ORLA
Planned hospital, natural breech birth – second baby.
Beforehand
I was pregnant with my second child and was put in touch with Suzanne Miller, who became my midwife. I warmed to her straight away but didn’t know at that early stage that she was going to have such a profound effect on my whole birthing experience. At an early scan it was discovered that my placenta was close to the cervix. This positioning could have put my plans for a home birth at risk, so I needed another later scan to check that the placenta had moved sufficiently up and away from the cervix.
At 32 weeks the scan showed the placenta had moved up, however the scan also revealed that our baby was in a frank breech position. That means that the baby was sitting with its bottom in my pelvis and had its feet beside its head up by my ribs. It was obvious she was a girl so from now on we can call her ‘Orla’.
Suzanne was actually quite relaxed about the breech position but I realised that if she stayed breech the common assumption was that the birth would be by caesarean section. The following eight weeks began with high hopes of her turning and I was given plenty of information and strategies by Suzanne to help achieve this. However as the due date drew nearer, it became clear that Orla had chosen this position and was happy to stay with it.
Suzanne remained calm and positive that whatever position she would be born in we could still achieve a positive natural birth experience. To her this was a manageable deviation from the norm rather than a black and white case for medical intervention. She was unwavering in her belief in the ability for women and babies to give birth naturally and placed importance on the value of it. This coming from someone with such wisdom and experience was what carried me through all the fear and anxiety I was feeling.
I was under mounting pressure from the medical system to have a caesarean section or at the very least, a medicalised delivery in stirrups. The pressure was such that if I chose a natural, midwife-assisted birth, there was a question over whether the specialists would attend if I needed them in an emergency. I feel strongly that anything but a natural birth would have put our baby in greater danger. Even more than in the usual presentation of head first, breech babies need a hands off delivery until the nape of the neck emerges to lower the risks associated with breech birth. I was also determined to birth her in an upright position as this would facilitate a faster and safer birth for my baby.
It wasn’t as though I was turning a blind eye to the increased risks of a breech delivery such as cord prolapse, head entrapment, ingestion of meconium and rapid decompression of the head. All approaches have their own risks. I wrote out and signed my birth plan explaining that I had done my research, was fully aware of the risks and accepted the responsibility for my decision. We had also agreed that if there were any indications that the birth was not going as it should we would move straight to a caesarean with a low threshold for making that decision.
In weighing this up, the favourable factors for a standing vaginal delivery were:
I had already given birth naturally – the normal homebirth of my daughter Olivia two years previously;
My baby was a good size – not too big and her head circumference was not too large at that stage;
The baby had a well-flexed head (i.e. her chin was on her chest);
She was in a frank breech position (bottom coming first with feet tucked well out of the way) which would open the cervix well; and
I felt strong in myself. I was committed to a natural birth with all the support of a trusting husband, a loyal friend in Lisa and a host of people who believed in me. This was one time in my life when, in my open and vulnerable state, their emotional support and positive energy was tangible and powerful. They poured love and strength into me and I drew on it freely.
Before I go on to describing the birth I would like to mention my mother. Two of her 12 births had been breech and she shared these experiences in detail in the weeks leading up to Orla’s birth. Her words would come back to give me strength when they were most needed. Unfortunately she was unable to be at the birth as planned because of ‘flu but I definitely felt her there in spirit.
The Birth
On Wednesday February 26th, three days past my due date, at 5:20pm I had my first contraction. It was followed by three more that were ten minutes apart, then one or two at five minutes apart, then many more at three minutes apart. My midwife had warned me that this could be a quick birth. Having birthed before I knew that these contractions meant business. Nick’s delicious barbequed lamb straps didn’t get the attention they deserved.
I rang Suzanne who was on my doorstep at 6:30pm. Upon examination she found I was only one centimetre dilated but my cervix was paper-thin. This was in-keeping with both my previous experience and my mother’s experiences of feeling the cervix opening like a flower rapidly just prior to transition, so I didn’t worry.
As each support person arrived, Olivia greeted him or her with a passionate kiss. She could sense the excitement in the air. She was told I was off to have a baby to which she nodded, “Mm. Baby! ‘Bye Mummy.” She was in good hands with Uncle Tim whom she was thrilled to have all to herself and I left feeling reassured.
Nick, Lisa and I piled into the car. Because of the power and frequency of the contractions, it felt most comfortable to kneel on the floor and I leaned on the front passenger seat for support.
Suzanne followed on that hot, balmy afternoon, down the hill and we passed some friends bathing at Mahina Beach. Nick tooted to them. Imagine their surprise when I popped my head up and waved. This was only the first of several coincidental encounters on the way to the hospital including waving to another friend passing in her car and then running into my sister, Ann, at the hospital.
We went on up to the delivery suite of Hutt Hospital where the midwives waved us through into a room that was set aside for potentially difficult situations. It was equipped for emergency caesareans should the need arise.
Aesthetically, its one redeeming feature was the view of mature gums and cabbage trees in the foreground and late sunlight on the hills beyond.
As my labour continued strongly, we made preparations. We warmed Orla’s silk shawl and layette. Judi Slankard, the backup midwife, came in armed with a ball, a beanbag, and a birthing stool. Nick set up the music, ‘Chopin’s Nocturne’, and brushed up on acupressure and homoeopathy. I positioned myself at a large sturdy sink. Was the mirror in front of me a help? My lips did look pale but I found it useful to reinforce my spoken affirmations and that helped progress my labour. Lisa was there beside me from the start working on the same acupressure points she had used for Olivia’s birth. They were equally effective this time.
At this point I started to go deeper and deeper into myself and yet I was acutely aware of the contributions of each of the people around me. Nick’s intuitive sense of when and how to be there for me, his choice of music, his touch, his loving strength, and his lack of fear. Lisa was so solidly there beside me and she helped me shed my inhibitions. The pressure in the points of my back was in tune with my contractions, easing the pain of labour. Judi was able to be there in an unobtrusive way and yet contribute so much. Just at the right moment she would murmur, “Remember to keep your throat open.” It helped me to bring down the sound, to vocalise inwardly where my energy was most effective. I remembered another midwife saying earlier that day that Judi was a wonderful energy to birth with and boy was she right. In a quiet and calm way, Suzanne closely monitored Orla’s heartbeat and offered me gentle support with breathing. When I started to feel fear, she kept me on track. I felt safe with Suzanne.
At 9pm I felt a definite shift. Transition was confirmed by the need to vomit. Suzanne said, “you’ll feel better with this out.” Then came a lull. Still standing, I rested my head on my arms and gathered my energy. At around 9:10pm my next contraction hit. I had entered another realm and I said, “I’m having this baby now.”
I began to birth what I thought was the body; it felt so solid. In fact it was the bag of waters, which Suzanne popped, having seen it contained meconium. My legs began to weaken. Suzanne asked, “Are you okay? Would you like to sit on the birthing stool?” My knees began to tremble and I replied, “I feel like a baby giraffe. Someone else can take over now.” Of course I knew it was only Orla and I who could do this and laughed. Nick and Lisa guided me onto the birthing stool. In the space of five minutes, with three strong, flowing contractions, Orla was to be born.
As her bottom rumped, the burning sensation of opening began. I had to summon all my energy to use the power of the contraction to keep the pressure on. It grew and it grew and it grew. I opened and opened and opened. I used everything I had, my will, my voice, and the last of my strength to push her out into the world. I said things that came from a primal source, “God help me,” and ” I want my Mummy.”
Nick was behind me. His arms enclosed me and supported me as I pressed down hard on them and received his strength. Lisa was at my side as she has always been. Suzanne was crouched below and in front of me, ready to receive Orla, with Judi to one side of Suzanne supporting us both. It was her eyes that sent me those good messages. There was a feeling of harmony and complete confidence, which was crucial at the time.
As Orla’s body emerged from mine, Suzanne asked, “Do you want to see her?” Although I could actually see her, I replied, “No, I don’t need to see her. I just want to get her out.” Suzanne waited but did not yet touch her body. Orla wriggled, first one hip, then the other and down to the armpits. She wriggled out one shoulder and arm and then the other and only then did Suzanne gently cradle her body. As Mum’s words came back to me, I knew I had to keep the momentum of the pushing to birth her head, which was surprisingly, the comparatively easier part. Suzanne passed Orla up to me. She felt slippery and silky. I didn’t know how to hold her. Suzanne said, “You won’t drop her.” I remember her chubbiness, her fat tummy, her feeling of softness. I wanted to bring her up to my chest and hold her against me but I couldn’t quite get a grip to turn her around. Suzanne helped me turn her to my chest and offered her my breast.
I had been prepared for her to be grey and quite floppy as many breech births are. In fact she was a good colour and breathed spontaneously, shortly after birth. She had APGAR scores of nine and ten, just like her sister, Olivia.
Suzanne indicated the cord could now be cut because it had stopped pulsing. Nick did this and they helped me onto the bed as at this stage I was going into shock. They gave me rescue remedy and arnica, which really helped. Nick carried Orla over and placed her to my breast and Lisa lay down beside me and comforted and supported me. I was so relieved to be on this side of it all and that we were all safe. We had our beautiful girl!
Looking back
I felt that the whole medical profession had a closed mind. I was not respected as an intelligent woman able to make an informed decision and kept coming up against the assumption that it was my midwife pushing me to have a vaginal birth and not my own free will. The fear surrounding breech birth takes the choice away from women even in those instances when a vaginal birth may be the best option for birthing their babies.
I was also frustrated by the lack of information provided by the obstetricians to enable me to make a good decision. Very little information was provided about the risks associated with caesarean birth and I had to really seek that out. The medical professionals I encountered also refused to look at any of the information about natural breech birth that I provided. On a personal level I feel really disappointed that the specialists didn’t work together with us and refused to even attend the birth. They missed an opportunity to witness a normal breech birth and to gain some of the experience that is now so lacking. There will always be vaginal breech births because a quarter of all breech babies are undiagnosed until labour and many breech labours are very fast. The skills to catch those babies safely are now being lost.
Nick and I almost got scared off from going ahead with the vaginal birth and at one stage I was booked in for an elective caesarean before my baby was even due. The fear and guilt put on women wanting a vaginal birth is really extreme and I can totally understand women choosing to have a caesarean birth. The support I received from my family, friends and from my midwife combined with my previous birth experience and belief in natural birth carried me through to the birth that we had.