Is a Complete Breech Vaginal Birth Possible with Experienced Providers in SWFL?

A big thank you to 6th time mom, Dallas, for her firsthand account of her sixth birth story.

"From the beginning of my pregnancy with our sixth and last baby, I consciously pursued a healthy lifestyle full of activities for optimal fetal positioning.  So, when our sweet baby decided despite all that to flip to a breech position at her 30 week prenatal appointment, I had misgivings about the potential for returning her to a vertex position.  Nevertheless, I practiced Spinning Babies exercises daily, visited a pelvic floor PT specializing in pregnancy and fetal positioning, and had regular visits with a Webster technique trained chiropractor -- all to no avail.   I realized that my hope of birthing with the licensed midwife team that I knew and trusted was fading, and, frustrated with the lack of legal choices for having a birth attendant actually trained in breech to support a breech delivery, began to explore my options as a healthy mom with a history of uncomplicated, expeditious vaginal deliveries.    

After some investigation and dead ends, we found a team of certified nurse midwives on the other side of our state who were happy to welcome me into care for delivery, as well as offer an in-clinic ECV so I could have one more chance at birthing at home with our familiar midwife practice.   The ECV was unsuccessful, and we booked an Airbnb in the new group's city for the window during which I had historically given birth before.  One additional twist in this logistical labyrinth was that the practitioners, offering breech and twin services as they did, had a breech and twin conference for the four days prior to my due date -- thus adding another question mark regarding how all this would play out.    One of our new midwives suggested that we attempt a natural "induction" of labor when we came into town, because although all of us would prefer to let baby choose her birthdate, we were facing a choice between legally mandatory but unnecessary surgery and a free birth, which we weren't entirely comfortable with given the potential complexities of a breech presentation.  

So, my husband and I left our children in the care of my amazing parents, and checked into our Airbnb 2 1/2 hours away at baby's gestational age of 38 weeks 3 days.  The following morning, we went to the CNMs' clinic for a membrane sweep to attempt to nudge labor, but even the sweep was difficult to fully perform because of the thickness of my cervix.  This was followed up at our Airbnb with a dose of a castor oil concoction at 10 a.m., as well as homeopathics every hour and breast pumping.  4 hours later, there was still no sign that those steps had occurred, and I was wondering if any of them had even been noticed by my body at all.   At 2:45, while we were trudging through Lowe's searching for an adapter to fit the hose for the birth tub onto the showerhead, it became all too apparent that my gastrointestinal tract at least had indeed noted the morning's events.  However, the afternoon and evening wore on, and as my insides seemed to melt away from the castor oil without any uterine activity, I was losing hope that it would have the effect we had hoped on baby's advent and began to discuss with my father potential plans to retrieve our children and let them wait for baby with us during the days until the new midwives had to attend their conference.

At 8:30 that evening, I felt baby give three strong kicks, the last of which released the membranes.  As water spilled out onto the floor, I began to shake uncontrollably and felt long, strong contractions that brought me to my knees.  I called the birth team right away and they walked in the door about 10 minutes ago later -- right about the time those contractions began to weaken.  This concerned me since although I had a history of irregular labor patterns, I had never experienced contractions that literally floored me and then stopped.  However, the midwives told me that apparently I had gone from 3 to 7 cm and completely thinned out in those 10 minutes, and not to worry....the baby would be coming.  After I did side lunges and walked around in an attempt to strengthen labor, they encouraged me to try to rest/sleep alongside my husband and my contractions would probably start up again.   So, we tried to doze off, although every so often I would have an insanely painful surge of only 5-10 seconds.  Confused and tired, I fell into a light sleep and awoke at midnight with a long, strong contraction, (again) uncontrollable shaking, and the irrational conviction that despite the intestinal clearing that had occurred that afternoon, I was unbelievably constipated.  As I was shaking and moaning on the toilet, not entirely in my right mind, one of the midwives checked on me and I told her my belief.  She smiled and said, "No one looks or sounds like that when they're constipated.  You're having a baby.  Reach down and feel her.  Let's get in the birth tub.".  I was stunned to feel the baby, and got in the birth tub my husband had set up earlier in the aftermath of the ruptured membranes.  

One of baby's feet emerged, as well as a length of her (uncompressed) cord, and I labored in the tub with strong contractions for about an hour.  The midwives encouraged me to attempt to bring the baby down further, but with the presenting parts not well applied to the cervix given the single foot, this was difficult even with trying different positions, including lunges, in the tub. Around 1 am one midwife said that although I didn't need to get out of the tub, I could if I wanted and she could check and see if there was something else going on.  I welcomed this suggestion and we went into the bedroom, where she found that I was at 9 cm  and baby had crossed one of her feet over the other leg.  The midwife brought down the undescended leg and, consistent with baby's persistently complete breech position during pregnancy, the little one immediately crossed both her feet once they came out.  I flipped over to hands and knees and realized that I could now push.  Even with 5 previous births, I can confidently say that the following few minutes were the most intense of my entire life as baby's legs emerged spontaneously, and then I pushed the entire torso out.  For a moment I thought I was done, but I couldn't see that baby's head was still inside and the midwife was briefly checking heart tones.  She quickly told me that the head had to come out now, and, challenged not only by the searing sensation of being split in two but also by the need to direct energy into a place that had simultaneously to be relaxed for baby to emerge, I pushed the head out as the midwife exerted supraclavicular pressure on baby to help her complete her journey earthside.   She scooted baby forward to me, I picked up the little one, and was thrilled to see her look right at me, cry briefly, and immediately explore her new world.    Daphne Isabel was born at 1:15 a.m. that morning, with 1 and 5 minute Apgars scores of 9 and 9.   

Although none of this was what we had initially wanted -- neither a breech birth, nor giving birth so far from home, with an unfamiliar care team, and an induction -- it was truly remarkable afterwards to see how all those parts came together to allow our baby the most peaceful, safe, gentle entry she could have had into this world.  The circumstances and logistical considerations weren't conducive to allowing our much loved doula, Tara, to be physically present, but she provided invaluable support throughout the many twists, turns, and uncertainties of this pregnancy and birth.  We are forever grateful to her, the prenatal midwife team, and, most importantly, a birth team that could address complexities before they became complications, for the support needed to give our baby such a wonderful start."

Authored by Dallas, 6th time mom