A (surprise!) breech birth story

A few months ago, I posted a breech birth link on FaceBook for my non-birthy friends and was very surprised at the answers: many of them were born breech, knew someone who was, and one even had twin siblings both delivered breech. Many made jokes about their choice of presentation coming into the world, but by and large, they all considered it a totally normal, if not slightly old-school way to be born, and something to be proud of. Some seemed completely surprised that nowadays, cesarean section is usually the general rule of thumb (at least in the United States).

So when I saw that one of my readers had a breech vaginal birth, I got excited! Having two breech-presenting babies myself, I wanted to hear how it went and have been dying to post her story. Farrah has her own blog here, but has graciously offered to let me borrow her story so you'll see it here, too!

One of the topics I have hoped to touch on in my blog is natural childbirth. Most people are amazed at the birth story of my youngest child who is now 14 months old.

People thought that Joe and I were crazy when we conceived our third child when our daughter was just a few months old. Maybe we were. I don't know, but I do know it felt right (and still does). From the beginning, we had tossed around the idea of a home birth, but I went back and forth about it my entire pregnancy. 

Fast forward to my 39th and most miserable week of pregnancy. I went to visit my midwife, to find out that my baby was breech. Of course, the medical standard is that breech equals an automatic c-section. I wasn't just going to give in and accept that. I told her that I was still a few days away from my due date and I felt that I could give him a chance to turn. She offered some suggestions such as inversion. I decided to visit a chiropractor who specialized in the Webster Technique, which is known to help breech babies flip. I also used techniques from Spinning Babies.

After some belly mapping and a medical opinion, we were convinced that the baby was now head down. I decided against any sort of medical induction and decided that I would go into labor on my own at home. My labor started at approximately 8pm and my water broke by the early morning. Now I was induced twice in the past (once for true medical reasons and the other was an elective induction), so maybe that is the reason I'm used to my babies coming out within 15 minutes of my water breaking. That didn't happen this time. I can't say that I was intending on staying home through the whole thing, but I froze up in the midst of active labor from lovely vomiting and pain that I just couldn't communicate that it was time to go to the hospital. 

I remember wanting to push and there was vernix and meconium coming out. It dawned on me that the baby had flipped BACK to breech. And I thought what a stubborn child this would be (and he is). We called the paramedics and I needed to push in the ambulance, but they kept wanting me to hold him in. To this day, I still find that ridiculous. It did cause problems because he needed to come out and needed oxygen after he was born. 

My breech baby was 8lb 15oz and was 21.5 inches long. It was just about as painful as a pitocin induced birth (I've never had a epidural). But it is an experience that made me stronger. I do hope to see more childbirth professionals educate themselves on the "hands off" breech technique and realize that breech babies CAN be born vaginally. I don't know if the United States is starting to change (I doubt it), but I know that in Canada, they have said that mothers should be allowed to try to birth a breech baby vaginally instead of automatically doing a c-section.

Farrah did say the birth was pretty painful; she could feel contractions going all the way down her legs and was "seeing stars." I am in awe of her intuition to head to the hospital when she felt the pushing phase was taking too long, and realized that yes, her baby was breech! She said that on the way to the hospital, medical staff was alerted to her baby's position and quickly "read up" on how to deliver a breechling. She said, though, that "within 20 minutes of arriving at the hospital, I was pushing him out." Wow!

Despite needing oxygen shortly after his birth, she says that her little boy nursed like a champ and was very healthy. "He's an amazing, content, breastfed, and intact baby boy. I love him very much and his birth was a very healing experience for me."

More reading:
Keep Your Hands Off The Breech, by Mary Cronk, MBE
No more automatic c-section for breech births, says OB/GYN Society

My response to Free Advice Legal Forums: Childbirth issues

Once in a while I stumble on the mother lode of all blood pressure triggers: in this case, it wasn't The sOB but the legal forums on freeadvice.com. "Outstanding advice, unbeatable price" is their motto. Let me tell you: you get what you pay for.

There are no shortage of odd, extremely sad cases floating around over there, and this was one of them: in short, a mother was 38 weeks pregnant with a breech presentation, and requested an ECV to turn the baby. The doctor was hesitant - probably taking the "Well, it might not work and you'll end up with a cesarean anyway!" approach that is so typical. Basically, the mother was given a VE-turned-membrane sweep and began labor three hours later. *sigh*

It's clear that the doctor was hesitant to do the ECV because she was afraid it would work, not because it wouldn't. The patient was obviously somewhat, at least, informed that she had options, and when she tried to exercise her rights, was thwarted. A cesarean ensued, and the patient had other problems as a result. While this was three years ago (so her child would be about six now), she still had lingering thoughts and bitterness over it, which was understandable and completely justified.

Boy, did the idiot comments fly after that. Of course the "You have a healthy baby, get over it!" was among them. I had been reading this forum for a few days prior, and saw the nastiest comments come up from the same woman every time - but this time I could not keep my big mouth shut. I had to say something before my brain exploded.

Here is my response:

While I know this is an old thread, hopefully someone might return to it to gain some perspective and help. 

There are some major philosophical issues that first must be addressed here - namely, the rights of the pregnant patient. People seem to have a lot of trouble understanding those areas and that, even though you are pregnant, you are still entitled to be treated like a person. Some of the comments here are so hateful and almost misogynistic - and I think that is indicative of our legal culture when it comes to childbirth issues and injuries/malpractice that might occur - that basically say, "You wanted a baby - you should therefore subject yourself to anything that might happen to you in order to deliver that child." That is not true, but because it's the predominant theme among most people, they'd lead to believe that the things happening to you were somehow normal and justified, and you should just "get over it." Too bad!

Unfortunately, I can't say their answers would be the same if this were a male patient; or someone receiving cardiac care, for example. There is such a double standard that exists when discussing childbirth issues and most of it, I think, is from ignorance. Yet, ironically, those very same people come back and tell YOU that YOU are uneducated. Very sad. 

You have every right to be bothered by this, but unfortunately because of the time frame, you probably don't have much recourse legally. Unless there are multiple complaints filed against the physician or hospital, they probably wouldn't do much to entertain your complaint. Even if there were multiple complaints filed, they probably wouldn't do much more than issue a perfunctory slap on the wrist. I say this not as a legal or medical professional, but as a childbirth advocate who has talked to many (MANY) women who have gone through similar scenarios, and as a mother of three young children. 

Reading between the lines here, I think it was obviously very unwise of your doctor to purposely strip your membranes without your permission. While some people think you can't really "prove" that this is what happened, you will know that a typical vaginal exam does NOT feel the same as when your membranes are stripped - that is your first clue. Not only that, but the obvious admission from your nurse friend says that she knew in advance that a stretch and sweep was going to be performed; I'd be curious to know what it says in your chart about that. Why would they do this when the baby was in an unfavorable position? Because they wanted you to go into labor and hence deliver the child by cesarean. I think your doctor hesitated about the external cephalic version because she was afraid it *would* work, not because she feared it wouldn't. A portion of them ARE successful, and while painful, that is why they admit you to the hospital and administer an epidural - most of the people who commented here either overlooked that or didn't know that is usually standard procedure. Unfortunately, what they also don't know (or don't want to admit) is that sometimes, babies will turn up until the last minute, even while in labor, into a vertex position. While some people will tell you this is rare, I think it's probably because the baby was never given a chance to turn because mother was sectioned before labor even began. 

A healthy baby DOES matter, but so does a healthy mother. Many people are too quick to completely dismiss any emotional or psychological aspects of birth, especially those that are traumatic. What many of those same people - including mothers - don't realize is that often times the very procedures we're subjected to cause more problems than if they had just been left alone; in other words, they treat birth like an accident waiting to happen, instead of treating things as they happen, IF they happen. Preventative, defensive healthcare in pregnancy and childbirth often causes more harm than good. 

It is the lack of compassion and utter venom that people like these forum members spew that makes women afraid to file complaints against their doctors, and the idea that unless you've lost your uterus, your baby or your life, there is no harm done. Bull----. And if you do complain, someone steps up and gets into a virtual pi***** match to compare birth stories and just how more terrible theirs was than yours, so you just better sit down and shut up. The truth is, few people know what normal is anymore, and are actually normalizing the abnormal. Unfortunately, it's rampant in obstetrics, and very difficult to just up and switch care providers, especially at the last minute. While it sounds like a good idea to just tell the OP to change doctors - at 38 weeks? Are you kidding me? No one would have taken her on, I'm sure. 

Consider your rights and options should you have another child (maybe you've already had one) and at least know that you have them. I'm glad someone mentioned ICAN; they are a good resource for support. Your lack of trust in doctors is not uncommon and you should not be made to feel like a freak because of it - you were violated and had things done to you without your permission. If this had been a sexual rape, would those same people tell you to just "get over it?" Is it simply okay because this was a physician, someone we should trust and respect, who did it instead? It's still a violation of your body and your rights and has changed the course of the way you birth future children FOREVER.

Sally, who thinks your birth was the worst ever and you didn't sue, no! This one's for you.

I'll anxiously await a response. *eyeroll*

A loving (form) letter from my OB

After a few days' vacation I returned to find a couple of craptastic things in the mail. Besides the summons for jury duty, I also received a nice, warm robotic form letter from one of the OB's in my practice.

As I looked at the return address on the envelope my stomach sort of went sour. I immediately thought it was a bill. Upon opening it, I realized it was nothing like that - but rather a plea for me to follow her in her new venture as she branched out into a private practice of her own.

Considering my feelings for her, I read her letter with amusement. Equal parts fake concern mixed with complete arrogance, I immediately began crafting a response in my head before I even got to the "I look forward to seeing you again" that mocked me at the bottom of the page.

She writes:

I would like to thank you for the trust you have given me as your OB/GYN physician during the last three years. Your health and wellness have always been and will continue to be my top priority.

Unfortunately, your convenience is obviously top priority, too. As is your "just forget your quaint little plan to have a VBAC and let's just get this birth over with" mentality.

A little back story: when I gave birth to my youngest, I was in the throes of late-pregnancy hypertension. I never had any protein in my urine or other symptoms except for elevated blood pressure, and her attitude certainly wasn't helping, that was for sure. I was trying for a VBAC, and of course it seemed towards the end I got the heavy rotation of not-so-supportive care givers in the last weeks and days of my pregnancy. I called her "Dr. Congeniality" because of her perfectly coifed hair, trendiest clothes and slim figure - did this woman have kids? - she swept in and out of the room like a human Barbie doll and barely spent more than the allotted 4 1/2 minutes with me. At one point, she said I was measuring small, and I'm not even sure how she could tell because she barely took any time to whip that tape measure out. (In hindsight I'm sure that was a ploy to get me to consent to a cesarean and skip the VBAC, but the ultrasound tech confirmed my suspicion that the baby was perfectly fine.)

With less than ten days from my due date, my blood pressure was still a concern and now the baby had flipped into a transverse position. The head OB in the practice decided to admit me for observation for several hours, so I sat in a hospital bed being grilled by various residents, including Dr. Congeniality herself, who was on-call. Before I left for the hospital, I stole glances at the on-call schedule at the clerk's desk at my OB (as if I somehow felt I was not entitled to know that basic information of who would be available to deliver my baby) and found out that Dr. Congeniality would be on-call on my due date (as if that mattered). I memorized the schedule and silently prayed, Do not go into labor on Wednesday...do not go into labor on Wednesday...

Since I was just there for observation, no one except my mother knew I was there (and of course my husband was with me the entire time). The phone kept ringing in the room, and in my confusion, I didn't answer it - after all, I didn't consider myself a real patient. Who the heck knew I was there? And crap, where was the phone? I felt like I had to twist myself like a pretzel, somehow maneuvering around all the monitors and my huge belly, to even find it, and by the time I decided I should probably answer it and find out who the heck it was and what they wanted, it stopped ringing.

It must have rung twice, I can't even remember, and still we didn't answer it. In my mind, I was still trying to come up with a plan of action, and really didn't want to be there or talk to anyone anyway. So I ignored it. It rang a third time. This time I picked it up.

"Do I have to come down there?" a voice demanded. My brain turned as I tried to put pieces of the puzzle together and figure out just who the (!@&% this was, talking to me like I was a six-year-old child. I immediately went on the defensive.

Of course it was my "doctor," who felt that "oh, it's too bad you wanted a VBAC, but now I think you should just have the cesarean." As if she really cared for my plans - but I thought, I have to stand up for myself. I cannot just let this chick walk all over me and I have to be the advocate I'm always encouraging others to be. I told her I felt the doctors in the practice were being alarmist (after all, I had been through this before with my second pregnancy and there was nowhere near the fervor and intensity over it) and told her I wanted to give my baby time to turn on its own. "I am not having this cesarean for no reason," I said, which she did not like. She sighed audibly and said, "Well, okay then. 'First, do no harm,'" as she flippantly cited the Hippocratic oath. Yeah, as if, I thought.

Soon after a nurse (a wonderful one, I might add!) came into the room and said how she too had fielded a call from the OB, who didn't even identify herself. Wonderful Marilyn firmly said (before she knew who it was on the other end of the line) that she wouldn't put Dr. Congeniality through to me because I had been through a lot today, and was upset and confused about what to do next. Apparently Dr. C was furious, but Wonderful Marilyn stood her ground, bless her heart.

Five days later I had gone into labor on my own but the baby was now breech. Thankfully even though I had gone into labor on a Wednesday, the head OB was still on-call from the night before, and he did the cesarean. Whew. 

Of course, she did come in to examine (rather, what felt like punch me in the guts) my uterus, and made a snide remark about the baby's position and not wanting "feet coming out of my vagina." As if to scold me for my rash decision to avoid a cesarean sooner. I wanted to take down that Pitocin drip (you know, the one I didn't need because I was successfully breastfeeding) and strangle her with the tubing. I forget what I said, but I wish I could have come up with something in my typical smart ass fashion if it were not for the Percocet-induced haze.

...I have exciting news: I'm starting my own private medical practice, a comprehensive women-centered practice, where the patient comes first.

Unless she wants an atypical birth, right? You know, the ones that don't involve being coerced into induction or made to feel stupid for her decisions. And if she doesn't follow your advice, you'll just berate her and treat her like a child, I presume? Yeah, that sounds very "women-centered."

I will be offering a variety of hours to accommodate your busy schedules...

Yeah, we all know what a laugh this is. And that we'd probably be sitting there for at least an hour to be seen for a five-minute appointment, just like with your former employer.

As you transfer your care to my new practice ... 

Ha! This one made me laugh. How about, 'As I transfer my care far, far away from you and your former colleagues, whom the very thought of makes me want to vomit uncontrollably and reminds me of how completely crappy my last birth was'? It also struck me how forward this sounded, and I wondered if she left the old place on good terms. But then again, being this presumptive is right up her alley, I have found.

My highly qualified and dedicated team is committed to providing you with the outstanding care and service you deserve..

Oh yeah? How about supporting more mothers who want to have VBACs or normal, natural births?

Compassionate care has always been my focus, and along with my knowledgeable staff and state of the art technology, I will provide you with the most up-to-date medical treatments available. 

Except if you are delivering vaginally, in which case I'll likely tell you, based on outdated information, that you can't eat or drink while laboring; that you must lie down at all times to be examined and hooked up to monitors, and you won't be allowed to get out of bed for any reason. You'll also be subjected to monitoring that has been proven to raise the cesarean rate and failed to detect the very condition in babies that it's designed to prevent. You will also need repeated vaginal exams - even though you are GBS+ - although your body could just as easily tell you when you're hitting transition and it's time to push. And by the way, when it is time to push, we'll tell you how and when - even though in the average woman the urge to push is like an unstoppable freight train. And if you don't have the urge to push, we'll tell you to, anyway. And if you show up with a breech-presenting baby (which you seem to like to do), we'll insist on an instant cesarean, even though recent, up-to-date studies suggest otherwise.

Yes, that all sounds very compassionate and "women-centered." Never mind that even with all our "superior" state-of-the-art technology and care, we still have abysmally high rates of neonatal and maternal death.

I look forward to (never seeing) you again.

 I hope all your patients up and decide to hire a midwife.

The "C" in ACOG stands for "Castrated"

OK, call me bitter. But every time I read about a brand new and improved ACOG guideline, especially the latest ones about VBAC and VBA2C being safe, I think, "What's the point? Who is really listening?"

Ever since this summer, the news of the safety of VBAC was on the tip of everyone's tongue and ACOG was urging doctors and hospitals to relax their restrictions on doing them. Yet, thousands of women are still turned away, led to believe no doctor will support them and that they are actually illegal, according to state laws. Thousands more are still telling other women how dangerous they are, even though they know little about them. I'd love to see the figures on what this lack of support is doing to increase the alarmingly high rate of c-sections in the US.

What does ACOG really mean when they restructure guidelines like this, or create new ones? Who's listening? As I decide about having a fourth baby, after two cesareans, what does it mean for me as a patient? And is there any doctor in my county who will "allow" me to have a vaginal birth?

I'm beginning to think that ACOG is the new United Nations, an organization that probably means well but has little power when it comes right down to it. They can shake their fist, demand better, and set 'guidelines,' which is really saying, 'We'd like you to do this, but we are powerless to do anything should you decide to ignore us.' Is ACOG personally going to come after and investigate doctors who have astounding c-section rates? Those who don't do VBACs? Yeah, as if.

One of the biggest reasons for primary cesareans, and in my case as well, is if the baby is breech. I had a primary cesarean in 2003 for breech presentation, and another one last year for breech as well. ACOG's website doesn't necessarily say "we don't recommend a breech birth," but neither do they say "This should be recommended as a way of cutting down on the number of cesareans." Not too many doctors, I suppose, would be willing to admit that a sheer lack of training (among other things, as well) in this area is what leads to a surgical birth. I think that perhaps that would be a blow to your pride, to have to admit that you don't know what the hell to do if a mom comes in at 10 centimeters, waters broken, with a footling breech (been there, done that). So you just whisk them straightaway to the OR.

ACOG's website on this subject actually implies that there are "options" for a mom when she realizes that her baby is breech. Yeah, like "would you like to be sectioned on a Monday or a Tuesday?" While they acknowledge that there can be risks to a vaginal breech birth, they admit that "most breech babies are born healthy." (No where do they mention the skill of a caregiver being able to mitigate significantly risks to you and the baby when he actually knows what he's doing.) Without really coming out and saying it, it's like they're quietly whispering, "If you have your baby vaginally, it'll probably be alright." Not screaming, "YOUR BABY IS GOING TO DIE!" They go on to say that "it's not always possible to plan for cesarean birth," and as your due date approaches, if your baby is breech your doctor "will discuss the risks so that together you can plan the delivery that is best for you." Cue the happy music and the hugely pregnant mom wading through a field of daisies ... I think I am going to barf.

Right! If you read between the lines, ACOG says right there in plain text: "Your doctor will discuss the risks." Of a vaginal birth, you mean. Never a cesarean. This is also what happened to me on at least more than one doctor visit - he sure discussed the risks with me, all right. Let's not mention the benefits of a vaginal birth - like not having a scar on your uterus and all the complications that come with it, both potentially life-threatening and just plain annoying. No more is this underscored than in the death of a mom after her fourth cesarean , due to a combination of placenta problems and doctor error.

This death could have been avoided, some suggest, if more women were encouraged to have VBACs, or - dare we say it - not have a cesarean in the first place, even if the baby was breech.

In this area, I wish ACOG would look north to their Canadian cousins - The SOGC, or Society of Obstetricians and Gynecologists - to get the scoop on how to handle breech vaginal births. It seems, from what they're saying, is you don't have to 'handle' anything: just let it happen, and chances are, the mom and baby will do fine. But that's our biggest problem: they can't keep their hands out of the cookie jar, even when the jar is empty and there's nothing to grab - just leave it alone already and we'll let you know when you're needed.

I'm beginning to think that if ACOG were really serious about lowering the c-section rate and giving women "options," they'd be passing that information on to everyone and her sister and not just allowing it to rest in the often idle hands (and brains) of your well-meaning, but obstinate, physician. Still think your OB is only acting with your best interests at heart?