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breech

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Jacob's Birth Story: A fast breech vaginal birth

Before I begin my most recent birth story, I need to give some background information about myself. I am a Neonatal Nurse Practitioner and work at the same hospital that I receive my OB care; therefore, I have a close professional relationship with my OB providers. I also have a uterine anomaly called a bicornuate uterus. This means that my uterus is divided into two sections. This was discovered at my 13 week nuchal transluceny ultrasound with my first pregnancy. The complications associated with this anomaly are cervical insufficiency, preterm labor, preterm delivery, growth restriction, and breech presentation. The risk of breech presentation is due to the limited space for the baby to turn. Because of this anomaly, I was followed very closely by the high risk OB and had approximately 13 ultrasounds with my first pregnancy. My son was born by vaginal delivery after spontaneous labor at 37 weeks and 2 days. At every ultrasound he was head down.

With my second pregnancy, my son was in breech presentation at every ultrasound. I really became concerned about this around 26-28 weeks, given the limited uterine space and that my first son was always head down and this time my son was always breech. Everyone (both medical and non-medical) tried to reassure me that “there’s plenty of time for him to flip.” It was at this point that I began my research on getting a baby to turn. I googled, youtubed, and read a lot of articles and blogs. I tried anything and everything to get my baby to turn, with no avail. At 34 weeks I had a discussion with my OB about attempting an external cephalic version (ECV); however, I am not a candidate for this procedure given my uterine anomaly. It finally started to sink in that I was going to have a c-section. My OB decided not to schedule me for a c-section, rather we would wait until I went into labor in order to give me every opportunity for the baby to flip.

Breech presentations include:

  • Frank Breech (Bottom down, feet are up by the head)
  • Footling breech (One or both feet are by down)
  • Complete breech (Bottom is down and legs are crossed. Imagine baby sitting Indian style.)

During a casual conversation one day at work with the high risk OB director, I expressed my concern for having a c-section and how much I did not want to have one. He agreed that I was not a candidate for an ECV and what I thought was jokingly, he said,“Well you could always do a breech vaginal, the only problem is I would have to be at your delivery, and that might be uncomfortable for you.” My response was that I would not have a breech vaginal because of the risks associated with it. That was the extent of our conversation. I did not have any conversation with my primary OB about a breech vaginal delivery.

So what are the risks with breech birth?
- Placenta being compressed
- Head getting stuck
- Some incidence of large limb fractures
Biggest issue currently is finding a provider who is experienced and educated in delivering a breech!

At 37 weeks I went to my routine OB appointment, and again had a discussion with my OB about a C-section, and again expressed my feelings and anxiety about it. She was very empathetic, but tried to reassure me that it wouldn’t be as bad as I thought and also gently brought me to reality that this baby would most likely not flip at this point. I was 1 cm dilated and 50% effaced at this appointment and not having any significant contractions.

The next morning, at 37 weeks and 1 day, I woke up with some intermittent cramping back pain. It wasn’t very painful, but it was certainly noticeable. Shortly thereafter I began to have some lower abdominal cramping similar to that of a period. I didn’t time the cramping but thought something might be happening given that it was intermittent and not a consistent discomfort. At this point I didn’t want to call my OB, because I knew she would want me to come in right away given the breech presentation and I didn’t want to have my husband come home from work and call my childcare if this wasn’t, “the real thing.” But, I did get my (almost) 2 year old set up with breakfast and hopped in the shower, did my hair and makeup, and got myself all ready “just in case” this was it. I packed the car with our bags before heading out with my son. Throughout the pregnancy I constantly thought about the, “last day” that it would be just, “us.” My son loves ice cream, so I wanted to take him out on an ice cream date. We got to the ice cream parlor a little before noon just to find out they didn’t open until noon. We went next door to the grocery store to kill a little time. By this point the cramping was occurring more frequently, but not necessarily with more intensity. I stopped in the bathroom on our way out and that’s when I had my bloody mucousy show. It finally sunk in at that time that I was in early labor. We got our ice cream and I just sat and enjoyed those last minutes with my son before my attention was going to have to be shared.

Megan the morning of Jacob's birth.

Megan the morning of Jacob's birth.

We got out to the car around 12:15 and I called my OB to report my symptoms. As I expected, she told me to come to the hospital to get evaluated. I called my husband who was working an hour away and my sister who was going to watch my son. By the time my husband got home and we got out the door it was around 1:30. We weren’t in the car more than 5 minutes when the intensity of my contractions increased and I was unable to talk during them. The ride to where we were meeting my sister was about 25 minutes. Just as we pulled up my water broke. I called my OB again to give her an update and that we were about 20 minutes away. By the time we arrived to the hospital I could barely think or talk due to the pain of the contractions which were now about a minute apart.

I was immediately taken into a room (the PACU was full) and my OB checked me and said I was 6 cms. There were so many medical professionals in my room working diligently to get me prepared for my c-section since I had progressed into labor so quickly and was continuing to have very strong contractions every minute. That was when my OB told me that the hospitalist was on service and she has experience with breech vaginal deliveries and asked if that was something I wanted to consider. I could barely focus on her words so she decided to get me my epidural and get me comfortable before we had any further conversation. As soon as I got my epidural she checked me again and I was 9 cms (that was about 30 minutes after the first time she checked me). I had to make my decision very quickly after having a brief but serious conversation with the hospitalist. I knew in my heart that this was the right decision for me. My husband was against it, but said he trusted me and my OB and knew that I was very aware of the risks associated with this type of delivery given my medical background.

So we moved into the OR, which is where I had to deliver in case they had to do an emergency c-section. As was explained to me before making my decision, I labored down for about an hour before I started pushing in order for the baby to optimally move into the birth canal vs pushing him into position. I pushed for 18 minutes until I heard the most beautiful sound in the world which was that of my baby crying. He was placed skin to skin with me and I just cried tears of joy and relief. He weighed exactly the same as my first son, which was 6 lbs 13 oz. I had no tears and felt so wonderful during my recovery. Every day I thought about how different my recovery would have been if I had a c-section.

On the way to the hospital when I was contracting so painfully I thought to myself, “Why did I wait so long to call my OB? I should have called this morning! This pain is so unbearable I could have avoided this if I hadn’t waited!” Afterwards, I was so thankful that I did wait to call, because my delivery experience would have been so different. Everything happened to just fall into place to make this all possible. The OB that I had such extensive conversations with was on service at the hospital so she knew my anxiety about having a c-section, the hospitalist who will do the breech vaginal delivery was on service, I was in spontaneous labor with contractions every minute with very fast cervical dilation, and my baby was tolerating the labor. Had any one of these factors been missing or different, I would have had a c-section. I absolutely love my birth story and I hope you enjoyed reading it!

Jacob meets his big brother.

Jacob meets his big brother.

 

 

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How I Turned My Breech Baby at 37 Weeks

My second pregnancy has been filled with a few challenges. While at an ultrasound, staff thought that one of the baby’s legs wasn’t growing as well as the other (only in the 5th percentile), requiring further ultrasounds to check her progress. Turns out, the baby was just fine, and at 35 weeks my OB wanted to do one final ultrasound to conclude the issue. At this point, I had a pretty good relationship with the ultrasound tech in the office. As soon as she started the scan, she says, ”Oh, are you planning a C-section. ?”

My brain goes haywire, “NO! What in the world?”  What I actually manage to spit out, “Um… no, why?”

“She’s breech. Her head is in your ribs, and her bottom is what is down low.”

Breech shouldn’t be the issue it is in birth, but we will save that for another post. In the area I live and with the doctors I work with, their hands are tied by the hospital. I was also not in a position to have a homebirth with a midwife. With a short window to get this baby flipped, I started tackling all my options and plan of attack. To break it down, here is what I focused on: posture, Spinning Babies, belly binding and mental aspects.

Fetal position can be affected by several things, but posture is a big one. Slouching on our comfy couches and less than ergonomic car seats can make for a breech or posterior baby. I started making sure I was sitting up straight or sitting on the floor cross legged, to give baby room to move and alter any poor alignments in my back and hips. I also found out it’s important to stay off the birth/exercise ball until I could confirm baby was flipped. The ball is great for many things, but sitting on the ball while she was breech could help her to engage deeper into my pelvis and not budge into a proper position.

To further aide in getting baby to flip into a proper position, I spent a lot of time on the website, Spinning Babies. There are several positions and exercises that promote proper fetal positioning, but the one I focused on was a steep forward inversion. While baby is actively moving, keep legs on the end of a couch or bed, and place elbows on the floor, keeping hips over the shoulders. Hold for three breaths and release. You are basically doing a shoulder stand, using gravity to get baby out of the pelvic cavity into space where they can more easily turn. (Definitely have help or a spotter for this one!) Here is the link to Spinning Babies and how to perform an inversion: http://spinningbabies.com/learn-more/techniques/the-fantastic-four/forward-leaning-inversion/

On to belly binding! This was very new to me, but super helpful and enlightening. With subsequent pregnancies, the tendons holding our uterus in position become more relaxed, creating a pendulum effect. (That explains the extra discomfort and ligament pain this time around.) For further information, check out http://midwifeatyourdoorstep.com/articles/optimalfetalpositioning.html . Typically binding is done with a wrap, but I used a ring sling to be able to quickly bind off by myself. Excuse my iPhone picture, but it was the best I could do at the time.  I spent most of my active time during the day with my belly bound, and noticed a decrease in ligament pain. I noticed a drastic increase in Braxton Hicks contractions, as well as pelvic pressure. I assume it was from finally getting baby into a good position. When I would get too uncomfortable I would take the binding off and just rest.

Using my ring sling to belly bind in my last trimester. Note to self: take better pictures.

Using my ring sling to belly bind in my last trimester. Note to self: take better pictures.

Throughout this time, I spent a great deal of energy in prayer and fear release meditation. I did not want a cesarean, and I knew a lot of my worry and stress could result in tension in the baby, negating any attempts to get her out of the breech position. I had spent my entire pregnancy listening to hypnobirthing recordings (watch for another post), and I increased my time spent in deep relaxation, as well as talking to the baby. I asked her to flip for me, so mama wouldn’t miss out on those first moments with her. I prayed about my fears, my concerns, and gave them to God before I fell asleep each night. I had to mentally let go of the iron grip I had on the expectations for my pregnancy and birth, and know no matter the end result, we would get our baby earth side and I would heal. Here's my favorite fear release:  

Finally, at 37 weeks baby flipped head down one evening before bed. She was kicking and I quickly did an inversion off the side of my bed. Throughout the night I could feel her shifting her position, and the next morning I had very strong pelvic pain, and Braxton Hicks were incredibly strong. At my next appointment, my doctor confirmed she was head down.  

For more resources on positioning and exercises to aide in flipping a breech check out:

Videos:


 



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