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Sunday, January 2, 2011

Unmedicated vaginal breech hospital birth story in photos!

If you know this fabulous couple and their story, their doctor or hospital, please don't post their real names in the comments. This momma gave me permission to share her incredible story and photos so long as I blurred their faces and withheld their names. She has told her story far and wide and is proud of her accomplishments, but would like to not be associated with the photos as far as Google searches for her name and things like that. If it were me, I wouldn't want high school friends seeing pics like this, either. Maybe she will comment anonymously and fill in any details that I miss. (I'm still waiting for her to write her own birth stories!)

****THESE BIRTH PHOTOS ARE GRAPHIC. FACES HAVE BEEN BLURRED; THE BUSINESS END HAS NOT.*****

We'll call them Jessica and Eric. I met Jessica early in her pregnancy and we became fast friends. She was pregnant with her 3rd baby and was thirsty for info. I forget how our first conversation about birth came about, but it's probably not a surprise to you that birth and/or breastfeeding just happen to come up often when I'm around. It's funny how it works out that way. :-)

I try to sow seeds gently and see how much interest moms have. If they get defensive or change the subject, I (try to) drop it. It's better to leave it be and let them know I am here if they want to talk about it later. But Jessica took interest right away. I explained the Cascade of Interventions to her and some of the risks of some of the most common interventions. She was intrigued and wanted to know how it was that so many birth interventions were pushed on her without any of the risks being explained.

With her previous two births, she went into labor on her own (around here, it's a major feat to escape induction), and everything that was done to her in the hospital was done because of routine. She didn't want the epidural but had one both times because the staff told her, "Now it's time to get your epidural." She was led to believe that was safest for her baby, and that it was what everyone does. She did manage to have vaginal births both times, but she had quite a few side effects that she didn't realize were results of the epidural and other medications that were subsequent interventions (such as Pitocin). With her first baby, she pushed for 10 minutes and the OB gave her a deep episiotomy and pulled her son out with forceps. With her 2nd baby, she had told the OB that she did not want an episiotomy and did not receive one, but tore badly due to the epidural. Both times, Jessica had blood pressure problems as a side effect of the meds, as well as PPD, a disconnected feeling from the birth and her babies, and difficulties breastfeeding. Once she learned the cause-and-effect, she wanted to avoid duplicating her previous experiences.

Over the next few months, I recommended a lot of great books and articles for Jessica, including The Thinking Woman's Guide to A Better Birth by Henci Goer, Ina May's Guide to Childbirth by Ina May Gaskin, and Birth Your Way by Sheila Kitzinger. (There are plenty of other great birth books--see my Amazon.com widget to the right of my blog for others--but these are the ones I had on hand at the time.) I lent her my DVD copy of The Business of Being Born and asked her if Eric would be willing to watch it with her. I find that a lot of husbands are more willing to sit through an 84 minute documentary on birth and the failure of the American maternity system than to read a thick book on the topic. Besides, The Business of Being Born is short, riveting and easy to follow and hold attention for a layperson--even for a husband.

Jessica learned about birth plans and options and normal, physiologic birth. She and her husband were my first clients in my birth classes for my ICEA certification as a childbirth educator. She asked me if I would attend her birth as her doula. She started attending birth meetups to network with midwives, doulas, childbirth educators, homebirthers, and other birth advocates to learn what their birth options were. 

Jessica left her OB when she asked a few questions that led her to believe that her OB would be less-than-supportive of an unmedicated birth this time around. She interviewed several other care practices and started seeing a CNM (certified nurse midwife) with an OB practice at the hospital with the lowest cesarean rate around.

Things went along smoothly until her baby flipped breech at 35 weeks along. This was unexpected! I wanted to make sure that Jessica knew what her options were: even if her baby stayed breech, breech vaginal birth *was* a real, safe possibility. The most current research says that vaginal breech birth can be the safest option for some moms and babies. Jessica read everything she could find on breech and did everything she could to encourage her baby to flip vertex. Avoiding a cesarean (unless it was an absolute medical necessity) was very important to her.

Jessica re-read the full chapter on pros and cons of breech vaginal birth versus breech cesarean risks in The Thinking Woman's Guide to a Better Birth, as well as positive breech vaginal birth stories. In the meanwhile, she did *everything that could be done* to encourage baby to turn head-down on his own. She practically memorized the breech section of SpinningBabies.com. Jessica practiced inversion of various sorts as often as she could at home, including inversion over an ironing board leaned against her couch and inversion in a swimming pool. She tried hot/cold therapy and lights and music to coax baby head-down. She started regularly seeing a chiropractor who specialized in the Webster technique to encourage baby to turn head-down. She crawled down stairs head-first. One of the OBs at her midwife's practice attempted an external version. All to no avail. This baby was persistently frank breech, but fortunately, this is the safest breech position for vaginal breech birth, and one of the OBs at the practice said that Jessica was an excellent candidate for breech vaginal birth. I couldn't believe she found a hospital OB who would agree to take her on as a client! (Well, "patient," not "client," technically, but I get so miffed about perfectly well mothers being called "patients" when they are not sick! I digress.)

The OB was pleased that Jessica was planning for an unmedicated birth and told her that this would give her the best odds of having a vaginal breech birth. With a vertex birth, it's important to feel your body's cues to help baby rotate and descend, but it is even more important to feel and respond to those sensations with a vaginal breech birth. I was pleased that everything Jessica said that her OB said, lined up with the research. This sounds obvious but you would be amazed at how many times OBs' advice is contrary to evidence-based information.

I had my doula bag packed and ready and was on call for Jessica once she reached 37 weeks. Jessica had had sporadic stretches of contractions that kept her up at night for about a week and a half (commonly known as prodromal labor). At 38-and-a-half weeks, I received a phone call at 3:40 a.m. Jessica sounded calm but told me that this was probably it and her contractions were about 4-5 minutes apart and that she and Eric were leaving for the hospital after the drop their other children off with a family member. I had almost an hour's drive to the hospital and was out the door less than 10 minutes after receiving the call.

Jessica later told me that she had been managing to cope through the contractions with techniques I had taught her in her birth class, from a little after midnight until 3:30 a.m. so well that she didn't even bother waking Eric. Once they got closer together, that's when she awoke him and they got ready to go to the hospital, but she still felt that the contractions were manageable and tolerable. Once they got in the car, Jessica's contractions intensified suddenly. She was in transition and didn't know it.

I didn't know any of that. I arrived at the hospital at 4:40 a.m. and came to the OB floor front desk. I asked the nurses which room was Jessica's, and introduced myself as her labor support, then handed them a goodie bag with Baked Tostitos, salsa, and chocolate chip cookies as bribery of sorts. (I've read mixed reviews as to whether this will *actually* get a patient preferential treatment over the next 2-3 days that they will be admitted, but it was an inexpensive insurance policy just in case. Plus, nurses are underappreciated in general. It doesn't hurt to thank them and bring them food.) They told me Jessica's room number and looked a bit confused; they told me they've been trying to keep her from pushing. Whaaaat?

When Jessica arrived at L&D and explained who she was and that her baby was breech, there was a bit of confusion, and one of the nurses asked if she was here for a C-section ("Um, no! I'm here for a planned vaginal breech birth!"). Thankfully, her OB who had been on call specifically for her *had* been notified and was on the way. When the nurses checked Jessica, she was at 10 cm and the nurses begged her not to push until her OB arrived. Even in the midst of that chaos, the nurses tried to talk Jessica into getting the routine IV, which Jessica had already discussed with her OB. She asked for the hep lock instead. She had the presence of mind to advocate for herself at 10 cm!

I turned toward her room and saw the OB walk in seconds before me. Here I was with my bulky doula backpack loaded up with a camcorder ready to record the birth, a tripod, fake battery-operated candle for aromatherapy and visual comfort, heating pad, massage tools, my Labor Progress Handbook, and more. None of it mattered! Jessica was in the zone and already involuntarily pushing. The whole thing happened so quickly that there wasn't even time to turn down the bedsheets. Jessica was pushing on a chux pad on top of the blankets and sheets and everything. There was no time to move anything. I was up against the door--literally--camera in my hand and my hands shaking with excitement and adrenalin.

Folks, I realize that my photography is disappointing. I was nervous and rushed and cramped and at the foot of the bed. I was trying to take these photos with the camera raised overhead like you would at a concert. I didn't feel that it would be appropriate for me to ask that nurse to please move so I could get a better shot. But Jessica gave me permission to post her photos and I'm over the moon! I'm sad to say that attending a vaginal breech delivery is probably a once-in-a-lifetime opportunity. I remembered about my camcorder that was in my backpack, ready to go, and Jessica wanted me to record with it, but I literally could not reach it and could not set my backpack down. Things were going so quickly that I knew that I'd miss it if I moved at all.

Jessica started out pushing on her side. What you see is her bulging bag of waters--still intact!


Soon her water broke on its own. The rump started rumping (I guess you can't call it crowning?). What you see here is baby's testicles on the left (the darker part) and his bottom on the right, emerging.


More of baby's rump is emerging. His testicles are at 9 o'clock. He's passing meconium, which is normal for a breech birth, since he's being squeezed that direction.


OB gets ready to help rotate baby a little as he emerges.


OB is supporting/rotating baby a bit. His legs have emerged and baby is born as far as his belly. The rest of him just slid on out easily, after a grand total of about 10 minutes of pushing!


Congratulations, Momma! You did an amazing job! Jessica enjoyed skin-to-skin contact with baby and rooming in to help establish breastfeeding. With the right information and support, Jessica has been able to exclusively breastfeed her son, which she wanted to do but did not know how with her others. I love seeing Eric's hand lovingly stroking his wife's forehead in this pic.


First nursing



Dad Eric gets ready to cut the cord after about 25 minutes of delayed cord clamping.


After that, they weighed and measured baby while Jessica pushed out the placenta (on her body's cues, despite the nurse's INSISTENCE that she get it done in the first 10 minutes postpartum). Jessica's bleeding was so minimal that she did not need a shot of Pitocin. Isn't it neat to see baby's legs piked in the frank breech position with which he was so familiar?


This is Jessica's favorite photo from the birth, with her son's inky little feet from getting stamped on the birth certificate. (Gee, you don't want to frame the one with your son's rump "crowning"?)


This proves I was there.



Oh and by the way, Jessica didn't tear A BIT this time! She felt great and said she would do it again in a heartbeat! What a victory!

On one hand, I was thrilled and honored to witness this beautiful, rare natural breech birth. On the other hand, I was saddened--why should this be such a rare event? I heard one nurse say to the other, "Gosh, how long has it been since we've had a vaginal breech birth here?" to which the other nurse replied, "There was that one vaginal breech birth about 10 years ago," and the first nurse said, "No, I think that was more like 15 years ago."

Yeah. That ONE.

Edited to add: "Jessica" has posted in the comments below. If you have any questions or comments that you would like to post for her, I'll email her to let her know.

25 comments:

  1. Awesome! For my doula training I had to interview a mother over 60 & the lady I talked to had her 3rd baby vaginally and he was Frank breech too! Thanks for sharing! I will be keeping this in my inspiration file for my Doula clients! What an amazing, beautiful birth!

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  2. That was awesome! Thanks for posting! :)

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  3. Good job Sarah! Well written! Was wonderful to hear her birth story again. She'a so proud of her birth, which she should be!! Good photos, too. ;)

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  4. Fantastic birth story! I'm in awe that this mama found such a birth-friendly OB in this area!

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  5. "Jessica".......birth mommaJanuary 3, 2011 at 10:56 AM

    Thank you so much Sarah for working with me to get my story finally written out. I've struggled for months on where to start, what to include, etc, and you did a wonderful job putting it all together for me. I pray that this story could help someone to not have a bad birth experience like I did w/my 1st 2, and encourage someone who is contemplating a vaginal breech birth.You don't know how much your knowledge, support, and friendship has meant to me. Above all, I thank God for his guidance. Through much prayer and support from my husband we really felt a peace that we were making the right decision. I'm happy to give Him the glory :)

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  6. I've been waiting for this one! Yaayyyy! How a-mazing! Truly, TRULY amazing! Great job, Momma! So inspiring!

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  7. I love it!!!!! Thanks for sharing Sarah and thank you for sowing seeds of info among others. It can be discouraging when so many are not interested in natural birth, exclusive breastfeeding, etc, but sometimes we really do get to inspire someone in that direction, and it is a phenomenally gratifying when it happens.

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  8. Wow, wow, wow! Beautiful and inspiring!

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  9. So wonderful! I am thrilled she found a supportive OB and that her birth went so well.

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  10. so amazing and beautiful..brought tears to my eyes. I loved hearing this beautiful story and the photos are wonderful. What an awesome Mama, and amazing labor support. And yes, it is such a shame that this type of birth isn't considered normal. So glad she found the support she needed and educated herself with the right information.

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  11. Thank you for posting this, and thank you to "Jessica" for sharing her experience. We're due in 3 weeks and although we're still trying to do everything we can to flip our breech baby, we're starting to plan for the possibility of a vaginal breech birth. It's hard after having had our son at home, in a birth pool, with no challenges/interventions, etc. So I'm trying to find as many positive vaginal breech birth stories as I can to get into a positive frame of mine. It will be at a hospital, it will be much more medicalized (e.g. the OB said she needs me on my back and she wants to put in an IV tube and epidural (both without any medication, "just in case"). I know these are important to make everyone feel comfortable, but it does make me feel less comfortable. Wish us luck!

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  12. Ripples of Motherhood, best wishes to you! Your baby does still have time to flip (possibly even during labor). I'm glad that you have found a care provider who is willing to attend a breech vaginal delivery if your baby doesn't flip, but I'm curious what her reasoning is to insist upon routine IV (as opposed to hep/saline lock) and epidural--other than the fact that it's faster to do a C-section.

    I haven't seen any studies or even articles to suggest that vaginal breech birth is safer with a routine IV nor with an epidural. Particularly in the case of the epidural, that's the opposite of what I have read pertaining to preparing for a safe vaginal delivery. "Jessica's" OB told her that NOT having the epidural was going to be crucial in her success of having a safe vaginal breech birth, since it was extremely important for her to be able to feel the sensations of his descent so that she could respond appropriately to the her natural urges to push on cue. If she had been anesthetized, it would have been far more difficult to bring her baby down in an efficient manner.

    Since you mentioned that you are hoping to have a birth with as few interventions as possible, you might be able to ask your OB if she can show you the studies to back her suggestions. Is it a provider preference, or can she show you reliable studies showing a difference in safety & maternal and infant outcomes in vaginal breech deliveries with versus without epidural and/or IV? Maybe your OB can accommodate your requests.

    I hope you have a beautiful birth, whatever choices you need to make based on your circumstances.

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  13. Thank you, and thanks to Jessica, for sharing this story.
    Like the commenter above, I am trying to fill my brain with positive stories of vaginal breech births. Our baby was confirmed breech by ultrasound at 36 weeks, and by 37 weeks, my midwife still felt what she strongly believes to be his head up near my ribs. Like Jessica, I've been trying everything to coax him along to the head-down position. I've even promised him a puppy! We will go in for a scan on Thursday morning to see if he has managed to turn, and then they will attempt a Version. If that doesn't work, they will want to schedule a c-section at 39 weeks... I want to give him as much time as possible to make the turn on his own. My midwife will support me in a vaginal breech delivery (we were hoping for a natural birth at home in water--pretty much as far from a c-sections as you can get!), but I will have to deliver at the hospital if he remains breech and I know they will try to push a c-section. I am trying to remain positive and hold onto hope that he still might go ahead and turn on his own.
    Thank you for sharing this birth story and information about breech deliveries.
    R.

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  14. R.- Thank you for sharing your story. I hope your baby turns head-down soon! The promise of a puppy is too alluring for baby not to take on that challenge. If not, you're doing well by preparing yourself for your options for breech vaginal birth.

    I hope you come back and tell us your birth story. Best wishes for a positive birth in every way.

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  15. Thank you for sharing your story, that is awesome that you had a birthing team that supported your decisions. I had a vaginal breech birth at home. We found out that he was rump first while in the birthing tub. It was my midwife's first breech birth. It was amazing!

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  16. WOW! Love this story. So inspirational. Here is hoping for more natural breech deliveries to come. Stand Strong breech mommies and insist on your power to push and your right to not be cut! Breech is just another variation of normal!

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  17. midwife sue { amazing birth glad all well just thought id let u know that some places still encourage breech vaginal births.im in uk at my unit we prob get one a month usally delivered by a midwife if nice and *normal* often a second twin. my last breech? it was a homebirth just over 2 yrs ago. happy birthings

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  18. What an incredible story! I am so happy that she found a doctor who would do this for her! There is hope after all....
    Thank you for sharing.
    And congratulations to the parents.

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  19. At 38 weeks, my baby is not flipping. She's head up and facing my left side. I want to do what is best for her. I;m so torn. I have changed to a birthing center, where the OB is well versed and experienced in breech births. The other hospital that I was assigned to (we are military) would only talk about c section. I didn't want that to be my only choice. But now that it comes down to it, I'm getting scared. Not about the pain. Pain is relative, and I have had 2 natural births in the past. I'm using hypnobirthing to help me with the "pain". My worries are with the baby. Why has it been so engrained in hospital OBs that breech deliveries can harm the baby? Why do they feel they need to instill this stress and worry into our heads? I have decided to have a breech water birth. To give it my all, my best.

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  20. @MegaSway Best wishes for you to have your breech water birth. It sounds as though you're in good hands and prepared, and that you're a "good candidate" for breech birth. Let us know how it goes, I'd love to hear an update. facebook.com/wellroundedbirthprep or wellroundedbirthprep at gmail dot com.

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  21. I,too,had a unmedicated vaginal breech birth! I had an ultrasound the day before my induction and she was head down. Somethime during the day she flipped and I delivered my daughter a surprise frank birth with no meds in less than 2 hours!b My Dr was incredibile!

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  22. I am the mother of five children, four were breech, all a little different, dangling footlings, frank, successful version, only one c-section...3 were delivered vaginally and there were so many doctors, students, residents and nurses in the delivery room each time..because it was something that was rarely seen - the delivery of breech babies vaginally...typically the doctor/mother would opt for a c-section. With mine minimal medication was given in order for the contractions to be felt, so I was able to assist in bringing the babies down and out....when the head is not presenting first, Mom really has to help push baby through the birth canal. Lots of work, but amazing!!

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  23. Wow, 2 more testimonies of vaginal breech births! This is so encouraging, ladies. Thank you so much for sharing your stories. You are giving strength to other women who are researching their options to see what's best for their situation.

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  24. Sadly, we won’t be bringing our sweet baby boy home tomorrow. Instead, we will be burying him. Our sweet, much loved and much desired little grandson perished last Friday as he was struggling to be born. His cause of death was head entrapment. He never had a chance.

    He was a footling breech, but the positioning of the placenta made it impossible for his mom to deliver him via C/S. Extraordinary measures on the part of medical staff could not deliver his head . He died with half of his body protruding from his mothers birth canal, and half still in her pelvis. She, our little Eli who was no longer alive, and his Daddy had to remain in this position for over an hour waiting for his mother’s cervix to release it’s grip on his head so he could finally deliver.

    He was never able to take a single breath, never able to open his eyes, never able to grasp our fingers with his little hands. Not even once.

    His birth was a hugely traumatic event for the 20+ medical personnel who tried so very hard to save him. These are super experts with every advanced technique, true expertise and experience, and all possible equipment available to them. These are super specialists who are known for their ability to beat poor odds. But they could do nothing to change the outcome of Eli’s birth despite their heroic efforts.

    In the end, our little Eli’s strong steady heartbeat fell from strong and vigorous, to thready, to nothing. His poor bruised little head finally delivered on its own, long after his heart had beat it’s last.

    His mother and father are devastated and traumatized. His mother suffered physically traumatic procedures to try to help him and suffered internal injuries as a result. She hemorraged after his birth and was at high risk of bleeding out. She underwent emergency surgery to save her life.

    Eli’s OB is traumatized and wept openly. His neonatalogist and perinatalogist is are both deeply shaken. Everyone in the room was crying.

    This all happened at one of the four best institutions in the USA for handling obstetrical and perinatal emergencies. The best of the best.

    Head entrapment does happen. The results are tragic. The interventions are few and brutal. The outcomes are poor. This condition isn’t a joke or a myth. It is all too real.

    If your OB tells you that you are at risk for this complication, please don’t blow him or her off. Please don’t “doctor shop” or worse- seek out a midwife who will reassure you that the vaginal birth you desire will turn out well. Please don’t seek to find someone who will agree with your desire to have a vaginal birth. Don’t let well meaning advice from others sway you. It isn’t worth the risk. It isn’t worth a life, or maybe two.

    We will never forget the things we saw that day. We will never forget holding our precious little Eli, so still in death, and caressing his poor bruised head. We will never forget the heroism we saw that day, or the heart. We will never forget the agony of every moment and the zeroing of hope with each second of entrapment.

    Will this happen to you? Maybe not. But, is it worth the risk to find out?

    If you are the mother whose child dies in this horrific way, then the mortality statistics are 100 percent for you. And they are very high for any child who becomes entrapped.

    I’ve learned that this kind of event is considered to be one of the the worst nightmares for OBs. Ask questions, get a second opinion from a high risk OB. Listen. Please don’t take chances.

    Yes, vaginal birth is beautiful. It is preferred. But, please don’t risk your baby’s life to experience it.

    If even one of you makes a choice that avoids the loss we have experienced, then Eli’s death will have served some purpose.

    Please love your baby more than you want to experience vaginal birth. Don’t take the chance of walking the hard road we have found ourselves on. Please. It is a road of lost hopes and shattered dreams. Please do not join us on this empty road.

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