I loved being pregnant. I felt that it suited me and I felt very healthy – better than I had been in years. I knew that I was growing a lovely little baby girl and we decided early on to call her Matilda, which means 'strength in battle'.
We first learned that Matilda was breech when I was 32 weeks pregnant, in the context of interviewing an independent midwife about the possibility of a home birth. I was disappointed that the public hospital I was planning to give birth in did not have a family birthing unit. Having recently arrived from London, I naively thought that all modern hospitals had this sort of facility! I wanted a low intervention, non-medicalised birth. I was not planning to use pain relief. After all, I was pregnant, not sick. In my view, I did not need to be in a hospital to birth my baby.
Before the midwife left, she examined me and commented that our baby was breech. My husband and I then spent the weekend deliberating but couldn't commit to the home birth. At the time we couldn't identify why because all the factors pointed in favour but possibly we knew deep down that the home birth would not happen. Or possibly we hadn't been in Australia long enough for our house to be 'home'.
As I was not working, I had read a lot about birth and was aware that vaginal breech birth (VBB) was possible, albeit not the path generally recommended by obstetricians. I set about reading more and more – in fact, all the material I could find on the subject. I read the policies of the various professional bodies of obstetricians in Australia, Canada, the United Kingdom and the USA. I read the various medical studies which have lead to policies of elective caesarean section for breech in most of the developed world. I also read numerous birth stories of VBBs and saw several videos online as well as Karin Ecker's film, http://www.abreechinthesystem.com/. I learned that the risks were overstated (when viewed in absolute terms) and that in well-controlled circumstances VBB would be the best option for us overall. There was no doubt that I wanted to attempt a VBB even if Matilda did not turn.
Throughout this period, I felt conflicted because part of me wanted Matilda to turn to suit the medical establishment and remove the 'high risk' label from my pregnancy. That part of me wanted an 'ordinary' birth with a midwife and no doctors, at the public hospital. (In fact, I kind of hoped not to make it to hospital on time and to have an unplanned home birth …) Another part of me felt that my baby had grown in her own particular way and that I should accept her as she was. I felt that she was being unduly criticised for not conforming. I told her that I loved her just the way she was. I would even go so far as to say that I felt proud of her for standing out against the norm. That part of me was willing to give birth to her bottom first and was not particularly worried about it – if my body grew her that way then my body could surely birth her that way.
At 36 weeks it was confirmed by an obstetrician that Matilda was breech. I was offered an attempt at External Cephalic Version (ECV). Again, a conflict arose: why should Matilda turn if she was healthy where she was? Why should I let the doctors interfere with her naturally assumed position? My husband and I decided that although we both had misgivings, it was the best thing to do, as it could remove the 'issue' and the risks were low. Nevertheless, it felt wrong to agree to the ECV for the sake of the hospital's birth policy.
I underwent the ECV without the usual uterine-relaxant drugs as I didn't want the drugs in my system, having read concerning things about them. I am glad I did it this way but the procedure was extremely uncomfortable and felt 'wrong'. The doctors tried twice to turn the baby, both times unsuccessfully. My husband later told me that he considered asking them to stop in the middle as it was so stressful to watch. I was having the same thought but was focusing on 'zoning out' using breathing techniques – apparently I looked like I was sleeping! If I have another breech baby I will not undergo ECV.
The next step was a meeting with the registrar, at which I made clear that I wanted to give birth vaginally. I knew that, other than being a first pregnancy, all of the 'factors' in favour of VBB pointed in my direction (frank breech, baby not too big, position of placenta, etc). The registrar said that she would support my decision but that I would need to discuss it with the consultant. When we met the consultant it was clear that she had already discussed my case with the head of birth suite (known to be supportive of VBB). She told me that she would be willing to support my vaginal birth but the problem was that she could not be on-call for me. She told me that there were only three doctors at the hospital who were comfortable with VBB and if I turned up in labour and a different doctor was present, they may take a different approach. I did feel that the consultant was 'on my side' with the vaginal birth but was constrained by the public system and the views of her colleagues.
I now wish I had asked what would happen if I turned up in labour and refused a caesarean. I know that they cannot force you to undergo surgery. If the doctors present were uncomfortable or inexperienced with VBB, would they have an obligation to call in one of the doctors who could help me?
On the other hand, I knew that I would not necessarily be in a position to stand up for myself once in labour and I worried that an unsupportive medical team might have a detrimental effect on my labour. Also, the risks of VBB increase if the birth is 'assisted' by insufficiently experienced people (although one might respond that I was wanting to birth my baby myself and was not requesting an 'assisted delivery'). However, I did not ask my question. This is probably because I was so shocked that the doctor proposed to induce me at 39 weeks so that my labour coincided with her 24 hour shift. After a few exchanged shocked looks with my husband, for reasons I do not understand, I signed the consent form.
Over the next few days we both had increasing doubts about the proposed induction. I had read a lot about the dangers of unnecessary inductions and had formed the view (which has since been reinforced by the numerous induction birth stories I have heard recently) that an induction is a recipe for a caesar. It would be highly medicalised. I would be on a drip and would probably need an epidural to withstand the pain. I wanted a spontaneous labour, not an induced labour. I wanted my baby to be born when she was ready and when my body was ready to give birth to her. I wanted the healthy pain of labour not the unhealthy pain of artificial contractions. And there was no medical reason for induction. So, we decided against it.
That left me with two options: turn up to the public hospital in labour and hope for the best or find a private obstetrician who would support my decision to attempt a VBB and be on call for me (for some reason we did not investigate other local public hospitals, although in hind sight that may have been advisable). I did also consider reverting to the home birth. However, I talked to a highly experienced independent midwife, who recommended I approach a particular private obstetrician, which pointed against this as a good option. As my husband was no longer in favour of home birth, I dropped the point. I was at this stage in favour of showing up to the public hospital. I felt, and I still do, that the public hospital ought to be able to cater for my situation. My husband was very uneasy about this approach – he felt that I would end up being pressured into an 'emergency' caesar and regretting it afterwards.
So we investigated 'going private'. My husband asked around and came up with a list of three possibilities. One was unavailable as he was going on holiday and we couldn't get hold of the second. The third was recommended by a friend who had gone to him for a VBAC. He is generally known for supporting vaginal birth in situations when other obstetricians might not. We agreed that we would meet the obstetrician and if I got a 'good vibe' from him, then we'd transfer to his care and if not, we'd stay with the public hospital but not go for the induction. I would find a way to accept that whatever would be would be and hope for a supportive team on the day.
As it turned out, I thought the obstetrician was fabulous. He has a reputation for having a 'rough bedside manner' but I found him extremely caring and I liked his sense of humour. He is straight-talking but that is a good thing in my view. He answered all my (many) questions sincerely. I believe that he is truly dedicated to his profession and was extremely supportive of my wish for a 'natural as possible' birth, within the constraints placed. The constraints were: I would give birth at a private hospital, I would give birth in a semi-reclining position on a bed, I would have continuous electronic monitoring after I was 5cm dilated and I would 'probably need' an episiotomy. He advised against epidural (tick!) and induction in the case of breech babies. His timelines for dilation were wider than most – assuming everything else was going well. We disagreed on one point – the obsetrician wanted to break my waters after 5cm dilation if they didn't break spontaneously. His reason was that this would speed up the labour. I saw it as an unnecessary intervention which could add a risk of infection. We agreed to 'wait and see' on the day – thankfully the question didn't arise. I also made it clear that I did not want the episiotomy unless absolutely necessary – it should not be treated as automatic.
My husband and I decided that my best bet of a VBB would be to stick with the private obstetrician, who claims to have a 75% 'success rate', which we thought was significantly higher than my chances of a VBB at the public hospital. We had to borrow the money but what price do you put on the integrity of your reproductive organs?
At just under 41 weeks I started having Braxton-Hicks contractions at regular 3-4 minute intervals over a couple of days and they were starting to get pretty uncomfortable. I knew I wasn't in labour but eventually we called the hospital. The midwife agreed that I probably wasn't in labour as I wasn't feeling any pain but that it was possible to have a painless labour (although rare) and suggested coming in for a 'check-up'. Big mistake.
We arrived at the hospital and it all started to go wrong. The contractions stopped. The midwife we were allocated was patronising and quickly suggested I might have to 'adjust my expectations'. I told her that I wanted no pain relief but nevertheless she offered me pain killers, despite the fact that I had told her that I wasn't even feeling pain. She even tried to tell me that I really was in pain but was just being stoic! After 2 hours or so, with no vagina examination (VE) and no more contractions, I was told that I would be spending the night and offered sleeping pills. What?! At that point, my husband and I agreed to 'escape'. So (after the midwife sought 'permission' from the obstetrician), we went home. Phew!
When it did happen, three days later, it happened pretty fast. Contractions started at about 11pm at night, we arrived at the hospital at about 12.45am and Matilda was born at 6.23 in the morning. I wanted to avoid arriving at the hospital too early and had been advised to try and rest through the initial stages of labour and then to get 'active'. I tried to lie down and breath through the contractions in bed but they were too strong. I tried leaning over the kitchen bench but that wasn't much better. So I woke my husband, whose view was to take me straight into hospital. We were greeted by a lovely midwife, who said that she used to run a home birth team in England (where home birth is supported by the National Health Service). I think my husband must have briefed her outside the door as she seemed familiar with my views and ideas.
I was standing and walking around for about an hour. Then my waters broke spontaneously (what a shock that was!) and after that it all moved pretty fast. Soon my lower back couldn't support me (apparently common with VBB) so I ended up lying on my side on the bed. Actually, I found this to be pretty comfortable, although I wonder whether it contributed to my 'need' for an episiotomy and I wonder whether warm water on the back might have done the trick and enabled me to stay active. The midwife gave me my first VE at around 2am and didn't tell me at the time but later said I had been 4-5cm dilated. She called the obstetrician, who arrived at about 3am. He did a second VE and said I was 8cm dilated and fully effaced but not to push. I then started feeling my contractions 'convert' to what felt like spasms of some sort (the baby moving down the birth canal – obvious now but it wasn't at the time). I was not actively pushing but I could feel my uterus pushing for me. I tried to relax through it using breathing. My husband felt sure the baby was 'on its way' and called the midwife, who confirmed that she could see the baby's buttocks and called the obstetrician. I had no pain relief and nobody offered it, which was what I wanted, but OMG it hurt!
The birth itself wasn't at all how I imagined: no breathing the baby out and letting my body do its job at its own pace. Up until I was told to turn onto my back, I had been feeling the baby moving by itself – I never actually pushed as such, I just breathed. Once I was on my back, I lost the sensation of the contractions and the movement of the baby. At that point it became an externally managed process rather than an internally guided one. It was all push push push. Although I was happy enough at the time, I have since wondered whether the managed pushing was responsible for the need for an episiotomy. Maybe if we had taken it all more slowly this could have been avoided?
Once the obstetrician cut me, Matilda's body came out on the next contraction, he then gently flicked the legs and arms out (that sure felt weird!) and with some very closely managed pushing the head came out soon after. For that part of the birth the obsetrician told me when to push, how much, when to stop, to hold it there, push a bit harder, a bit less, etc. I understand this is to prevent the head from 'popping' out too quickly and suffering any damage from the change in pressure. I'm told he swung the body of the baby up to the ceiling as the head came out (the Mauriceau-Smellie-Veit manoeuvre, perhaps?). I had a physiological third stage but (against my preferences) it was necessary to cut the cord before the placenta had birthed as my baby needed a spot of oxygen.
After the birth, I remember lying on the bed gazing at my husband in amazement and shock about the whole experience. It was very surreal. Although nothing at all went wrong during the birth and at no point did I feel at risk or unsafe or unsupported, I would describe it as traumatic, both physically and psychologically. There was something primitive and animal about it. My husband was also pretty shocked by the experience. We don't plan to do it again any time soon.
Reflecting back, I have some regrets for not having been strong enough to walk into the public hospital in labour and birth my baby. Although moving to the private system guaranteed me 'the opportunity' of a VBB, I resent the fact that this is seen as something I should be grateful for. In my mind there was never any question that I could birth my baby and it is insulting that I should need an 'opportunity' to be provided to me, let alone to pay for it. On the other hand, given that the risks of VBB decrease with the presence of a skilled birth-attendant, and given the importance of feeling supported during the birth, overall transferring to the private obstetrician who would support my wishes for a trial of labour was the best decision in the circumstances.
I am glad that Matilda chose us for her parents and I am proud of my little breech baby for challenging the system by coming out bottom first. She is now 15 months old and continues to be strong-willed. I wonder whether that is a 'breech thing'?
We first learned that Matilda was breech when I was 32 weeks pregnant, in the context of interviewing an independent midwife about the possibility of a home birth. I was disappointed that the public hospital I was planning to give birth in did not have a family birthing unit. Having recently arrived from London, I naively thought that all modern hospitals had this sort of facility! I wanted a low intervention, non-medicalised birth. I was not planning to use pain relief. After all, I was pregnant, not sick. In my view, I did not need to be in a hospital to birth my baby.
Before the midwife left, she examined me and commented that our baby was breech. My husband and I then spent the weekend deliberating but couldn't commit to the home birth. At the time we couldn't identify why because all the factors pointed in favour but possibly we knew deep down that the home birth would not happen. Or possibly we hadn't been in Australia long enough for our house to be 'home'.
As I was not working, I had read a lot about birth and was aware that vaginal breech birth (VBB) was possible, albeit not the path generally recommended by obstetricians. I set about reading more and more – in fact, all the material I could find on the subject. I read the policies of the various professional bodies of obstetricians in Australia, Canada, the United Kingdom and the USA. I read the various medical studies which have lead to policies of elective caesarean section for breech in most of the developed world. I also read numerous birth stories of VBBs and saw several videos online as well as Karin Ecker's film, http://www.abreechinthesystem.com/. I learned that the risks were overstated (when viewed in absolute terms) and that in well-controlled circumstances VBB would be the best option for us overall. There was no doubt that I wanted to attempt a VBB even if Matilda did not turn.
Throughout this period, I felt conflicted because part of me wanted Matilda to turn to suit the medical establishment and remove the 'high risk' label from my pregnancy. That part of me wanted an 'ordinary' birth with a midwife and no doctors, at the public hospital. (In fact, I kind of hoped not to make it to hospital on time and to have an unplanned home birth …) Another part of me felt that my baby had grown in her own particular way and that I should accept her as she was. I felt that she was being unduly criticised for not conforming. I told her that I loved her just the way she was. I would even go so far as to say that I felt proud of her for standing out against the norm. That part of me was willing to give birth to her bottom first and was not particularly worried about it – if my body grew her that way then my body could surely birth her that way.
At 36 weeks it was confirmed by an obstetrician that Matilda was breech. I was offered an attempt at External Cephalic Version (ECV). Again, a conflict arose: why should Matilda turn if she was healthy where she was? Why should I let the doctors interfere with her naturally assumed position? My husband and I decided that although we both had misgivings, it was the best thing to do, as it could remove the 'issue' and the risks were low. Nevertheless, it felt wrong to agree to the ECV for the sake of the hospital's birth policy.
I underwent the ECV without the usual uterine-relaxant drugs as I didn't want the drugs in my system, having read concerning things about them. I am glad I did it this way but the procedure was extremely uncomfortable and felt 'wrong'. The doctors tried twice to turn the baby, both times unsuccessfully. My husband later told me that he considered asking them to stop in the middle as it was so stressful to watch. I was having the same thought but was focusing on 'zoning out' using breathing techniques – apparently I looked like I was sleeping! If I have another breech baby I will not undergo ECV.
The next step was a meeting with the registrar, at which I made clear that I wanted to give birth vaginally. I knew that, other than being a first pregnancy, all of the 'factors' in favour of VBB pointed in my direction (frank breech, baby not too big, position of placenta, etc). The registrar said that she would support my decision but that I would need to discuss it with the consultant. When we met the consultant it was clear that she had already discussed my case with the head of birth suite (known to be supportive of VBB). She told me that she would be willing to support my vaginal birth but the problem was that she could not be on-call for me. She told me that there were only three doctors at the hospital who were comfortable with VBB and if I turned up in labour and a different doctor was present, they may take a different approach. I did feel that the consultant was 'on my side' with the vaginal birth but was constrained by the public system and the views of her colleagues.
I now wish I had asked what would happen if I turned up in labour and refused a caesarean. I know that they cannot force you to undergo surgery. If the doctors present were uncomfortable or inexperienced with VBB, would they have an obligation to call in one of the doctors who could help me?
On the other hand, I knew that I would not necessarily be in a position to stand up for myself once in labour and I worried that an unsupportive medical team might have a detrimental effect on my labour. Also, the risks of VBB increase if the birth is 'assisted' by insufficiently experienced people (although one might respond that I was wanting to birth my baby myself and was not requesting an 'assisted delivery'). However, I did not ask my question. This is probably because I was so shocked that the doctor proposed to induce me at 39 weeks so that my labour coincided with her 24 hour shift. After a few exchanged shocked looks with my husband, for reasons I do not understand, I signed the consent form.
Over the next few days we both had increasing doubts about the proposed induction. I had read a lot about the dangers of unnecessary inductions and had formed the view (which has since been reinforced by the numerous induction birth stories I have heard recently) that an induction is a recipe for a caesar. It would be highly medicalised. I would be on a drip and would probably need an epidural to withstand the pain. I wanted a spontaneous labour, not an induced labour. I wanted my baby to be born when she was ready and when my body was ready to give birth to her. I wanted the healthy pain of labour not the unhealthy pain of artificial contractions. And there was no medical reason for induction. So, we decided against it.
That left me with two options: turn up to the public hospital in labour and hope for the best or find a private obstetrician who would support my decision to attempt a VBB and be on call for me (for some reason we did not investigate other local public hospitals, although in hind sight that may have been advisable). I did also consider reverting to the home birth. However, I talked to a highly experienced independent midwife, who recommended I approach a particular private obstetrician, which pointed against this as a good option. As my husband was no longer in favour of home birth, I dropped the point. I was at this stage in favour of showing up to the public hospital. I felt, and I still do, that the public hospital ought to be able to cater for my situation. My husband was very uneasy about this approach – he felt that I would end up being pressured into an 'emergency' caesar and regretting it afterwards.
So we investigated 'going private'. My husband asked around and came up with a list of three possibilities. One was unavailable as he was going on holiday and we couldn't get hold of the second. The third was recommended by a friend who had gone to him for a VBAC. He is generally known for supporting vaginal birth in situations when other obstetricians might not. We agreed that we would meet the obstetrician and if I got a 'good vibe' from him, then we'd transfer to his care and if not, we'd stay with the public hospital but not go for the induction. I would find a way to accept that whatever would be would be and hope for a supportive team on the day.
As it turned out, I thought the obstetrician was fabulous. He has a reputation for having a 'rough bedside manner' but I found him extremely caring and I liked his sense of humour. He is straight-talking but that is a good thing in my view. He answered all my (many) questions sincerely. I believe that he is truly dedicated to his profession and was extremely supportive of my wish for a 'natural as possible' birth, within the constraints placed. The constraints were: I would give birth at a private hospital, I would give birth in a semi-reclining position on a bed, I would have continuous electronic monitoring after I was 5cm dilated and I would 'probably need' an episiotomy. He advised against epidural (tick!) and induction in the case of breech babies. His timelines for dilation were wider than most – assuming everything else was going well. We disagreed on one point – the obsetrician wanted to break my waters after 5cm dilation if they didn't break spontaneously. His reason was that this would speed up the labour. I saw it as an unnecessary intervention which could add a risk of infection. We agreed to 'wait and see' on the day – thankfully the question didn't arise. I also made it clear that I did not want the episiotomy unless absolutely necessary – it should not be treated as automatic.
My husband and I decided that my best bet of a VBB would be to stick with the private obstetrician, who claims to have a 75% 'success rate', which we thought was significantly higher than my chances of a VBB at the public hospital. We had to borrow the money but what price do you put on the integrity of your reproductive organs?
At just under 41 weeks I started having Braxton-Hicks contractions at regular 3-4 minute intervals over a couple of days and they were starting to get pretty uncomfortable. I knew I wasn't in labour but eventually we called the hospital. The midwife agreed that I probably wasn't in labour as I wasn't feeling any pain but that it was possible to have a painless labour (although rare) and suggested coming in for a 'check-up'. Big mistake.
We arrived at the hospital and it all started to go wrong. The contractions stopped. The midwife we were allocated was patronising and quickly suggested I might have to 'adjust my expectations'. I told her that I wanted no pain relief but nevertheless she offered me pain killers, despite the fact that I had told her that I wasn't even feeling pain. She even tried to tell me that I really was in pain but was just being stoic! After 2 hours or so, with no vagina examination (VE) and no more contractions, I was told that I would be spending the night and offered sleeping pills. What?! At that point, my husband and I agreed to 'escape'. So (after the midwife sought 'permission' from the obstetrician), we went home. Phew!
When it did happen, three days later, it happened pretty fast. Contractions started at about 11pm at night, we arrived at the hospital at about 12.45am and Matilda was born at 6.23 in the morning. I wanted to avoid arriving at the hospital too early and had been advised to try and rest through the initial stages of labour and then to get 'active'. I tried to lie down and breath through the contractions in bed but they were too strong. I tried leaning over the kitchen bench but that wasn't much better. So I woke my husband, whose view was to take me straight into hospital. We were greeted by a lovely midwife, who said that she used to run a home birth team in England (where home birth is supported by the National Health Service). I think my husband must have briefed her outside the door as she seemed familiar with my views and ideas.
I was standing and walking around for about an hour. Then my waters broke spontaneously (what a shock that was!) and after that it all moved pretty fast. Soon my lower back couldn't support me (apparently common with VBB) so I ended up lying on my side on the bed. Actually, I found this to be pretty comfortable, although I wonder whether it contributed to my 'need' for an episiotomy and I wonder whether warm water on the back might have done the trick and enabled me to stay active. The midwife gave me my first VE at around 2am and didn't tell me at the time but later said I had been 4-5cm dilated. She called the obstetrician, who arrived at about 3am. He did a second VE and said I was 8cm dilated and fully effaced but not to push. I then started feeling my contractions 'convert' to what felt like spasms of some sort (the baby moving down the birth canal – obvious now but it wasn't at the time). I was not actively pushing but I could feel my uterus pushing for me. I tried to relax through it using breathing. My husband felt sure the baby was 'on its way' and called the midwife, who confirmed that she could see the baby's buttocks and called the obstetrician. I had no pain relief and nobody offered it, which was what I wanted, but OMG it hurt!
The birth itself wasn't at all how I imagined: no breathing the baby out and letting my body do its job at its own pace. Up until I was told to turn onto my back, I had been feeling the baby moving by itself – I never actually pushed as such, I just breathed. Once I was on my back, I lost the sensation of the contractions and the movement of the baby. At that point it became an externally managed process rather than an internally guided one. It was all push push push. Although I was happy enough at the time, I have since wondered whether the managed pushing was responsible for the need for an episiotomy. Maybe if we had taken it all more slowly this could have been avoided?
Once the obstetrician cut me, Matilda's body came out on the next contraction, he then gently flicked the legs and arms out (that sure felt weird!) and with some very closely managed pushing the head came out soon after. For that part of the birth the obsetrician told me when to push, how much, when to stop, to hold it there, push a bit harder, a bit less, etc. I understand this is to prevent the head from 'popping' out too quickly and suffering any damage from the change in pressure. I'm told he swung the body of the baby up to the ceiling as the head came out (the Mauriceau-Smellie-Veit manoeuvre, perhaps?). I had a physiological third stage but (against my preferences) it was necessary to cut the cord before the placenta had birthed as my baby needed a spot of oxygen.
After the birth, I remember lying on the bed gazing at my husband in amazement and shock about the whole experience. It was very surreal. Although nothing at all went wrong during the birth and at no point did I feel at risk or unsafe or unsupported, I would describe it as traumatic, both physically and psychologically. There was something primitive and animal about it. My husband was also pretty shocked by the experience. We don't plan to do it again any time soon.
Reflecting back, I have some regrets for not having been strong enough to walk into the public hospital in labour and birth my baby. Although moving to the private system guaranteed me 'the opportunity' of a VBB, I resent the fact that this is seen as something I should be grateful for. In my mind there was never any question that I could birth my baby and it is insulting that I should need an 'opportunity' to be provided to me, let alone to pay for it. On the other hand, given that the risks of VBB decrease with the presence of a skilled birth-attendant, and given the importance of feeling supported during the birth, overall transferring to the private obstetrician who would support my wishes for a trial of labour was the best decision in the circumstances.
I am glad that Matilda chose us for her parents and I am proud of my little breech baby for challenging the system by coming out bottom first. She is now 15 months old and continues to be strong-willed. I wonder whether that is a 'breech thing'?
