Planned VBB, John Hunter Hospital Newcastle, 22/02/2013, Birth stool
My breech birth journey began at my 36 week anti natal appointment when my midwife told me that my baby was breech. An ultrasound the following day confirmed that the baby was in a frank breech position. Over the following weeks I tried everything in my power to try and turn bub, including ECV, moxabustion, breech inversion/tilts, hot/cold packs, and acupuncture. But despite my best efforts my baby remained happily breech.
Not knowing much on the subject I automatically assumed that I would be booked in to have a caesarean, however my midwife suggested that I explore the option of a vaginal breech birth. Despite my initial shock, I began doing as much research as I could on vaginal breech births and the more I read the calmer I began to feel and I accepted that this was the way my baby wanted to be born.
Armed with a page full of questions, at 37 + 4 I had an appointment with an Ob at my local hospital in Gosford to discuss a VBB. He was very positive towards breech and was encouraging me to birth there, however the approach that he explained was for a forceps delivery with a possible epidural and episitomy which didn't quite sit right with me and what I had read.
My midwife then suggested that we make an appointment at a larger hospital in Newcastle, 1½ hours away, where they had a specific breech clinic and were known to be experts in VBB's. We thought it couldn't hurt to get a second opinion so we went there the following day. This hospital was even more encouraging and passionate about breech being “just a variation of normal” and were also keen for us to birth there. They talked about the 'hands off' approach for a breech delivery and put us at ease regarding all the risks that we were worried about.
We then found ourselves in the extremely fortunate position of having two public hospitals that were willing and happy to attempt the breech delivery of our baby. However after some discussion we decided to travel to Newcastle hospital as we felt their approach was more in line with the current research we had read about breech birth. I had now gone from feeling completely stressed about the position my baby was in, and terribly upset about possibly missing out on naturally birthing my baby, to super excited and confidant about a VBB.
Over the course of the next few weeks I had a weekly appointment at the breech clinic, each time seeing the same OB and my midwife L, both of whom were passionate about breech. My midwife hadeven delivered her own daughters undiagnosed footling breech! I also had several ultrasounds during this time to check the baby’s weight and position. The hospital had a few guidelines they liked to follow regarding breech births, including spontaneous onset of labour, reasonably paced progression of labour, and foetal weight of no larger than 4kgs.
On Saturday 16th February my due date came and went with no signs of action and even though I knew it was common for a first pregnancy to go over,I was starting to get a bit anxious. Since around 39 weeks I had been doing everything I could think of to bring on spontaneous labour including acupuncture, walking, swimming, and bouncing on the ball, although nothing seemed to be working.
At 40+4 I went in for my weekly appointment at the breech clinic. I’d had another ultrasound the day before and was told bub was doing perfect and was at an acceptable weight so my Ob was willing to give me another week to see what happened. However we did make a plan for an ARM (Artificial Rupture of Membranes) the following week even though it wasn’t really recommended to be induced. I was sure I would go into labour before then though as my midwife L also did an internal examination and told me I was already 3 cms dilated and gave me a really good cervical stretch in the hope of getting things moving.
And move they did! The following evening at 7pm I stood up from the couch and my waters broke, hooray! I rang the hospital immediately and they told me to make my way in as soon as possible. With bub being breech they wanted me to labour there so they could keep an eye on things. So we set off on the hour and a half drive to the hospital. During the drive I started having very irregular contractions anywhere from 5 to 15 minutes apart and lasting an average of 30 seconds. They were not painful as I was still happily chatting away to my husband and mum. I was telling them both that this is how it was all meant to be as my midwife L ,who is experienced in VBB's, was going to be on shift that night and the breech expert OB was going to be there in the morning! I was not the slightest bit nervous or scared, just super excited that it was all finally happening and I was soon going to meet my baby.
By the time we arrived at the birthing suite it was 9pm and I was having steady mild contractions about 7 minutes apart. After getting ourselves organised, around 10pm, my midwife decided to do an examination to get a baseline of where I was at, which was 4-5cms. She also discovered that baby was posterior but would hopefully rotate during labour. She encouraged us to go for a walk outside to try and keep things moving but to be back at 11.30pm to check baby’s heart rate. So off we went for a wander up and back out the front of the hospital, lucky it was summer!
My contractions were now coming 5 minutes apart but still weren’t very painful, however I was feeling a lot of pain in my lower back due to the posterior position and I remember saying to my mum that I didn’t know how I would stick to my birth plan of minimal pain relief if this back pain keept up.
When it was time we went back upstairs so they could put the foetal monitor back on. I positioned myself on the ball so my husband could rub my back which gave me some relief. After a little while we decided to go back out for a bit of a walk but were told to be back by 1.30am for another check. This time we paced up and down the empty corridors of the hospital, one of the advantages of a night time labour!.My contractions were now about 3 minutes apart but still manageable by stopping and breathing through each one. I was so proud of myself and how I was managing but my mum reminded me that they were still fairly spaced apart and I probably had a long way to go yet!!
When we got back to the birthing suite I decided that I had had enough of walking and just wanted to stay put and find a position that was comfortable to deal with the contractions that were now getting stronger. I also now had to keep the foetal monitor on as bubs heart rate was a bit on the low side so this also meant no shower. I still hadn’t thought about pain relief but we got a heat pack to put on my lower back and I sat on the ball and rocked in circles. After a while I decided that this position wasn’t helping me any more, so I hopped up onto the bed on my knees, with my head resting on my arms and the back of the bed raised. Around 2.45 the pain in my back was starting to get towards unbearable so I decided the next time a midwife came into the room I was going to ask for some gas. However when she did come in, she suggested that I maybe try to hold off a little bit longer and continue with the breathing. I thought to myself holy crap how much longer do I have to go as I had no idea how far along I was since the internal at 10pm and my contractions were still 3 minutes apart. I asked if I could have another check but they were so busy in the birthing suite this night and my midwife L was delivering in another room so they weren't able to get around to it.
As it turned out I was probably in the transition phase. I asked the midwife if I could have the sterile water injections in my back as a compromise as I had heard that they were meant to help relieve back pain. Well that was a decision I still regret to this day! The injections hurt so bad, like a really bad wasp sting, and only took the pain away for about 2-3 contractions. I think I was probably too far along for them to really be effective. The other downside was that my husband could no longer rub my back for relief.
After another half an hour or so my contractions started to become very intense and I was finding it hard to control my breathing through each one. I also started to crouch down into myself and my husband and mum had to keep encouraging me to stay up on my knees to keep my pelvis open. Suddenly I was violently sick and said goodbye to all the water I had been drinking throughout labour and the very little food I had consumed. Surely I must be pretty far along I thought, but I still didn’t have any clear idea as unfortunately the hospital was very busy this particular night so there wasn’t always a midwife present to give us a lot of guidance.
A bit after 4am I got that uncontrollable urge to push and let out a loud guttural groan that brought the midwives running into the room. My midwife L was back from delivering twins in another room to examine me and told me that I was fully dilated and ready to start pushing. For some extra encouragement she told me if I wanted to put my fingers inside I could feel my baby's bottom, which I did. My contractions were still 2-3 minutes apart and lasting for 1 ½ minutes and I asked if I could now please have some gas as I’d gone this whole time without any pain relief! I was able to have a suck on the gas for about 2-3 contractions but then my husband got them to take it away as it made me a bit spacey and it was time to get pushing.
I was still up on my knees with my arms resting on the head of the bed and had about 2 contractions in this position before I said that my back was still hurting a lot. My midwife L suggested that I try hopping off the bed and using the birth stool for this stage of labour. I hadn’t really noticed too much who had come into the room at this point to assist with the delivery, but when I got off the bed I was suddenly faced with 3 midwives, 2 doctors and a neonatal nurse who were all keen to observe and assist with my breech birth. Being on the birthing stool I really had to resist the urge to straighten my arms and lift my chin, lucky I had L, my husband and my mum coaching me to bend my elbows and push downwards to be more effective. After a couple of contractions his bottom came out and greeted us with his meconium poo, then another contraction and his legs flipped down. At some point during labour he had turned and was no longer in the posterior position. The next push was a big one and he was almost all out except for his head and arms. I pushed again and one arm came down and then on the next contraction he rotated himself to bring down his other. My midwife L and the doctors stuck to their hands off approach, only supporting the weight of his body. Being on the stool I was able to look down and see this little body hanging out except for his head, which was an amazing sight, and whilst it showed I was nearly there I was exhausted and I didn’t push for the next 2 contractions. During this time whilst his little head was still inside, the midwives put the heart rate monitor back on him to make sure he wasn't in distress. L then encouraged me that it was just one more push and I would have my baby. So I did and at 4.44am, 40+6 days, my son Finn Kenneth was born. Whilst it felt like a lot longer to me, it had only been 5 hours 45 minutes of established labour with 24 minutes of pushing, fairly quick for a first time so I'm told though not uncommon for a VBB.
Finn wasn’t crying when he first came out and was rushed over to the trolley to get checked over. My husband cut the cord but I either didn’t see or just can’t remember because it all happened so fast. Those first 5 minutes whilst he was getting checked over were the longest of my life. The 7 people who had just been surrounding me were now surrounding my baby and I was still sitting on the birth stool supported by my mum. I forgot to even ask what the sex was but my husband rushed over and excitedly said it’s a boy! I had been pre warned that breech babies could have low apgars and just needed to catch their breath but I had forgotten to warn my poor mum and she later told me that she was so worried that something was wrong. I climbed back up on the bed and L turned to me and said he is absolutely fine and placed him on my chest for that first beautiful moment of skin to skin. I couldn’t believe how tiny he was laying on my chest with his legs folded up to his chin still in the perfect frank breech position. He weighed 3.110kgs, was 52cms long, and had Apgar scores of 2 and then at the second test a perfect 10.
I am so happy that my VBB turned out to be everything that I was hoping for and more. I had only a few small first degree tears that required a few stitches and was so proud of myself for going through it all with virtually no pain relief which had been my plan. I believe that by staying so active throughout the labour helped things to progress fairly quickly and also by using the birth stool I had gravity on my side to help with the second stage. My midwife L was fantastic and although she couldn't be with us for most of my labour she was there when it really mattered and delivered my breechling without any complications. My husband was so supportive throughout the whole process and to be honest, it was he who was initially the most enthusiastic about attempting a VBB rather than opting for a caesarian at 38 weeks, pretty good going to resist the instant gratification I think. Shout outs also to my mum who was such a great support and fetched me anything I asked for during labour and, using my iPhone, timed all my contractions for posterity.
The hospital in Newcastle where I gave birth is certainly to be commended for promoting such a positive attitude towards VBB's through their breech clinic. I'm so glad that I had a positive outcome that they can add to their books to help try and change other hospitals policies about breech births.
Published 1st July 2013