Tuesday, May 17, 2011

Confessions of a Mama who Birthed Breech in America

© Anonymous, name withheld as requested 2011. This strong and informed mama shares her experience with breech birth and a homebirth transfer. She gives excellent advise from her experience:

A little background first....

I'm incredibly blessed to have come from a mother who bore 11 children, all vaginally, 8 of them at home. And while she had some lousy experiences and screamed through a few of her births, I got to watch her birth her last one, just a year earlier than my child’s birth, in the midst of laughing and singing. I knew far more about birth than most mothers do, by nature of experiencing it as a sibling and watching many of my siblings be born. I knew why I wanted a natural birth, why I wanted to be at home, and I prepared as best I could. 

My own pregnancy progressed smoothly and as expected. I was sick the first half, and grew a lovely belly and a wiggly little girl inside. At the last few appointments with my midwife, my little wiggle-worm kept flipping. One week she was nicely head down and starting to get settled, the next week she had flipped and was breech. My midwife was superbly sweet and gentle. She lent me a fantastic book about breech babies (just in case) and we talked about how we would handle things if baby were still breech when the time arrived.

I had planned a homebirth, knew my back-up hospital option just in case, and learned as much as I could about breech babies, because despite most babies settling in by 36 weeks, my busy baby was still flipping. I would simply wake up in the morning to find she turned yet again. It surprised my midwife. Most first babies simply don't have enough room to do that, and I was not large at all. In fact, my abs muscles were a little too tight! 

In my research, I learned that breech babies, when butt-first (frank breech), are not too terribly different from headfirst babies. The little round bottom is slightly softer, but similar to a head in shape, and as long as you leave things alone (which can be very difficult for your attendants) there are no more risks than with the typical birth. Doctors are simply not trained on how to handle breech births anymore, as they only occur in about 3% of births and c-sections are easier for the doctor with less assumed liability.

Footling breech cases are a little more difficult. A baby with legs crisscross applesauce inside the belly simply won't come out the normal way. So I prayed that my baby, if she came breech in the end, was at least butt-first. It's the most common breech, and pretty simple and straightforward. Incidentally, I found out two of my aunts were breech. They were born vaginally as that is just what people did in those days. 

By 40 weeks, she was head down, getting settled, and it looked like I would have a nice head-down baby after all. I wore a maternity belt on and off, just to help her stay there. But, she turned. I spent the last week before her birth in awkward positions, taking herbs and homeopathics, visiting chiropractors and doing all sorts of things to get her to flip. We even tried the Webster technique, which includes an external, manual method of turning the baby without success.

I had always been incredibly accurate at determining her position all through pregnancy, and began to believe she was stuck. It seemed there was one foot down on my pelvis, but I didn't know where the other was positioned. An expensive trip to a local ultrasound place confirmed this. At this point I became a bit nervous. Footling breech is a little more difficult anyway, but with one leg up and the other down I didn't know what would happen. The last thing I wanted was to be in a hospital. I already had trauma in hospitals as a child. We had visited a couple to know our way around, and I still felt incredibly nervous just being in them. Besides, with the current attitude towards breech in America, any doctor would have taken one look at me, thought of his insurance and said "CUT HER OPEN!" 

At 10 days past my due date, contractions began late that evening. I wasn't sure, so I went to bed, but woke up early in the morning with back pain that wouldn't go away. With only 2 hours of sleep, I didn't really think I should get up, but cold wasn't helping (I should have done heat) and I was too excited that the day was finally here. I was still nervous that things might not go smoothly, but I had pushed all of that out of mind and remained confident that everything would be okay in the end. Even though I could feel she was breech, and most likely she was still in an awkward position, I had maintained hope and excitement all through the end of pregnancy. I just couldn't wait for my baby to be here! 

Labor was labor. She was posterior as well, so I had lots of back pain. I said constantly, "Hubby, push on my back!" And I had failed attempts at distracting myself just to get through the contractions. After several hours, contractions were coming really quick and hard, but with just a foot to dilate my cervix, I was getting nowhere fast. Midwives encouraged me to get in the shower, to try to relax, to nap (nap?!) and get things to slow down. Fortunately, we were able to do this. Things slowed down for a little while to a more manageable level, and yet it was torture. I wanted to just be done! 

Because we were pretty sure she was breech, I had a midwife I had been working with throughout the pregnancy, and another one who has handled many breech births. When we finally decided things were close enough for the midwives to come over, I felt bad because there wasn't a huge amount for them to do while I labored.

As labor picked up and I slowly dilated, I ended up on my side with pillows or arms holding my leg up. It wasn't the most comfortable spot, but we needed the angle to help the rest of the lip get out the way.  My poor husband would trade off with my mom in supporting me. By this time, it was evening again, so I had been laboring pretty intensely, aside from the little breather, for close to 18 hours. The most aggravating thing was that my hair was in my face. I kept pushing it out of the way, and it kept coming back. I promised myself a fat headband for my next birth. 

Slowly, agonizingly slowly, baby descended. 

And pushing began. My body was pushing. I couldn't decide whether to help it, or hold it back (not that I really could if I tried). I alternated between standing, holding onto someone for all his or her strength, leaning against a ball, or anything to help the process. I was completely exhausted and my legs couldn't take it anymore. I kept saying, “I can't do this anymore.” I was too tired. I wanted to look at the clock but everyone told me to focus. I couldn't read analog at that point anyway. 

Baby moved down a little, but it was painfully slow. I just wanted it to end at that point. Eventually there were little toes tickling down there. (Yes, it tickled!) I asked if I could reach down and feel this foot that had kicked my pelvis so many times during pregnant. That was the best part of my entire labor. Reaching down, and feeling little baby toes. The tickling was a nice distraction to the constant pushing, too. 

Midwives decided to check things again, because labor was extremely slow. Breech babies generally do take their time, but they wanted to make sure nothing was holding baby back. Hands in that tight area were not pleasant. One midwife checked, then the other checked. They shared whispers. One thought there were little boy parts; the other thought there was a cord. And the question was, if the cord was down, was it wrapped in such a way that baby cannot descend? 

They checked again, and in light of the time I had been pushing, the fact that there was only one foot and the cord was already there, erring on the side of caution, we were advised to transfer. 

I was both crushed, and relieved. On the one hand, the pain would be over soon! On the other, I had been working so hard, for almost 22 hours, and was getting through it, I was doing it, and now I will have failed? Not to mention I didn't look forward to the aftermath of a c-section. At least I had given my baby the trial of labor!

Everything was hurried now. The ambulance was called, which was our first mistake, and I was directed to crawl out the door. I tried to tell everyone that I just couldn't do that, but followed instructions. In crawling (out the door, down the steps, along the concrete... bleh) baby came down further. No one had pushed me to move around in that way earlier because I was so exhausted, but I'm definitely going to do some hip-swinging with future babies! The ambulance arrived, flipped, and packed us up to go to the hospital. We told them which hospital we wanted to go to, but they refused and took us to a different one. We didn't have any choice. 

Once in the ER, I was alone. No one was allowed to be with me. The whole ride I was stabbed with IV (they couldn't get it in right) and yelled at to "stop pushing!" Yes, you tell my body that. See if it listens. At the hospital they didn't allow anyone to be with me. They were asking me a million questions, never mind that I was exhausted and delirious. And somehow I refused morphine and stuttered out that, "Yes, we knew she was breech when she was coming down and we saw a foot." They didn't need to know about my incredible powers of knowing the baby’s position before birth.

And suddenly I was screaming, begging to die, and they ripped her out of me. At least a dozen people I didn't know stood around me, forcing me to stay in place while they did their deed. What happened to checking on the cord, and letting labor progress if we could???? I don't know how long it took for them to get her out. I always remember it as 10 minutes, but it probably was far less than that. I just screamed. 

They showed her to me for a split second, and I heard I had a girl. The whole time I thought I had a boy. The news sunk in a little oddly, but I didn't get to give it much thought. Now they were pounding on my belly to get the placenta out. They tried to force Pitocin in me too for bleeding, but I refused. I had herbs that can help.

Stitching me up took forever, too. By some miracle I wasn't ripped through the rectum, but it took over an hour for the top stitching guy to get finish. He was a jerk. He must have been having an awful day already, and having some crazy person who attempted a homebirth breech had added another task to his to do list. It was too much for him. At that point, I begged for pain relief. I couldn't deal with anymore. But the two things they tried did nothing. I felt every. single. stitch.

At long last, I was re-united with my mom and husband. All I could think about was the torture I had just gone through. "I was screaming," I kept telling them. I wanted to cry, but nothing came out.

Baby was still under oxygen with a million tubes. She was perfectly fine, but they were overzealous in their interventions. They didn't bother to bring her to me until 10 hours after she was born. And though I wanted to hold my baby, a big part of me didn't care. I didn't think she was worth what I went through. It would be a long time, months, before I could truly bond with her and not see her as the source of my suffering.

The most overwhelming sensations were of hurt and emptiness. I did not have any new baby euphoria. In fact, I didn't even care to see her. That was the biggest thing they robbed from me. They took away that magical moment when baby is born, and placed, mess and all, in my anxious arms and replaced it with pain and emptiness. Physical emptiness. I had been pregnant for a long 9 months, and suddenly, I was the most empty I had ever been. At least I could eat, now that I had room for it. But, ala, I was at a hospital.

And then, the hurt of how I had been treated, it stung deeply. We had transferred, hoping that if the cord was in a fine position, labor could progress in a gentle way. My midwives couldn't be seen as anything more than "friends" for fear of mistreatment from the staff, so their opinions stopped at the door. Once we arrived, we were given no say in anything. We were not human to the fellow humans shocked at our appearance.

I couldn't believe the pain and abuse I had just experienced and continued to experience during my time there. I had been trying to comfort myself with the thought of the pain ending during my ride to the hospital, (not that I really looked forward to a c-section) and now I had ten times more heaped onto my plate. I'm glad I didn't know before birth that I would experience a month of not walking from the pain of my stitches. God blesses me sometimes in just letting me take things as they come. 

The following days at the hospital were torturous. A few gentle souls treated us with charity, but we were hammered by most everyone and ridiculed for attempting to birth at home, much less with a breech birth. We must be idiots. It was a huge relief when they finally released us. I'll spare you the details beyond that. For however much we were treated as having no dignity, and those days at the hospital were the worst of my whole life, I'm sure that these people acted out of sincere ignorance and concern. They had never dealt with a transferred homebirth before and genuinely believed they had saved my baby's life and mine. 

The clincher was finding out that the cord was fine. It went down, and looped back up without wrapping around a leg or anything. We could have stayed at home. Home! I could have avoided so so so much. But "better safe than sorry,” right? Neither me, nor my midwives can turn back the clock and get a picture window to see that. When I had crawled out the door, baby had come down a lot more (we had a knee showing!) and we thought about turning around, but the ambulance had already been called.

I learned many things from the experience, and I think the best I can do is share:

-Breech babies just have a different method - a breech doing the splits is very very very very rare. Usually a butt first presentation is more typical, and in some ways easier than a head-down baby. Breech are just a different group of normal that doctors are typically not trained in anymore, but used to be considered no big deal. 

-Squats - those nasty exercises I was supposed to do daily throughout the pregnancy... and wasn't consistent about? Yes, some more leg strength would have been immensely helpful. They also encourage baby to be a in a good position. Sitting back in the chair does not. (darn!)

-Wiggle 'em hips... Maybe belly dancers have it right after all?

-Don't call the ambulance! Drive! Technically, we were completely within our rights to tell the ambulance where to take us, and we should be able to sue over them not following instruction, but we don't feel it is worth our time. Better to speed down the highway it seems. 

-If you let a breech baby be part of the way born at home, you can avoid the c-section (but better to stay completely at home!) I heard over and over how "lucky" I was that I didn't have a c-section. I suppose I am, but feeling traumatized and abused doesn't seem like a better experience. I still had a long period of painful recovery. 

-Find out if the hospital you are transferring to has ever seen a homebirth transfer before. The hospital we wanted to go to had and were much more welcoming. They didn't think the idea was crazy. The hospital we were taken to thought we had lost our marbles. 

-Demand more at a hospital. Much more. They shouldn't have kept my baby from me. They shouldn't have denied my rights at every turn. 

-And eat right during pregnancy. It is only a theory, but I discovered food allergies after my baby was born, and was able to solve her colic. Some think that a highly allergic baby will move a lot more inutero. Was my little girl so agitated that she couldn't get in a comfy head down position and eventually got stuck doing the splits? I don't know, but that end-of-pregnancy slow down never came, and we had a lot of challenges out of the womb. I didn't discover more about nutrition until later, so although I didn't eat a bad diet, I had more than my fair share of sugar and processed food. 

I also want to share the miracles, too, and not end on a sour note:

-Even though my baby was kept from me for 10 hours after the birth, she latched on beautifully and we've had a wonderful time nursing. 

-Baby did not have dislocated hips or other injuries from the way she was ripped out. 

-My tears seemed to have healed fairly well. 

-And I've been able to forgive everyone involved and recover from the experience. 

When I was at home laboring, it was hard. Really hard. People were trying to make jokes and keep the mood light so I could relax, but I couldn't laugh. I was giving birth! I made it to the point when I didn't think I could do it anymore, but the thing is, I was doing it! I had the right people around me for support, and I was doing the work I needed to do to birth my baby. My labor at home, for all that it was long and difficult and painful, was also empowering. And I hope and pray that next time, I get to bring the experience to completion and have the euphoria I've always heard follows birth. And it will be when I hold my new little one in my arms in that sweet moment.

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