Merryana's birth
I was birthing my first baby through a midwifery group practice at a public hospital, but had also had input from the obstetricians since finding out at 35 weeks that our baby was breech. I tried everything possible to turn her including ECV (not at all painful but unsuccessful), acupuncture (6 appointments), 6 chiropractor appointments, hypnobirthing breech turning relaxation script, visualisations, painting a turning baby picture, swimming, handstands in the pool, four point kneeling, and inversion postures. After researching vaginal breech birth I chose this option rather than the standard recommendation of a caesarean at 38-39 weeks.
After initially planning a natural midwife led birth, the plan was modified in relation to the baby being breech. I reluctantly agreed to the ob’s recommendation to have an epidural at 6cm which they advised in order to prevent an early fetal ejection reflex (apparently can cause the bottom to push out before full dilation achieved, trapping the baby’s head). After getting a second opinion from a private ob who is experienced in breech birth and pro natural birthing I agreed to the epidural, but only because I needed the two breech experienced obs to agree to be on call for me, and this was their requirement. I was disappointed to be preparing for an epidural and spent a lot of time planning how to keep the epidural experience as positive as I could. However the ob was happy for us to stay at home until I had surges 3 in 10 minutes regularly for at least an hour which was great. The obs also required that I have an epidural transmission system and cannula inserted as soon as I got to hospital (without being attached to anything), to make setting it up faster in an emergency. To negotiate my birth preferences took 3 meetings with the public hospital obstetricians, plus one with the private obstetrician, as well as standard midwife appointments. I had ultrasounds to confirm that we were frank breech (the easiest kind) and that the baby didn’t appear to be huge.
I started getting very mild surges just after midnight, four days after my estimated due date. The surges were quite sporadic but then my membranes released at around 2:30am so I knew it was definitely happening. I stayed in bed and phoned my midwife in the morning to let her know. She said I should come in for a check since my membranes had released but I wasn't in established labour (mild surges coming between 10 mins and 30 mins apart).
My husband and I went to hospital prepared to stay as my midwife had said they might want to keep me in due to risk of infection after my membranes releasing. Bub was checked on the CTG and the surges completely stopped. I was admitted to hospital as a precaution but was told it could be a few days yet until the baby came (they would let me go for up to 4 days before they got excessively worried about infection and wanted to Caesar me. I had been advised against induction or augmentation due to the breech position). My midwife did not check my cervix to prevent infection since my membranes had released.
I immediately went home on day leave and tried as much natural oxytocin stimulation as possible. This did restart the surges but they were still very mild (not even remotely uncomfortable) and about 10 mins apart. In the late afternoon we went back and hung out in the maternity ward for the afternoon. Hubby went home at 8pm (he wasn’t allowed to stay since I wasn’t in birth suite yet). Everything was still very mild, but I snagged a private room.
About 2am the surges started to ramp up a bit and were coming around 3 in 10 minutes but still fairly mild, not palpable by the midwives, and not really with any regular pattern. The main discomfort I had was a continuous strong feeling of pressure in my anus. I asked the ward midwives if hubby could come back in as I was feeling a bit uncomfortable and would like him there. They said that my husband could only come in if I moved to birth suite. As we all believed I wasn’t yet in established labour I didn’t want to move to birth suite as this would necessitate calling in my own midwife (and using up all her hours long before I was even close to birthing). I certainly wouldn't have come to the hospital at this stage if I had been labouring at home.
I couldn't sleep because I did need to change positions between surges (four point kneeling) and sleeping but everything was still sporadic and I had trouble knowing when I was having a surge (as the main feeling was pressure in my anus). I could still feel the baby’s head high up underneath my ribs. The ward midwives offered me paracetamol and a short acting sleeping pill which I initially declined. My own midwife (who is very pro natural drug free birth) came in to birth someone else and advised me to seriously consider the sleeping tablet as she was concerned about my ability to birth if I hadn’t had any sleep due to several days of prelabour.
I had the sleeping pill (Temazepam) and slept until around 6:30am, waking to find my midwife replacing the towels etc as she had finished her other birth. She said she wanted to put the monitor on me again but this time I had trouble remaining even in 4 point kneeling with it on - heaps of pressure in my bottom that never seemed to stop so that I couldn't even tell when I was getting a surge.
I was really frustrated as I couldn't relax between surges at all at this time and couldn't even distinguish them starting. Hubby arrived before 7am and I said to him that I thought I would have a caesar as I couldn't do this pre-labour thing for several days and then birth after that. I was only planning to birth vaginally if everything was going well but that a long prelabour would jeopardise my ability to birth safely in a breech position. I felt that I could definitely manage the sensations if I was actually in labour and achieving something, but having uncomfortable ineffectual contractions that weren’t causing dilation was very frustrating.
My midwife said she should check my dilation then and give me some antibiotics if I had decided to Caesar. She injected the AB's and then checked my cervix which was hugely uncomfortable as I had to lie on my back. She said that she would go and get a doctor to confirm her cervix check while I grumbled about how frustrated I was not in proper labour and probably only two cm dilated. The doctor came, examined me and said that I was 10cm dilated and we could move to birth suite now. My midwife pointed out as we walked to birth suite that fully dilated there was no need for an epidural and this was my opportunity to help this baby out the way I had originally hoped for.
A breech experienced consultant obstetrician was available (came in from his holidays) and he arrived about 20 mins after I moved to birth suite. I hadn’t met him before as I had done the birth arrangements with the other breech experienced ob. I stood leaning on a chair and did hypnobirthing J breathing each time I had a surge. I didn't find it at all painful, but my surges were still sporadic varying between 5 mins and up to 15 mins apart. I moved to the birth stool and finally the baby’s bottom descended after about an hour. The ob wanted me continuously monitored but I wanted to move, so my follow through midwifery student crouched behind me holding the monitor in place the whole time. The ob asked me to move to the end of the bed (as I had previously agreed). I sat on the bed with my legs hanging off (a position the obs requested in case they needed to do some obstetrical stuff) but when I got there I only got around 6 surges in 45 minutes, sometimes 15 mins apart. The baby’s bottom actually slipped back in a bit.
Eventually the ob agreed at my midwife’s suggestion that I should stand up again. I stood for a bit then went back on the birth stool until the bottom had come through about 10cm. Hubby lifted me back up on to the bed (a bit tricky with a fair hunk of baby bottom hanging out). Once the baby was out to the umbilical cord the ob’s did some manoeuvres (no pulling, just flicking the feet out/protecting perineum etc). Baby’s shoulders came out with a surge but I didn't get a surge to push the head out (which I wasn't expecting as they had never been closer than 5 mins apart in 2nd stage) so I just had to push with my stomach muscles. The obs used the breech forceps to bend the baby’s neck and help her out as there is a time limit to get the head out for breech babies once the umbilical cord has come down. Baby was born with about a 2.25 hour second stage, with 1.25 hours of active pushing (just on the upper limit of what is considered safe by many breech obstetricians)
After initially planning a natural midwife led birth, the plan was modified in relation to the baby being breech. I reluctantly agreed to the ob’s recommendation to have an epidural at 6cm which they advised in order to prevent an early fetal ejection reflex (apparently can cause the bottom to push out before full dilation achieved, trapping the baby’s head). After getting a second opinion from a private ob who is experienced in breech birth and pro natural birthing I agreed to the epidural, but only because I needed the two breech experienced obs to agree to be on call for me, and this was their requirement. I was disappointed to be preparing for an epidural and spent a lot of time planning how to keep the epidural experience as positive as I could. However the ob was happy for us to stay at home until I had surges 3 in 10 minutes regularly for at least an hour which was great. The obs also required that I have an epidural transmission system and cannula inserted as soon as I got to hospital (without being attached to anything), to make setting it up faster in an emergency. To negotiate my birth preferences took 3 meetings with the public hospital obstetricians, plus one with the private obstetrician, as well as standard midwife appointments. I had ultrasounds to confirm that we were frank breech (the easiest kind) and that the baby didn’t appear to be huge.
I started getting very mild surges just after midnight, four days after my estimated due date. The surges were quite sporadic but then my membranes released at around 2:30am so I knew it was definitely happening. I stayed in bed and phoned my midwife in the morning to let her know. She said I should come in for a check since my membranes had released but I wasn't in established labour (mild surges coming between 10 mins and 30 mins apart).
My husband and I went to hospital prepared to stay as my midwife had said they might want to keep me in due to risk of infection after my membranes releasing. Bub was checked on the CTG and the surges completely stopped. I was admitted to hospital as a precaution but was told it could be a few days yet until the baby came (they would let me go for up to 4 days before they got excessively worried about infection and wanted to Caesar me. I had been advised against induction or augmentation due to the breech position). My midwife did not check my cervix to prevent infection since my membranes had released.
I immediately went home on day leave and tried as much natural oxytocin stimulation as possible. This did restart the surges but they were still very mild (not even remotely uncomfortable) and about 10 mins apart. In the late afternoon we went back and hung out in the maternity ward for the afternoon. Hubby went home at 8pm (he wasn’t allowed to stay since I wasn’t in birth suite yet). Everything was still very mild, but I snagged a private room.
About 2am the surges started to ramp up a bit and were coming around 3 in 10 minutes but still fairly mild, not palpable by the midwives, and not really with any regular pattern. The main discomfort I had was a continuous strong feeling of pressure in my anus. I asked the ward midwives if hubby could come back in as I was feeling a bit uncomfortable and would like him there. They said that my husband could only come in if I moved to birth suite. As we all believed I wasn’t yet in established labour I didn’t want to move to birth suite as this would necessitate calling in my own midwife (and using up all her hours long before I was even close to birthing). I certainly wouldn't have come to the hospital at this stage if I had been labouring at home.
I couldn't sleep because I did need to change positions between surges (four point kneeling) and sleeping but everything was still sporadic and I had trouble knowing when I was having a surge (as the main feeling was pressure in my anus). I could still feel the baby’s head high up underneath my ribs. The ward midwives offered me paracetamol and a short acting sleeping pill which I initially declined. My own midwife (who is very pro natural drug free birth) came in to birth someone else and advised me to seriously consider the sleeping tablet as she was concerned about my ability to birth if I hadn’t had any sleep due to several days of prelabour.
I had the sleeping pill (Temazepam) and slept until around 6:30am, waking to find my midwife replacing the towels etc as she had finished her other birth. She said she wanted to put the monitor on me again but this time I had trouble remaining even in 4 point kneeling with it on - heaps of pressure in my bottom that never seemed to stop so that I couldn't even tell when I was getting a surge.
I was really frustrated as I couldn't relax between surges at all at this time and couldn't even distinguish them starting. Hubby arrived before 7am and I said to him that I thought I would have a caesar as I couldn't do this pre-labour thing for several days and then birth after that. I was only planning to birth vaginally if everything was going well but that a long prelabour would jeopardise my ability to birth safely in a breech position. I felt that I could definitely manage the sensations if I was actually in labour and achieving something, but having uncomfortable ineffectual contractions that weren’t causing dilation was very frustrating.
My midwife said she should check my dilation then and give me some antibiotics if I had decided to Caesar. She injected the AB's and then checked my cervix which was hugely uncomfortable as I had to lie on my back. She said that she would go and get a doctor to confirm her cervix check while I grumbled about how frustrated I was not in proper labour and probably only two cm dilated. The doctor came, examined me and said that I was 10cm dilated and we could move to birth suite now. My midwife pointed out as we walked to birth suite that fully dilated there was no need for an epidural and this was my opportunity to help this baby out the way I had originally hoped for.
A breech experienced consultant obstetrician was available (came in from his holidays) and he arrived about 20 mins after I moved to birth suite. I hadn’t met him before as I had done the birth arrangements with the other breech experienced ob. I stood leaning on a chair and did hypnobirthing J breathing each time I had a surge. I didn't find it at all painful, but my surges were still sporadic varying between 5 mins and up to 15 mins apart. I moved to the birth stool and finally the baby’s bottom descended after about an hour. The ob wanted me continuously monitored but I wanted to move, so my follow through midwifery student crouched behind me holding the monitor in place the whole time. The ob asked me to move to the end of the bed (as I had previously agreed). I sat on the bed with my legs hanging off (a position the obs requested in case they needed to do some obstetrical stuff) but when I got there I only got around 6 surges in 45 minutes, sometimes 15 mins apart. The baby’s bottom actually slipped back in a bit.
Eventually the ob agreed at my midwife’s suggestion that I should stand up again. I stood for a bit then went back on the birth stool until the bottom had come through about 10cm. Hubby lifted me back up on to the bed (a bit tricky with a fair hunk of baby bottom hanging out). Once the baby was out to the umbilical cord the ob’s did some manoeuvres (no pulling, just flicking the feet out/protecting perineum etc). Baby’s shoulders came out with a surge but I didn't get a surge to push the head out (which I wasn't expecting as they had never been closer than 5 mins apart in 2nd stage) so I just had to push with my stomach muscles. The obs used the breech forceps to bend the baby’s neck and help her out as there is a time limit to get the head out for breech babies once the umbilical cord has come down. Baby was born with about a 2.25 hour second stage, with 1.25 hours of active pushing (just on the upper limit of what is considered safe by many breech obstetricians)
Apart from the head and shoulders bit, which was painful, the second stage wasn't even uncomfortable. Baby came out and onto my tummy and then to the paediatrician to check - she had low Apgar’s (3 at 1 min, 5 at 5 mins, 7 at 10 mins) and the paed wanted to take her to special care nursery. My midwife talked them into letting her stay with us as she was starting to look OK after 10 - 15 mins. So baby stayed with us and after about 30 mins of skin on skin latched on and fed for an hour, all looking great and fully recovered. I had a minor 2nd degree tear and was able to walk with the baby back to maternity ward. The hospital requested I stay overnight to monitor the baby’s temperature due to the early membrane rupture. There were no temperature issues, but the baby was put into a brace due to hip dysplasia which she had to wear for 6 weeks (hip dysplasia is more common in breech babies and we have a family history of it). She was born at 10:15am, we hadn't even thought I was in labour until around 8am.
We left hospital at around 2pm the next day. Absolutely awesome birth experience - I'm now a bit famous in the hospital for having a breech vaginal delivery, and I am just dumbfounded that it didn't appear I was in established labour even though I was in transition!
Picture 1 : Feeling very happy just after finding out that I was fully dilated and moving to birth suite.
Picture 2: Little flattened breech head baby on her first afternoon in the world – no wonder I had reflux!
We left hospital at around 2pm the next day. Absolutely awesome birth experience - I'm now a bit famous in the hospital for having a breech vaginal delivery, and I am just dumbfounded that it didn't appear I was in established labour even though I was in transition!
Picture 1 : Feeling very happy just after finding out that I was fully dilated and moving to birth suite.
Picture 2: Little flattened breech head baby on her first afternoon in the world – no wonder I had reflux!
