The constant ringing of my in-laws doorbell that evening will forever be etched my mind. The sound announced little trick-or-treaters all dressed up, eagerly anticipating some special treat dropped into their bag. My own anticipation grew with each ring, but for different reasons. For several hours I had been having regular strong contractions that were increasing my hope that my long awaited first baby may be on the way….
Four weeks before, I was sitting in my Dr.’s office for a regular prenatal appointment. After a normal and healthy pregnancy I was getting excited to meet my baby soon. For my entire pregnancy I had been travelling 3 hours to the closest city for my prenatal care and was now staying with my husband's parents until baby made his or her arrival. This appointment felt like any other and I will admit it didn’t really register when my Dr. informed me that day that my baby was currently in a breech position. No big deal, I thought. Baby moves around all the time and will get into the right position I’m sure. By the next visit, however, my OB reaffirmed that the baby was still breech and we needed to start making other plans for delivery - meaning scheduling a C-section. At this point I woke up to the fact that things were not at all how I had planned and I began to question and… bargain. Young and inexperienced (maybe a good thing?) I insisted that I didn’t want a Caesarean and pressed for other options. My OB, a warm and grandfatherly type, let me know that generally, breech babies were best delivered surgically, but after begging him to “let me try” (?? whatever that meant to me?) he scheduled an ultrasound and said he would consider it. The ultrasound confirmed that baby was in the “Frank breech” position (bum down and legs up against the chest) and my Dr. agreed to let me attempt a vaginal breech delivery.
As my due date approached, he let me know that to go ahead as planned, I would need to go into labour on my own as the hospital frowned on what I was attempting and to add induction would be “too many complicating factors” for their protocol. I’m not sure how, but after some more begging I had somehow won his heart and he agreed to wait. I was scheduled for an NST (non-stress test) Wednesday the following week - 3 days post EDD. The NST revealed regular contractions and they sent me home to wait, but the following morning when the contractions had not produced a baby, my Dr. called and said if I did not go into labour that day, he would see me at the hospital Friday morning to begin an induction.
Here we go
Sometime around 4PM that day, I had a contraction that I felt in my gut was the beginning of labour. Those contractions continued at 10 minute intervals the rest of the evening and as the little trick-or-treaters arrived at the door, my excitement over the reality that my baby was coming increased. By 10PM the contractions were still manageable and my husband had arrived from home so I decided to get some rest if possible. I actually slept off and on most of the night though the contractions continued. We arrived at the hospital around 9AM for my scheduled induction but when they discovered that I’d been having contractions for 17 hours, they decided to wait on any medications to see what would happen. The most challenging thing at that point was the NPO order (nothing to eat or drink) as they clearly believed I would be having a C-section at some point (after I had “tried” for awhile) and my stomach would need to be empty as is regular surgery protocol. They hooked me up to an IV for fluids and I began the process of waiting out a hospital delivery.
My husband and I walked and walked, alternating with regular fetal monitoring. By 4PM (after 24 hours of regular contractions and hours of walking with nothing to eat or drink) I was beginning to feel very weary. I was also making little progress. As we made another round of the hallways hauling the IV stand, I suddenly had a contraction that made it difficult to stand, breathe, or move. I knew my labour had shifted into a new intensity and I soon found myself back in bed with pain that was previously outside of my thought realm. Crazy pain. Pain that blurred my thinking and shocked me at it’s intensity. I had no idea it would feel like THIS.
I will digress at this point to a previous office visit with my OB. As fairly private and concerned about my personal vulnerability, my husband and I were asking my Dr. about who would be in the room during the birth. I made it clear that I wanted NO ONE there except dad, Dr. and maybe one nurse. That was it. My modesty and self protection was at stake, and I was not up for any other non-essential spectators at my birth. No way. I remember his response so clearly. With a gentle smile (and somewhat knowing, almost amused twinkle in his eye) he assured me (without telling me who EXACTLY would be there) that only the people who NEEDED to be there would be there. I felt reassured, thinking that meant just the four of us. Naive.
After about 3 hours of this ridiculous pain, I remember one trip to the bathroom where my husband actually had to physically help me there. As I sat on the toilet, door open with him holding me up, I remember hearing a strange voice call my name. Without any hesitation I told the man to come on in. A new Dr. introduced himself as my OB’s partner, filling in for the next hour or so while my Dr. was on a supper break, and checking in on me to see how I was doing. I chatted with him as I was able, telling him my story thus far, and somewhere in that conversation, with the three of us all cozy in the bathroom, me sitting on the toilet, hubby holding me, Dr. standing there…. I suddenly realized I had lost all sense of dignity!! I was in so much pain I didn’t even care who was there. A new reality. I laugh now and remember my Dr.’s wise and gentle answer to my concern for privacy. He knew I would get to this point.
Give me drugs. Now.
Somewhere in the hour that followed, I lost my ability to cope with the pain and gave in to the continual offers for pain medication. My plans for an unmedicated birth fell by the wayside as I grasped for relief. My resolve probably collapsed after the internal check that revealed I was only 5-6 cm (when I had been in labour for so long and was SURE I must be almost at the finish line..) No one told me that the first 6 cm were the longest and hardest, and that the rest could go quicker. I thought I was in for another 12 hours of this to get fully dilated. They gave me one shot of Demerol and it made me incredibly groggy. I could hardly stay awake between contractions and was woken up by the pain when I was already too far into the contraction to get on top of it with my breathing. It barely touched the pain but completely destroyed my own sense of control and being able to manage. It would be the only pain medication I ever accepted for eight pregnancies.
Finally giving up
I think the nurse said I was around 7 cm when I finally gave in. It was about 9:45PM and I was done. I’d had enough. The pain was too much. I wasn’t progressing. Hadn’t eaten or had anything to drink since 8AM. I was exhausted and couldn’t carry on. The nurse called my OB and he came into my room at 10PM. We talked for a few minutes (I mostly cried) and he said he would advise a C-section as I wasn’t progressing and he could see I was out of strength. I said yes, it was time. I almost screamed when I heard him say he would book the OR - for 11PM!!!! WHAAATTT??! I had waited until I couldn't handle it any more so I meant PUT ME OUT NOW!! I didn’t want to experience even ONE MORE CONTRACTION!! I was devastated and began to cry more. A nurse came in to start prepping me for surgery which at that point still meant shaving the incision site. That was done by 10:08 and she left the room for supplies to start a catheter.
Wait, what’s happening?
A minute after she left, I had another contraction and felt my water break. I told my husband to call the nurse and she came in response to our call, ready to insert a catheter for the surgery. I had an intense sensation of needing to have a bowel movement and moaned that I needed to get to the bathroom. She checked me and immediately told me I didn’t and started rushing around, calling for another nurse and yelling for my OB. Everything was a blur as my pain, Demerol fog, and inexperience left me lost as to what was happening around me. I remember being annoyed at this nurse who wasn’t taking my bathroom need seriously (If I say I need to go, how can she tell me I don’t?? Fine, I thought. I’m going to go right here…) There was sudden tension and arguing between the nurses and my OB as the nurse prepared the room to deliver right there and the Dr said no, get everything to the delivery room… My husband and I were lost in the confusion and didn’t realize until a few minutes later that the baby was already presenting!!
We were quickly transported, and in a delivery room full of specialists and nurses, including a paediatric team (I hadn’t fully understood all the risks to the baby of being delivered breech..) our son made his entrance into the world at 10:27PM, bum first, minutes after my water breaking and with only 3 pushes.
The baby was immediately taken by the paediatric team and required some oxygen, but was healthy and beautiful. His head was perfectly shaped as is often the case with breech babies as their head hasn’t experienced any of the pressure normally placed on the skull during the birthing process. I was overwhelmed, exhausted, and grateful to be finished. He was taken to observation and while my husband called our parents (who still thought I was in the middle of a C-section) a lovely nurse brought me hot blankets, some toast and tea. It was the most amazing meal I could remember as I was completely famished! Toast never tasted so good.
That was November 1, 1990 - twenty seven years ago, and yet I remember it like it was yesterday. The baby I had dreamed of my whole life had finally arrived and with him came the new identity - mother. He chose to come into the world in his own way (which would be a sign of things to come!) and turned my world upside down with love!! <3<3
Take aways from my breech birth:
- I was incredibly blessed to have a Dr. trained and skilled in breech delivery who was willing to listen to a naive new mother who begged “Let me try.” Sadly, fewer and fewer doctors are trained in this skill as Caesarean delivery has become the norm. As a doula I had a client several months ago with a breech presentation so I did my research in an attempt to find options for her. Besides all the options for encouraging baby to turn, I was disappointed to find only two doctors in the entire nearest city who will attempt vaginal breech deliveries. They both also attempt ECV’s (external cephalic version) prior to labour, not an option I was given 27 years ago.
- I was informed prior to my breech attempt that I would definitely have an episiotomy. Though not my desire, it was the trade off to reduce the risks as there is no way of knowing how large the baby’s head is and once the rest of the body is already delivered, it’s not a time to have baby get stuck. Despite the speed at which things happened after my water broke, the episiotomy still happened to ensure my baby’s safety. The healing was long and painful.
- Breech deliveries can be long. The whole process took 29.5 hours, (only the last six were really intense labour) though we’ll never know if that would have been the same had he been head down and was just a typical first delivery. Many normal labours go longer than that and it was probably pretty average but my Dr. did forewarn me that breech labours can take longer simply because bums (being soft) don’t always dilate the cervix with as much pressure as heads (which are harder.)
- Though the delivery went very well, upon examination they found his little hips had been dislocated in delivery so he was fitted by a specialist with a “Pavlich harness” which he wore for the first 3 month of his life. It kept his legs in a frog-like position so his hip sockets would repair and grow deep. At 3 months the Dr. took it off and said “You can forget this ever happened.” And we did.
- Vaginal breech delivery is possible and is a good option if the conditions are right. Baby must be in the “right” breech position (my son was Frank breech - legs straight up) While the obstetric community has gone back and forth on their recommended protocols concerning breech deliveries over the past few decades, recent studies are pointing to the safety and lower risk factors of delivering breech babies vaginally. See this article
- I'm SO glad I didn't immediately opt for the C-section before pushing to try for a vaginal breech. VBAC's (vaginal breech after Caesarean) were not common at the time and according to my OB, the prevailing thought was "Once a C-section, always a C-section." I had no idea at the time how many children I would later want to have. Years later during a regular prenatal appointment with my sixth baby (I had the same OB for my first 6 pregnancies after which he retired) I recall listening to him discuss my history with an intern he was training. He told her what a good choice he made by delivering the firstborn breech vaginally or I would never have been able to have "all these babies"... I wanted to laugh and gently remind him who it actually was that pressed for that decision!!
Are you or someone you know facing a malpositioned baby? Reach out and let me help you with suggestions, support and encouragement for your best possible birth!!
Do you have a breech story? I’d love to hear it so please share in the comments!!