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.