A Natural Breech Birth
From: NEW BEGINNINGS, Vol. 18, No. 2, March-April 2001 pp. 47-49
It's been about a year now since I gave birth to my second son. I am still elated each time I think about what a rewarding experience I had!
My first son was in the breech position (head up, feet down) at the end of my pregnancy. Believing we had no other options, we scheduled a cesarean birth at around 39 weeks. Three years later, we were blessed with another pregnancy and began to plan for a vaginal birth. As the end of my pregnancy approached, we discovered that this baby was also in a breech position. This time, however, I was much more knowledgeable as I had done extensive reading on birthing, mothering, and breastfeeding in the past three years.
I had chosen to use a midwife during this pregnancy and hoped to deliver in her birthing center. Knowing my history of having a baby end up in the breech position, my midwife started monitoring my baby's position at 28 weeks, when he seemed to be in a transverse, or sideways, position. During the operation for my first birth, my doctor had commented that my uterus is heart-shaped. This tends to make the baby more comfortable sideways or, when he gets bigger, with his head up, because there is more room at the top of the uterus for his head. At 32 weeks into my second pregnancy, an ultrasound confirmed that this baby's head was up. I made the commitment to do whatever was in my power to turn my baby so I could have a vaginal birth after cesarean (VBAC). I made an appointment with an acupuncturist and started doing moxibustion, a technique to stimulate the babys movement. My plan with my midwife was to try everything to get my baby to turn head down (vertex), but if that didn't work, we could use one of her backup doctors, who specializes in delivering breech babies.
By 33 weeks, I was practicing almost a dozen recommended methods to try to turn my baby. At one point, we thought my midwife had turned our baby head-down so I stopped everything. Unfortunately, we soon learned that the baby either hadn't turned or had turned back a few days afterward. My pregnancy was further complicated when I started bleeding early one morning at about 33 weeks and had to go the hospital to be checked. Everything turned out fine and the bleeding stopped after about three hours.
At around 35 weeks, my midwife told me that because of the bleeding, my previous cesarean, and the likely breech presentation, she definitely
wanted me to have the baby in the hospital and to start seeing her backup doctor. This was hard for me because it meant that I wouldn't be delivering in her birthing center. Since I was entering the hospital scene, with all my risk factors, I felt the chances were fair that I would end up having another cesarean birth. Soon afterward, I scheduled an appointment with the doctor she recommended. We had planned to try an external version during this appointment, a procedure in which a qualified physician attempts to manipulate the baby manually to turn him head-down. However, an ultrasound exam showed that the baby was already head-down! My husband and I made our plans with this doctor, and he agreed to do a vaginal delivery either way, vertex or breech.
When I went back alone to my next visit with this doctor, my baby had moved back into a breech position. The doctor said he wanted to do an external version in one week and then immediately induce labor. I felt strongly that I did not want to be induced. I was concerned that this would be the first step down the road to multiple interventions and, eventually, a cesarean birth. I told him my feelings and asked him to do a vaginal breech delivery at fullterm, as he had agreed to at the previous appointment. He seemed more hesitant to commit this time, and it concerned me.
At my next appointment, around 38 weeks, ultrasound confirmed that my baby was still breech. However, when the doctor examined further with ultrasound, he could find only a few pockets of amniotic fluid around the baby. He immediately told me it was dangerous for me to continue my pregnancy and that he would recommend that I go to the hospital immediately and have a cesarean! I was in shock! When I resisted, he recommended either the cesarean or an attempt at an external version and a possible vaginal delivery. I asked for a few days to drink plenty of fluids, eat well, and rest, and then to come back to have my fluid checked again. He said he didn't think that would make any difference. I told him I needed to go home, think about it, and talk to my husband. The doctor wanted to monitor my baby to be sure he was okay before I left, which I consented to. After an hour of monitoring, he was convinced that the baby was fine, and I was able to leave.
I immediately started calling, looking, and reading to determine my next move, which seemed to be to investigate the only other doctor in my area who I had heard delivers breech babies vaginally. I spoke with another midwife and found out that he was her backup doctor. She highly recommended him, as she knew of a breech baby he had recently delivered. My first appointment went well. I showed him my birth plan, and he agreed to everything I asked for, as long as there were no complications. I was so happy! He was even going to let me go into labor on my own! I felt so pleased with this doctor and his approach. When I asked him about trying an external version, he said it was too late in my pregnancy to attempt it and we would just go ahead with the breech delivery.
Two days later, just as I went to bed, I started feeling some strange sensations. The contractions continued through the night and the following morning. Walking and eating normally helped me to deal with the intensity of the contractions. Around noon, my husband, son, and I met the midwife at her clinic. I was over six centimeters dilated and my cervix was 100 percent effaced! She asked me where I wanted to go to have the baby - a tricky decision to make at this time. The first doctor, with whom I had had an awful experience, was 20 minutes away, while the new doctor I had just seen for the first time two days ago, with whom I felt very comfortable, was 45 minutes away. I stuck with my feelings and chose the latter.
We arrived at the hospital around 1:15 PM and got settled into a small room. The nurse put an external fetal monitor on the baby for a few minutes, I called a close friend who wanted to attend my birth, and then the doctor showed up. My cervix was over seven centimeters dilated, and my water bag was still intact. I walked around and got into the bathtub which worked out great! The hot water in the tub intensified my contractions. Luckily, my friend had arrived while I was in the tub and was there to assist me during these difficult contractions. The baby was coming! The doctor suggested I push when I felt like it. A few contractions later, I did feel like pushing. That's when my water broke and out popped a foot! Under any other circumstances, this would have been a flag for an emergency cesarean delivery. Since I was fully dilated, the doctor was ready to deliver vaginally. I was moved into the delivery room and with the doctor's guidance and the help of my midwife, husband, and close friend, I pushed for about three contractions and out came my baby boy! It was a miracle!
Sawyer was born at 3:29 PM and weighed 7 lb 3 oz. Right after he was born, they checked him quickly and immediately put him on my chest, under my gown. The doctor sewed up my episiotomy, and I kept my baby with me for the next couple of hours, then through the night until we left the hospital the next morning. It was terrific! We got off to a beautiful start by breastfeeding, and we were a happy couple, both of us feeling great.
I am so glad that I stuck with my goal and wouldn't let go. Even my husband was unsure at times. For me, the obstacle to a breech VBAC was not the delivery, but finding a doctor who was knowledgeable about and experienced with breech births. My hope is that other women who are facing a VBAC and/or a breech delivery will read, investigate, and consider their options, because they do have options!