Wednesday, 7 February 2018

Night of the full moon: Sprite's breech birth story.

She is here!


Sprite, who in real life shares a name with this race car driver  and this tree arrived safely and swiftly on her due date, January 31st. Here is our story.

First of all, a recap of a few details:

  • Healthy pregnancy, with only issues being severe nausea in the first trimester, gestational diabetes diagnosed in second trimester (diet controlled). Compared to first pregnancy, I had much less anxiety.
  • At 37 weeks, an ultrasound showed Sprite footling breech.
  • Shortly after we started a variety of things to encourage Sprite to turn. Chiropractic work (Webster protocol), moxibustion, inversions, acupuncture and external cephalic version (ECV). First ECV, unmedicated, at Designated Hospital failed to get Sprite head down.
  • After ECV failed, we asked for a consult with the breech delivery team at New Hospital. Ultrasound showed Sprite still footling breech. We were given two options: 1) continue to monitor her position and 2) try the ECV again with spinal block. We decided to try both
  • During 2nd ECV Sprite was successfully turned twice, and turned back to breech, twice. I struggled with the spinal block and the operating room atmosphere. I really wasn't looking forward to a c-Section now, but we went ahead with scheduling a c-section at Designated Hospital and discussing gentle Caesarian birth with our doula.
  • At 39 weeks, however, another ultrasound showed Sprite in the frank breech position (bum down, feet up). We also met the other criteria for a breech birth at New Hospital: not too large baby, amniotic fluid good, no cord issues, healthy baby. The fact that I had had a previous vaginal birth also improved our chances. We rescheduled our c-section for a few days after the due date in hopes that it wouldn't be needed (but I wasn't willing to go a long way past due date to meet our baby, either).
 Week 39, and the consult with the doctors at New Hospital marked at turning point in my mental state. I felt very ready to have this baby, one way or another! I felt quite good about our decision to attempt a breech birth, but also a little anxious. There is a bit of history (and politics) around breech birth and why it is not widely available, but I won't get into that (this will be a long enough entry without). Speaking for myself, I know people who have had a cephalic vaginal birth (including me), and I know people who have a had c-sections, but I don't know anybody who has had a breech vaginal birth. Knowing that we were taking "the road less traveled" caused some trepidation and self-doubt.

There also wasn't a lot online or in my birth books to give me confidence. Most websites talk in general terms about why breech births are no longer common (OBs have lost the skills over a generation or two, and/or breech birth is considered riskier, if not by doctors then by their insurance companies). I did find and watch some videos of breech birth, but while fascinating these were either home births or happened in different countries: they didn't show the way our birth was supposed to take place. My "Birthing From Within" book only included one breech birth story, and it happened in a hospital and was a negative experience, unfortunately.  The literature that would usually give me confidence was almost all about cephalic birth, which didn't exactly erode my confidence, but didn't help it much either.

Ina May's Guide to Childbirth did include one breech birth story, and I found it helpful. In this story Ina May talks to a first time mother who is carrying a breech baby and is worried that it is too big to get out of her. "You're going to get HUUUUUUGE" Ina May assures her, and forms her hands to the size of a grapefruit. During her birth, the mother repeats "I'm going to get HUUUUUUGE" to herself as a mantra, and she does, delivering without issue.  Ina May also shares other images of the female body getting huuuuuuuge, including one of my favourites, the Sheela-Na-Gig. With this in mind I came up with an inspiring image for myself: a grapefruit with a Sheela-Na-Gig drawn on it.


As it turned out, I never got around to drawing on my grapefruit and taking it with me to the hospital (I drew this one after the fact). But the mental image of it did help give me confidence.

So what was our plan? We discussed the following at our consult with Dr. W at New Hospital:

  1. If my water broke, we would go immediately to New Hospital
  2. If I started contractions, I could labour at home for a while, but not as long as one would for a cephalic birth (maybe a couple of hours at most), then I would go to the hospital
  3. At the hospital, baby and I would be assessed and another ultrasound performed to check baby's position
  4. There would be constant fetal monitoring. However, other than that, no interventions such as pitocin. The idea is that, if it is going to happen, a breech birth will happen on its own.
  5. Time limits on transition (90 minutes) and pushing (60 minutes). Dr. W reassured me that for second time moms in particular, those are very generous limits. However, going over those limits and/or fetal distress would be reason to have a c-section. 
  6. The birth, or "pushing" phase would happen in the operating room with a full team standing by in case c-section was needed
  7. I asked about epidural. Dr. W. said it was mostly patient choice. It is easier to push without an epidural. However, that was more for first time moms: he didn't think it would make much difference for second time moms. In the case that forceps or an emergency c-section needed to be done, it helped to have an epidural placed in advance, otherwise they might have to use forceps without anaesthetic (ouch) or use general anaesthetic for surgery. I leaned toward no epidural as I knew it had limited my movement with AJ and I felt that if I was going to have a successful breech birth, I needed to be able to move my body.
  8. Dr. W went over worst case scenarios. The head might get stuck, leading to asphyxiation or spinal damage. If they couldn't get baby out, there was a "hail Mary" operation where they cut open the mother's pelvis, which has a high chance of maternal death. He added that nobody in the hospital had ever done such an operation and it was very unlikely, and I was a good candidate for breech birth. I listened to the reassurance but of course it was scary to contemplate these possibilities. 
After the consult, Dr W did the membrane sweep. He was able to open the cervix a couple of centimetres.  I went home feeling like I could go into labour anytime now, the sooner the better. I thought that once I was in labour I could cope with it, but it was uncomfortable to be waiting to see what would happen. But other than an increase in Braxton Hicks and some spotting, the next days were quiet.

Over the weekend I finally finished packing the hospital bags. I kept busy with various chores and other procrastinated tasks. I grocery shopped and cooked and  baked. Mr Turtle was at home with a bad cold. Tuesday January 30th, I talked about possibilities for labour induction with our doula. I had an appointment on the 31st to have the membranes swept again. Our doula, Joanna, also suggested acupuncture to encourage a strong labour.  I scheduled the appointment.  But then we started to have doubts. Joanna had another client who was very overdue. She was concerned that we might go into labour at the same time. Mr Turtle went to see his doctor who sent him to be tested for influenza. He raised concerns about a newborn being exposed to flu, if he had it. So by Tuesday evening I was leaning toward not inducing the next day.  I picked AJ up from daycare and as we were driving home I pointed out the big, full moon in the sky. It was of course the super blue blood moon. We had a nice dinner and I had a snack around 8:30 pm and went to bed.

Credit: Neight Elder

I woke a few minutes after midnight on the 31st with liquid pooling between my legs. I registered "water break!' and jumped out of bed fast enough to save the sheets and mattress. It was a very weird sensation. I threw on a pad and went to find Mr. Turtle, who hadn't gone to bed: he was playing video games. Mentally we found the right place on our "flow chart" of possible events (water break=>hospital!) and went into action. Phone calls were made to my FIL to come pick up AJ, who would spend the night with them then go to my mom's. Our doula was notified and asked us to let her know when we were checked into the hospital. I got sort of dressed. My pad had already soaked through. No contractions. The in-laws had arrived and we were ready to go by about twenty to one. I tried to tell AJ what was happening but she seemed too sleepy to respond. However, according to FIL she knew exactly what was going on and told them on the car ride over.

It was a quiet night and we had about a 15 minute drive to New Hospital. I was mostly calm but also had some anxiety. When had I last felt the baby move? There was no discernible movement at the moment. What would they find at the hospital? what would happen next? The radio played mellow Celtic music...such as the song "Both Sides the Tweed." I sang along quietly. I thought I felt some gentle contractions: little more than Braxton Hicks.

We arrived at the hospital. I was having more noticeable contractions as we walked in, but nothing painful and I had no trouble walking and talking. I started paying some attention to my breath, but more to practice than out of necessity. We checked in and went to triage. I was hooked up to monitors which found a strong steady heartbeat (phew). An IV was placed as this was standard for breech deliveries. I sat on the bed with the back up high as that was most comfortable. My contractions were getting stronger, and I felt them mainly in my lower back. I started to cope by sitting up straight and digging my fists into the mattress. As they became more intense I would also press my fists into my lower back. Despite the IV I still felt thirsty and sipped water regularly.

When the triage nurse heard we had a breech baby, she said "Breech births are so cool!" I found this statement reassuring. "Oh, so you've seen some?" "Oh yes!" she said enthusiastically. This helped me to feel like I had come to the right place. The resident I saw next did not inspire the same confidence somehow. Although she said and did all the typical things she did not seem very sure of herself. She asked if I have been told the risks of breech birth. This brought to mind asphyxiated babies and pelvises sawed open: images I didn't need at the moment. I said yes, I was aware of the general risks but with regards to my particular case, I was relying on their expertise to stay informed. Dr. Resident then did an ultrasound. She took a long time to locate both legs but was finally satisfied that they were up and no feet were presenting. She also did an internal check and said I was dilated 4 centimetres. This was encouraging and I continued to visualize grapefruit. (For comparison, I was only 2 centimetres dilated after 24 hours when I was in labour with AJ).

Next the OB on call, Dr. Z came in. She said we were good to do "trial of labour."  There was some uncertainty if I'd signed the consent form for breech birth because I didn't remember doing so, but I must have because I didn't hear about it again. She said that the plan was for me to labour mostly "hands off". Because my waters had broken, they would avoid doing many internal checks. I believe she said they wouldn't bother again until I was "quite uncomfortable".  Dr. Z went over mostly the same information I had discussed with Dr. W earlier. The ward was quite busy so we stayed another 30 or 40 minutes in the triage room. I went to the bathroom. I was starting to cope more actively with labour and the contractions were about 5 minutes apart. I tried not to think too much about them and when Mr. Turtle timed them and told me, I said that was nice but I didn't really care.

Finally, a birthing room was open (around 3am, I think) and another cheerful nurse came to show us there. I walked on my own. I had to stop a few times on the way to the room to lean on the wall and breath through the contractions. Cheerful Nurse sang the praises of the labour nurse assigned to me: her name was Janet and she had been a midwife in England. As we walked to the room Mr. Turtle and I joked about  my butt hanging out of my hospital gown, the fact it was a full moon and how we hoped to see another "full moon" tonight as our baby would be born butt first.

In the birth room, I climbed back on the bed with one foot curled up, one foot down. I was slightly annoyed that the bed was too high for my dangling foot to reach the floor. The contractions were increasing in intensity and frequency and I started to vocalize through them, mostly low hums and grunts. Janet was very steady and helpful. At one point I stood during a contraction and leaned on her. She definitely helped me feel safe and calm. I asked for a hot pack and Mr. Turtle put it on my lower back during contractions. My attention was starting to move inward and the other people in the room felt like they were at a distance from me. I was still hooked up to the heartbeat monitors but I wasn't paying too much attention. The monitors needed frequent readjustment because true to my intentions I was not sitting still. There was not much of a break between contractions anymore, and I was starting to feel them in front as well as in my back.  Janet kept trying to take my blood pressure between contractions but there was some kind of problem with the cuff: it wasn't getting an accurate reading. She finally gave up. But all this contributed to a fuzzy sense that baby and I were on one timeline and everybody else was on another.

After I had been in the birth room for a while I felt like I really had to pee, so I went to the bathroom. Nothing happened though, and I rode out about 3 contractions on the toilet before giving up. Janet asked if I would like a birth ball, and I said yes. I sat on it and leaned on the bed, which was where I stayed for the rest of labour. I came out of my daze long enough to ask Mr. Turtle if he'd called Joanna to update her. He said no, he'd better do that. In the back of my mind I thought we should have called her a while ago but I wasn't able to focus on the thought.  My labour continued to get stronger and I started to vocalize very loud. I was staying ahead of the contractions mentally and with my breath but it was getting very challenging. Joanna heard me groaning over the phone and was a bit shocked, realizing that things had progressed quite far. She started on her way.  My body temperature was fluctuating. In between contractions I felt hot and threw off my skimpy hospital gown. But during contractions I felt cold. I managed to communicate (with difficulty) that I wanted the gown off between contractions and over my shoulders during contractions.

Sometime around 4am (I'm estimating) Janet went on her tea break, and Michelle came in to cover for her. I vaguely heard Janet updating Michelle, telling her that I had started off coping easily but that it was getting more difficult. I continued to sit on the ball and lean into the bed, and was beginning to feel a bit frantic. Michelle asked if I wanted laughing gas. I said OK. The gas canister arrived and I felt like I was watching everyone move in slow motion, trying to get it set up. I had the impression the hose on the tank was all tangled up and they couldn't untangle it. This was probably not true but in any case the gas never made it to me.

The contractions were incredibly intense now and I felt like I was right at my limit, maybe over it. I started to howl and yell in a less mindful way during contractions. I felt like they were overtaking me and I was losing my ability to cope.  Michelle asked me at one point if I felt the urge to push. I said yes, a bit. She asked if I felt that only during contractions or also in between. I said only during contractions, but I was not really sure. Despite my intention to labour without an epidural, I thought an epidural sounded awfully good right now. But before I could find the words to vocalize this thought, I had the most irresistible urge to push.  It is hard to describe as I have never felt anything like that. Ina May Gaskin gives this advice to women who are afraid of what happens in labour: "Let your monkey do it." Meaning, don't try to intellectualize or control what is happening: labour as if you are an animal. My monkey was now 100% in control. I could only holler: "I need to push! I need to push!" while my body bore down madly. It would have been about 4:15 or 4:20 now (I was not looking at the clock, obviously).

I think Michelle said: "If you are feeling that way, you need to get back on the bed!" but she might as well have told me to hang upside down from the ceiling: I had no idea how to do that. I squatted over the ball and pushed with every piece of my being. Strangely, there was no pain anymore, just the feeling that I was about to take the biggest dump of my life. Suddenly, I was startled to feel something globular and wet between my legs....not a poop! I began bellowing "The baby is coming! The baby is coming!" The evidence of this very thing was plain through my mesh hospital underwear. I rather regret not having the presence of mind to notice Mr. Turtle and Michelle's expressions at that moment. Michelle now insisted I get back into the bed, which was not at all easy to do, considering my urge to bear down and the fact that a baby was falling out of me. Left to my own devices, I probably would have spread my legs and said "Ready....set....catch!" As it was Mr. Turtle and Michelle somehow got me onto the bed: I have no idea how but I guess they each grabbed a leg and hauled. The hospital underwear also disappeared at some point.

Every bright blazing light in the room was turned on, and people began pouring in. I continued to yell that the baby was coming and who knows what other nonsense. Everyone kept paging for a doctor, and it seemed to take forever for Dr. Z to arrive, although it was probably only a few minutes. I was vaguely aware that we were supposed to be doing this in the operating room and that it was not going to happen that way: was that bad? But mostly I was in the moment, and not focused on "should have beens." My feet were put in stirrups and Mr. Turtle and Michelle were holding my hands since apparently I kept reaching down to the baby (but I have no memory of this).

Finally Dr. Z and Dr. Resident were both in the room and everybody seemed organized. Someone told me the baby was peeing. This humourous and prosaic detail was reassuring (she also pooped, as breech babies usually do). With everyone in position, I got instructions to take a breath, hold it, and count to 10 as I bore down. This was briefly confusing to me because I did not feel like my conscious mind was in charge of pushing: it just happened. But I managed to reconnect with my body and bore down on cue.  Again there was no pain: just a burning sensation as the perineum stretched. It was simply a physiological urge on a magnitude I had never experienced. But it didn't matter what I knew or didn't know. Let your monkey do it. 

One push, another push...or two...I knew she was coming but I could not see her.  The last was the head. This is of course the critical part in a breech birth, but I was not worried: this baby was greased lightning and she was not going to get stuck now. Dr. Resident was pressing on my lower abdomen as I pushed out the head. Suddenly - plop! I see a baby. She is grey and purple looking but has a human face and open eyes.  It is 4:29am. They put her on my abdomen. Mr. Turtle gets to cut the cord. I was apparently laughing and cheering madly....in an ecstasy Mr. Turtle said. All I remember is being astonished at what I have just done.


Sprite was put on my chest and was immediately alert and active. She was crawling around on my chest looking for a nipple, and somebody helped her to latch. She remained at my breast for the next hour, nursing on both sides. Joanna arrived shortly after the birth. It is too bad she missed it but it was great to have her there to assist me and talk to me after the birth. It also allowed Mr. Turtle to go take a nap, since of course he hadn't slept all night and was sick. One great thing about New Hospital is all the birth rooms have a bed for the support person to sleep in. 

I had some difficulty delivering the placenta as my bladder was very full. They had to put a catheter in to empty it, and then I pushed the placenta out. I also had a second degree tear which required some freezing and stitching. All the mucking about in my nether regions was uncomfortable but at least I had Sprite to distract me.

The high I had from the birth lasted all day and I felt very peaceful and blissed out.  In the pictures from after the labour I notice how healthy I look, compared with after AJ's birth. I bounced back quite quickly: it was much easier to go to the bathroom and regain normal functions without the after effects of anesthetic or major tears. We left the hospital a bit over 24 hours later with a healthy baby and happy mom and dad. Breastfeeding has continued to go well. I had a couple of hairy nights when Sprite was cluster feeding, but it served to bring my milk in and she is quite a chill baby so far. As of this writing Sprite....hereafter Dani....is a week old, alert and responsive, a great feeder and a decent sleeper for a newborn. Mr. Turtle was able to take a couple of weeks off work so we have been relaxing and settling into our new life as a family of four.

AJ has been doing really well, too, I think. She talks lovingly of her "baby sister" and likes to give her gentle pats and kisses. She is working through the idea of an expanded family in her own way: For example she likes to count us: "One....two....three....four!" and give us titles: King Daddy, Queen Mommy, Princess AJ......and Princess Dani. But I feel like I have lost my oldest baby. AJ was always little to me, and now she looks huge by comparison. She is indeed the Big Sister, and although I love her to pieces just as she is I feel like she has grown up even more since Dani was born.  The contrast is just too obvious.


I look forward to writing more as we embrace our new reality, both joyful and poignant. Thank you to everyone who reads and I wish you many blessings on your path.




18 comments:

  1. What an awesome birth story! I'm glad that everything went so well! Congratulations and welcome Danika. Can't wait to hear how life with two kids is going for you. :-)

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    1. Thanks! Enjoying life with 2 so far: mind you we are still on holiday/doing some winter hibernation. But everything feels miraculous.

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  2. This is an amazing birth story!! I am amazed at the clarity with which you are able to recall everything. You were more in control than you think! And holy wow—that after birth picture, you look amazing and beautiful and nothing like someone who just naturally birthed a breach baby!!!! Amazing job Mama!!! Congrats a million times over!

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    1. Thank you! *blush* Yes, I feel so lucky with how it went especially considering the extra worry beforehand. I’m also so grateful for all the support and choices and excellent health care. All that makes a big difference.

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  3. Congratulations! What a beautiful picture of the two kids together <3

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    1. Thank you! It is a lovely thing to see!

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  4. Wow, what a birth story!! And Bravo to you for trusting your body and doing this. The outcome is absolutely wonderful and I wish all 4 of you a lifetime of happiness.

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    1. Thank you! It was an amazing experience. Yay for new beginnings!

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  5. Woman YES!!! How incredible and what a contrast to AJ's birth. I'm so happy it all went so well. You give me hope. Bean Sprout took 48 friggin hours, pitocin and an epidural ... I hope my next flys by like yours did!

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    1. Thanks! Ha, sounds like we had similar first labours. Fingers crossed that you have a smooth one!

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  6. HOORAY! I've been checking in daily and am thrilled to see the arrival of adorable baby Dani. That last photo of your girls together makes me so excited for when our little one arrives and I'm thrilled you avoided having a c-section. Congratulations!

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    1. Hooray indeed! Yes, excited to see the sibling relationship develop!

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  7. Congrats! Welcome to the world Dani! I left a few comments on previous posts and sadly my phone glitched. Anyhow you’ve been in my thoughts. I loved reading Dani’s birth story. You did such an amazing job with the road less traveled and in less than 5 hours. It’s sad that there aren’t more birth teams able to take on breech births. I also used the “I am going to get huge!” visualization. Loved it! But of course I love birth! You look like you are glowing.

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    1. Great to hear from you Marcy! Ha, that’s too funny we used the same visualization. I guess it works. I kind of hope sharing my story might encourage someone in a similar position. I’m so grateful it went well and I gave a beautiful baby and feel great mentally and physically.

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  8. Aw such a fantastic story! I'm delighted you were able to deliver her naturally and everything went so well! Congratulations on your beautiful family! Reading this also makes me feel less anxious about my birth coming up in a few weeks :)

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    1. Thanks! Hurrah for less anxiety! Enjoy the last few weeks.

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  9. Congratulations! So glad everything went well and she arrived safely! <3

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