Ethan's Birth Story
Everything at the start seemed to come easily. I fell pregnant on our second month trying, didn't get morning sickness to any great degree, our NT scan showed no issues, i was accepted into WA's homebirth programme even with my newly diagnosed hypothyroidism, first felt our bub move around 15 weeks, and the morphology scan showed a perfectly sized baby for my body - our little boy.
I took advantage of the courses the midwifery group runs and booked in for the Preparation for Childbirth series of classes, the Breastfeeding workshop (covered in Prep for Childbirth but a good refresher), and the Active Birth workshop (again covered in Prep for Childbirth but great to go through again). I also took a hypnobirthing course after attending an introductory session at the midwifery group's head office.
As we progressed further, the strange shape of my belly became apparent and intrigued my midwife, who at 27 weeks started to suspect a bicornuate uterus. No big fuss was made about this and i was assured i could still birth at home. I did a lot of research, found that most people with one could still birth naturally, but often they'd go into labour early - not necessarily pre-term however. My 30 week appointment at the local tertiary hospital showed a head down baby and the consultant said if they're head down at this stage in a bicornuate, that's usually where they stay. My research agreed with this, but i was still worried about position and tried Spinning Babies to get him from his right lying position into a more favourable LOA. Nothing seemed to move him.
I took advantage of the courses the midwifery group runs and booked in for the Preparation for Childbirth series of classes, the Breastfeeding workshop (covered in Prep for Childbirth but a good refresher), and the Active Birth workshop (again covered in Prep for Childbirth but great to go through again). I also took a hypnobirthing course after attending an introductory session at the midwifery group's head office.
As we progressed further, the strange shape of my belly became apparent and intrigued my midwife, who at 27 weeks started to suspect a bicornuate uterus. No big fuss was made about this and i was assured i could still birth at home. I did a lot of research, found that most people with one could still birth naturally, but often they'd go into labour early - not necessarily pre-term however. My 30 week appointment at the local tertiary hospital showed a head down baby and the consultant said if they're head down at this stage in a bicornuate, that's usually where they stay. My research agreed with this, but i was still worried about position and tried Spinning Babies to get him from his right lying position into a more favourable LOA. Nothing seemed to move him.
Fast forward to almost 35 weeks and i had my first appointment with my backup midwife. She was also intrigued with the shape of my belly, but pronounced bub engaged after a palpation. She thought he was measuring small, and had forgotten my anti D, so asked if i'd mind going into the hospital to get my injection and their opinion on the measurement. This is where a growth scan showed our little terror had flipped upside down - footling breech. I knew this was not a good position at all - footlings present feet first, not bum, and leave room for a cord prolapse (10-15% risk) when waters break. They couldn't see a septum on the scan, but said often at this stage of pregnancy septums can't be seen, and suggested a scan at 6 weeks postpartum to determine the shape.
I got into high gear at this point, was on the Spinning Babies website every night trying the breech tilt, inversions off the couch and bed, frozen peas on bub's head, warm-hot baths, shining a torch, playing music with headphones in my waistband, pegs on my little toes (acupressure on BL-67), pulsatilla, listening to a Hypnobirthing script (Turn Your Breech Baby), and visualisation, both of baby turning and of me giving birth in the birthing pool in my lounge room. I booked in to a chiropractor who could do the Webster technique and went for five sessions. Bub moved a lot after these various attempts but didn't turn.
Just before 37 weeks i got 3+ protein on a routine urine test (we did the test twice), with a higher blood pressure than usual (although still normal) and my midwife asked me to go to the hospital again so they could check bloods. The urine test at the hospital came back with only a trace and they asked me to wait for bloods but said all looked good. I mentioned i was interested in an ECV and they called in the consultant to speak to me, the same one i'd had at 30 weeks. She explained the procedure and the risks, and i agreed to go ahead with it and booked in for 37+2. She said not to worry about waiting for bloods as they were happy with the urine analysis.
So at 37+2 hubby and i headed back to the hospital to try to turn bubby around. We were at the hospital for about 7 hours that day, with about an hour of that actually doing anything. Ultrasound in the morning showed bub still in the same position (but this time not showing his face - anterior). It wasn't till around lunch that we got taken into a room for the CTG to be hooked up to monitor bub, and we were left there for an hour and a half until a workman kindly got a grumpy midwife to look in on us. That seemed to get things moving and we had another midwife come in to administer the drug to relax my uterus. Our consultant came in 15 minutes later and checked his position, then attempted to turn him. He moved 5 or 6 cm and that was it. She held pressure on him, hoping he'd manage to kick round, but no luck. So i was monitored for another half hour until they were happy with his trace, given another shot of anti D in case of bleeding, and went home.
We didn't know what to do now. Home birth was out, and it looked like the only options were to hope he turned, or prepare for a scheduled c section. I posted in a forum where one of the ladies pointed me to the positive caesarean area - i posted another question here (i was worried that breech automatically meant vertical cut and so nasty scar and no VBAC) and was reassured by lots of kind people who told me their stories (all breech transverse (bikini) cuts). I also emailed a friend whose birth had ended with a c section and she told me her story, she hadn't minded her c section at all and gave me some good tips on recovery.
I got into high gear at this point, was on the Spinning Babies website every night trying the breech tilt, inversions off the couch and bed, frozen peas on bub's head, warm-hot baths, shining a torch, playing music with headphones in my waistband, pegs on my little toes (acupressure on BL-67), pulsatilla, listening to a Hypnobirthing script (Turn Your Breech Baby), and visualisation, both of baby turning and of me giving birth in the birthing pool in my lounge room. I booked in to a chiropractor who could do the Webster technique and went for five sessions. Bub moved a lot after these various attempts but didn't turn.
Just before 37 weeks i got 3+ protein on a routine urine test (we did the test twice), with a higher blood pressure than usual (although still normal) and my midwife asked me to go to the hospital again so they could check bloods. The urine test at the hospital came back with only a trace and they asked me to wait for bloods but said all looked good. I mentioned i was interested in an ECV and they called in the consultant to speak to me, the same one i'd had at 30 weeks. She explained the procedure and the risks, and i agreed to go ahead with it and booked in for 37+2. She said not to worry about waiting for bloods as they were happy with the urine analysis.
So at 37+2 hubby and i headed back to the hospital to try to turn bubby around. We were at the hospital for about 7 hours that day, with about an hour of that actually doing anything. Ultrasound in the morning showed bub still in the same position (but this time not showing his face - anterior). It wasn't till around lunch that we got taken into a room for the CTG to be hooked up to monitor bub, and we were left there for an hour and a half until a workman kindly got a grumpy midwife to look in on us. That seemed to get things moving and we had another midwife come in to administer the drug to relax my uterus. Our consultant came in 15 minutes later and checked his position, then attempted to turn him. He moved 5 or 6 cm and that was it. She held pressure on him, hoping he'd manage to kick round, but no luck. So i was monitored for another half hour until they were happy with his trace, given another shot of anti D in case of bleeding, and went home.
We didn't know what to do now. Home birth was out, and it looked like the only options were to hope he turned, or prepare for a scheduled c section. I posted in a forum where one of the ladies pointed me to the positive caesarean area - i posted another question here (i was worried that breech automatically meant vertical cut and so nasty scar and no VBAC) and was reassured by lots of kind people who told me their stories (all breech transverse (bikini) cuts). I also emailed a friend whose birth had ended with a c section and she told me her story, she hadn't minded her c section at all and gave me some good tips on recovery.
We hadn't given up entirely on trying to get him to turn, however. The only thing i hadn't tried was acupuncture, so i rang around and got hold of some moxibustion and an appointment for acupuncture. Moxa made him wiggle, but no turning. Acupuncture did the same. I did three sessions, the last one with acupressure on my ears.
In the middle of this i had an appointment with my midwife where she indicated that it was still a possibility to have a vaginal breech birth with a footling. She explained that although the risk of a cord prolapse was higher, cord compression was lower as there was only a pair of feet there instead of a hard head and the cord was less likely to be compressed. She asked if i'd like to talk with another of the midwives, who'd birthed a frank breech with our consultant. I met with her the next day, she went through the research, risks and studies that had been done with me and was pleased i was well informed on the issues. Frank breeches have about the same risk factor as a head down birth, and the hospital was able to offer a vaginal birth for franks (so long as you fitted other criteria also) but she seemed to think that our consultant would be open to listening to my wishes even though ours wasn't frank.
The next day was my appointment with the consultant, at 38 weeks. I was more than a little nervous, but by this time had read enough to be confident in asking if she'd support me in a trial of labour. So i asked. As everything else apart from his footling position and my being a primip was in my favour, she was happy to consider it. She went through the risks and what she was willing to do; basically as i hadn't given birth before her conditions were that my pelvis was adequate (she suggested CT pelvimetry) and that bub was in a good position (he was lying oblique at the scan that day). She also prefers continuous monitoring, i would have to dilate from 4cm to 10cm in around 6 hours, and she would like to see a presenting part within an hour of pushing - deviations from this could indicate i may run into trouble trying to birth the head as it doesn't have time to mould. My other two options were an elective c section, or go into labour and come in for a c section (advantage being bub gets labour hormones to mature his lungs and i get to labour, increasing my chances of a successful VBAC). She said they try to do the low transverse cut, but rarely they can't get the baby out through this and have to make the vertical incision). I ruled out option 2 and said options 1 and 3 were my preferred. She asked me to come back at 39 weeks with my decision and the results of the pelvimetry if i had it done.
I went home and researched again. I didn't like the idea of the CT scan - one because of the radiation, even though it is a low dose it could put bub at risk of childhood cancers, and two because it doesn't show how far my ligaments could stretch during labour. I decided to go with option 1, to let labour progress and if i didn't fit her criteria for progression during either active labour or pushing, or bub showed signs of distress, then i'd take her professional judgement and opt for option 3.
At 39 weeks i went back and let her know our decision. As i'd decided against the CT pelvimetry she did a clinical assessment instead and said that my pelvis was average size. We discussed when to come in to hospital, and she explained what would happen during my labour (i can labour in any position i like, but they prefer you sitting or lying at the edge of the bed once a presenting part appears). Bub also has to be frank or complete breech for them to be happy with me attempting vaginal birth, she will wait till the day to check him. I can labour at home until contractions are regular at 5 minutes apart, or until my water breaks, and then i'm to come in. All the obstetricians at the hospital are experienced with breech birth, but not all of them support it. I got the impression it was ok to insist upon my trial of labour (within the conditions) if i ended up with a non-supportive one and our consultant was away. If baby had not made an appearance by the time i reached 41 weeks i was to come back and we'd reassess.
At 40+4 i had lost tiny bits of my mucus plug and was starting to think that maybe bub would make an appearance before 41 weeks, and that we wouldn't have to go down the path of an elective c section. By that night i had mild cramping but didn't think much of it, went to bed as normal.
At 40+5, 3:20am, i woke in early labour. There was no ignoring it this time, cramps coming every 5 minutes. Not bad ones, but enough to be felt. After getting up to the toilet, i was hit by a particularly bad one and braced my back against one wall of the toilet and my hands against the other. This was the worst one i had - the following contractions were back at the mild stage. All of a sudden i felt the pad i had on become soaked and sat back down quickly on the toilet - by this stage i realised my water had broken. I checked the toilet and was thankful to see it was a milky white colour with no meconium. I stuffed a towel between my legs and found my phone, called my husband Rob to start the drive up from the country where he works and called the hospital who asked me to come in for monitoring.
The midwife there asked permission to do a VE to check there was no cord prolapse. (This was the first one i had throughout the entire pregnancy - and it didn't hurt a bit). She pronounced me 3cm, stretchy to 4cm, and was quite excited to find toes but she couldn't feel a bum. She went away and a doctor came in to tell me that bub was footling breech still and they strongly recommended an immediate c section. I told them my consultant was happy for me to birth vaginally, and they went back and checked what she'd written in my notes. Came back again, and said that she'd specified not footling. I then asked for an ultrasound to check that he really was footling, not just a slightly extended complete breech. They said it probably was not going to help me, but were happy to oblige.
At this stage i called my midwife in. This was about 5:30am. She arrived at about 6am.
Ultrasound showed bub was in a difficult position. He had his feet presenting on my cervix, but his bum was over in the middle of my left side and his head high in my right, which made him an oblique footling breech - almost transverse. Now, footling breech babies can be delivered naturally and there are many success stories, but with this little man's position and knowing that 10-15% of footlings have a cord prolapse leading to a possibility of suffocation and stillbirth, i decided not to risk his life. Bub's heartrate was good, and i negotiated with the doctors to wait until Rob arrived. This was not as difficult as I thought it may be, I think as i understood the risks and was able show that I knew them, and what I was willing to do to avoid them - I agreed to continual monitoring (which would indicate any cord issues), and also told them that if there was a prolapse they had my permission to whisk me away to the OR immediately.
My midwife arrived at this point and was with me for the insertion of the epidural, which worked to slow down my contractions and was in place in case of an emergency section, that they might be able to use it for pain relief instead of putting me out with a general anaesthetic. The surgeons pushed back the scheduled sections for that morning so that an OR would be available to me in case of emergency.
At 7:40am Rob arrived at the hospital and was taken to pre-op to get into his protective clothing. At this point things started moving very quickly in my room. My anaesthetist finished her shift and wished me luck, i was carefully wheeled through the elevator and taken to pre-op where i saw hubby for the first time, my midwife left my side to get scrubbed in, and i was pushed into the room before the theatre where my new anaesthetist team administered the spinal block. Then i was in the theatre and they were checking to see what i could feel. My midwife came in and let me know she was there so i had a familiar face before hubby was allowed in, and she then took Rob's camera so we could have some photos of the surgery and our boy's arrival. They waited for the paediatric team to arrive then started.
The next day was my appointment with the consultant, at 38 weeks. I was more than a little nervous, but by this time had read enough to be confident in asking if she'd support me in a trial of labour. So i asked. As everything else apart from his footling position and my being a primip was in my favour, she was happy to consider it. She went through the risks and what she was willing to do; basically as i hadn't given birth before her conditions were that my pelvis was adequate (she suggested CT pelvimetry) and that bub was in a good position (he was lying oblique at the scan that day). She also prefers continuous monitoring, i would have to dilate from 4cm to 10cm in around 6 hours, and she would like to see a presenting part within an hour of pushing - deviations from this could indicate i may run into trouble trying to birth the head as it doesn't have time to mould. My other two options were an elective c section, or go into labour and come in for a c section (advantage being bub gets labour hormones to mature his lungs and i get to labour, increasing my chances of a successful VBAC). She said they try to do the low transverse cut, but rarely they can't get the baby out through this and have to make the vertical incision). I ruled out option 2 and said options 1 and 3 were my preferred. She asked me to come back at 39 weeks with my decision and the results of the pelvimetry if i had it done.
I went home and researched again. I didn't like the idea of the CT scan - one because of the radiation, even though it is a low dose it could put bub at risk of childhood cancers, and two because it doesn't show how far my ligaments could stretch during labour. I decided to go with option 1, to let labour progress and if i didn't fit her criteria for progression during either active labour or pushing, or bub showed signs of distress, then i'd take her professional judgement and opt for option 3.
At 39 weeks i went back and let her know our decision. As i'd decided against the CT pelvimetry she did a clinical assessment instead and said that my pelvis was average size. We discussed when to come in to hospital, and she explained what would happen during my labour (i can labour in any position i like, but they prefer you sitting or lying at the edge of the bed once a presenting part appears). Bub also has to be frank or complete breech for them to be happy with me attempting vaginal birth, she will wait till the day to check him. I can labour at home until contractions are regular at 5 minutes apart, or until my water breaks, and then i'm to come in. All the obstetricians at the hospital are experienced with breech birth, but not all of them support it. I got the impression it was ok to insist upon my trial of labour (within the conditions) if i ended up with a non-supportive one and our consultant was away. If baby had not made an appearance by the time i reached 41 weeks i was to come back and we'd reassess.
At 40+4 i had lost tiny bits of my mucus plug and was starting to think that maybe bub would make an appearance before 41 weeks, and that we wouldn't have to go down the path of an elective c section. By that night i had mild cramping but didn't think much of it, went to bed as normal.
At 40+5, 3:20am, i woke in early labour. There was no ignoring it this time, cramps coming every 5 minutes. Not bad ones, but enough to be felt. After getting up to the toilet, i was hit by a particularly bad one and braced my back against one wall of the toilet and my hands against the other. This was the worst one i had - the following contractions were back at the mild stage. All of a sudden i felt the pad i had on become soaked and sat back down quickly on the toilet - by this stage i realised my water had broken. I checked the toilet and was thankful to see it was a milky white colour with no meconium. I stuffed a towel between my legs and found my phone, called my husband Rob to start the drive up from the country where he works and called the hospital who asked me to come in for monitoring.
The midwife there asked permission to do a VE to check there was no cord prolapse. (This was the first one i had throughout the entire pregnancy - and it didn't hurt a bit). She pronounced me 3cm, stretchy to 4cm, and was quite excited to find toes but she couldn't feel a bum. She went away and a doctor came in to tell me that bub was footling breech still and they strongly recommended an immediate c section. I told them my consultant was happy for me to birth vaginally, and they went back and checked what she'd written in my notes. Came back again, and said that she'd specified not footling. I then asked for an ultrasound to check that he really was footling, not just a slightly extended complete breech. They said it probably was not going to help me, but were happy to oblige.
At this stage i called my midwife in. This was about 5:30am. She arrived at about 6am.
Ultrasound showed bub was in a difficult position. He had his feet presenting on my cervix, but his bum was over in the middle of my left side and his head high in my right, which made him an oblique footling breech - almost transverse. Now, footling breech babies can be delivered naturally and there are many success stories, but with this little man's position and knowing that 10-15% of footlings have a cord prolapse leading to a possibility of suffocation and stillbirth, i decided not to risk his life. Bub's heartrate was good, and i negotiated with the doctors to wait until Rob arrived. This was not as difficult as I thought it may be, I think as i understood the risks and was able show that I knew them, and what I was willing to do to avoid them - I agreed to continual monitoring (which would indicate any cord issues), and also told them that if there was a prolapse they had my permission to whisk me away to the OR immediately.
My midwife arrived at this point and was with me for the insertion of the epidural, which worked to slow down my contractions and was in place in case of an emergency section, that they might be able to use it for pain relief instead of putting me out with a general anaesthetic. The surgeons pushed back the scheduled sections for that morning so that an OR would be available to me in case of emergency.
At 7:40am Rob arrived at the hospital and was taken to pre-op to get into his protective clothing. At this point things started moving very quickly in my room. My anaesthetist finished her shift and wished me luck, i was carefully wheeled through the elevator and taken to pre-op where i saw hubby for the first time, my midwife left my side to get scrubbed in, and i was pushed into the room before the theatre where my new anaesthetist team administered the spinal block. Then i was in the theatre and they were checking to see what i could feel. My midwife came in and let me know she was there so i had a familiar face before hubby was allowed in, and she then took Rob's camera so we could have some photos of the surgery and our boy's arrival. They waited for the paediatric team to arrive then started.
At 8:40am the surgeons reached into my left side and lifted bub's bum, got his feet out from my pelvis then manoeuvred him around to get his back and arms out, but got stuck at his head. Took them two minutes to get his head unstuck and out, my uterus had started contracting down and was clamping down on his head, and he was getting quite stressed. He was pink until they clamped his cord at which point he turned blue, but my anaesthetist dropped the curtain for me and hubby to see bub as we had requested before the surgeons whisked him over to resus. He breathed right away before they could suction him and yelled! He was handed to me and hubby to cuddle while i was stitched up. One of the surgeons then came over to congratulate us and told me that i had an arcuate uterus which had very likely been the cause of him flipping and getting stuck feet first in his oblique position.
I was taken into recovery with bub and my midwife while Rob went to find where my handbag had been left, and because I had my midwife with me was able to start breastfeeding. Once out of recovery i was wheeled into my room where hubby met me and my midwife stayed until i was settled, letting me know she'd see me at home when i was discharged.
I saw our consultant before i was discharged and she said if my next baby was head down, she saw no reason i couldn't try for a VBAC, and i had the advantage of having laboured with Ethan so would have a higher chance of success. Breech VBACs unfortunately are against hospital policy. Just have to hope for a head down bub to make things easier! Would love for the homebirth programme to be covered by insurance so i could have my antenatal care with them again, i found them a fantastic resource and extremely supportive, with lots of midwives going out of their way to help me. The government probably won't have changed their views on this in time for my next baby however, but i can at least attend the NBAC class run by the midwifery group.
