that information, it was now just after 9pm.
My husband got back with my hospital bag, and I told him I wanted to get back to the ward. My contractions were coming thick and fast, and I was unable to walk or talk through them. The short walk back was interrupted by two or three contractions.
When we got back to our room, I felt I had to be forward, on all fours during contractions – just like with my son. I told my husband to call the midwife to let her know I needed gas and air now. She came in and saw I was in established labour, and faffed around trying to get the G&A to work. She had to call another midwife in to help her connect to the wall, but as soon as it was in my hand, I went into my own world with it.
I was in the zone now, and was aware I had transitioned; from now on, my body ruled my mind. I let go, and felt the urge to push, so I did, telling the room (my husband and the midwife) that I was now pushing. I don’t recall anyone telling me not to (not that I’d be able to stop it anyway!).
In the zone
Pop! Gush! My waters broke all into my pyjama bottoms and down my legs. From this point on, it is all a blur. My husband tells me this is when lots of midwives started pouring into the room. The registrar also joined us and wanted us in theatre. The senior midwife told him that there would be no time to get us into theatre now; she was cannulating my left hand, and I was now lying on my back on the bed. It had only been half an hour, at most, since the registrar had checked me and had confirmed I was 3cm dilated.
He told me I needed to be in ‘lithotomy’ position – legs up in supports, and I obliged. The bottom of the bed was removed, ready for my baby to be delivered. During the next contraction, and my involuntary pushing, I heard the midwife tell him that the ‘presenting part’ was visible, and confirmed Baby was breech. I just continued to do what my body was telling me to do, all the while staying intuned to the sounds of my environment. I was able to hear voices directed at me, and obeyed commands when I was told to do things (“Shuffle your bottom to the right.” etc.).
My husband was a constant in my left ear, telling me I was in control. I could feel that he was stroking my head; I can’t remember, however, if we were holding hands. :cloud9: I knew my left hand now had a cannula in it, and the gas and air was in my right hand. I could hear midwives telling me I was doing really well, and that I was amazing… always nice to hear!
I continued to push with every contraction (3 or 4 to get Baby down and body out), and heard the registrar giving specific delivery directions to the midwife, who was actually delivering my baby. When I had pushed my baby’s body out, I heard the registrar say that Baby’s body was born at 21:45. The midwife asked him if she needed to rest Baby’s legs on either side of her arm. He said yes, then spoke to me.
I opened my eyes and looked at him: “Rebekah, everything is out but Baby’s head. With your next contraction…”
I interrupted him, “Big pushes, yeah?”
“Don’t push until we tell you to.”
We were waiting for the last contraction. I was having a bit of a breather, because it was taking a bit longer than between the other contractions, but was back in my zone again. My husband tells me the senior midwife stimulated my bump, which brought on the contraction. I started puffing on the gas and air and heard the registrar talk to the midwife about Baby turning on its own. I didn’t really understand, but was waiting for my body to tell me to push, as well as the registrar. When I got the urge, I heard no-one tell me not to push, so I pushed for a longer time than usual, and felt I was also consciously pushing to help things along.
Piper Joy is born!
Then, there was relief. The pressure had gone, and my baby was born! She was placed on my chest, but hadn’t started breathing yet, so she was taken to have a bit of oxygen. As she was being taken away, my husband said to me, “I think we’ve got a girl!” and the midwife confirmed this, saying, “I didn’t want to say, but it is a girl.” Of course – they had known since the presenting part had been born!
Our little girl was brought back to us, and I requested skin-to-skin contact. I took my crop top off, and put her on my chest. My husband and I then confirmed to each other that her name was Piper Joy. She started routing and being interested in feeding, so we gave it a go. She latched like a pro, and stayed there for a good while.
After feeding, and being left for a while for cuddles with her daddy, Piper was weighed – 6lbs 7.5ozs, 6ozs heavier than her big brother at his birth.
After all the checks, we were discharged home the next day, at 12:30pm, only 15 hours after Piper was born.
The End… The Beginning!
I am still in shock that we have a girl. It’s what we secretly wanted – one of each, and it is still such a novelty to say ‘she’, and change girly nappies. A few pink clothes have filtered in, but she’s only been in unisex outfits so far.
By Maggie Banks, Birthspirit Midwifery Journal 2009; 3:15-19
“The use of deep water immersion with mal-presentation (read: breech) is contraindicated in hospital clinical guidelines on waterbirth, and the use of water is absent as a modality in vaginal breech birth guidelines. Embracing these, giving birth in water to a breech baby would be out of the question for some maternity providers. Yet others are very specific in seeing breech presentation as a positive indication for waterbirth because of the buoyancy afforded to the baby and umbilical cord, both of which are kept warm in the water until surfacing into the cooler air Ponette”
An unexpected footling breech birth with transfer to hospital.
“Her words are ingrained on my memory, as is the sound of controlled panic / urgency in her voice. She said, “Oh God; it’s a foot, it’s breech, dial 999 NOW, get an ambulance, it’s a footling breech. Tell them it’s urgent”.”
“Four days after the birth I met with the midwife for a debrief. It was a useful conversation and happened at the right time in my recovery. Prior to that I was just grateful all was well, and wouldn’t have asked the right questions. By day four, though, relief had given way to anger. I was angry that despite my desire to be in control and have a natural delivery, and my best efforts to secure that by aiming for a homebirth, it had transpired to be a labour characterised by panic and lack of control and I felt the midwife could help me understand why. The crux of it was why hadn’t I been given the chance to continue labouring at home, with the medical team and ambulance waiting outside to intervene if need be. Why hadn’t my body been allowed to do its job?”
“Just one other thought … all the midwives in the hospital were very positive about the birth and congratulated me on the natural delivery and telling me I had done well. In contrast, the two doctors I spoke to took a much more negative point of view and focused on the fact that an ambulance delivery was ‘less than ideal’.”
A planned breech home birth surrounded by mothers!
“Her fluid was perfect, her placenta was posterior, her cord was adequate, and she merely arrived bottom first in 4 of the most intense pushes that I have ever experienced. With vertex babies (my previous 4 were posterior vertex), the “work” is basically over once the head and shoulders emerge. The rest of the baby sort of slithers out quickly. Not so with breech babies. I had to work for every inch of my baby daughter’s arrival. The first pushes of her birth exposed her bottom. (She pooped….not unusual for breech babies when their bottoms are exposed to the cool air). The next brought forth her legs because her hips were flexed and her legs were folded Indian style against her body. I roared with the push that brought her shoulders, and lastly, one enormous push later her head was born and I couldn’t believe that Evelyn was saying, “Carla, take your baby!” in a shocked voice.
Evelyn never needed the special techniques to encourage her arrival. She never needed to help guide her legs down, help free the cord, or reach up to guide her head down by the chin. My daughter and I had done it together, and all my midwife had to do was wait and catch. She later remarked that what was poised to be the most challenging birth of her month ended up being the fastest and easiest.”
A calm undiagnosed footling breech birth at home
“Everything seemed to be going well, and at two weeks out the baby dropped. I have to admit, right before the baby dropped, I thought there was a chance she had changed positions, but being it was a first for me I didn’t speak up and let Annette know. A word for the wise…
always trust your instincts!!!”
“I couldn’t have been more grateful with how smoothly things went considering the circumstances. I am so thankful Annette knew exactly how to handle things. Looking back I would not change a thing. If I would have known Emsley was breech, I would have been tempted to go the medical route and more than likely I would have ended up with a C-section. I am now even more confident about having a home birth as I head into it for a second time.”
An unplanned unassisted footling breech birth at home!
“What was most interesting to me was that my contractions never got closer together than 3 minutes. This was part of the reason we held off calling the midwife because both Artene and I thought we still had quite a bit of time left to go.”
“On the next contraction, Joseph’s first foot popped out and I was completely shocked. I didn’t even feel him coming down the birth canal since, you know, feet are so much smaller and more slender than a gigantic HEAD, so the foot was a total shock to me.”
“I could NOT believe what had just happened. We had planned a home birth and everything was perfect. Then, in less than 12 hours, we found out he was breech, I went into labor, and we birthed a breech baby at home without our midwife there (which is known in the birthing world as an “unassisted” birth).”