Bruno’s Birth Story

Michel Odent writes that the introduction or suggestion of breech has a “nocebo” effect: the inundation of concern and worry from family, friends, and most particularly healthcare practitioners can easily disempower a pregnant woman, leaving her doubtful of the ability and power that she has to give birth naturally.  Benna Waites includes an entire chapter on “The emotional impact of breech” in her book Breech Birth.   She discusses the isolation, fear and sense of urgency that often overcomes women carrying a breech baby, who are finding out their child’s position at such a late date that they may feel they don’t have time to seek out resources or support.  They may feel they have no choice but to succumb to whatever option is presented to them by their caregiver (usually an ‘elective’ cesarean section).  I am writing Bruno’s birth story because I believe that it can serve as an example of how women can use this adverse situation to empower themselves to still have a joyous, fulfilling birth experience.  This story is also an encouragement to the vast majority of midwives in Washington State to realize that they are first and foremost responsible for their clients’ well-being, and that their practices should not be governed by the fear of liability.

Bruno was breech (head up) for as long as we could tell.  At 30 weeks, I started discussing the issue with our midwives, who assured us that we need not worry, as most babies turn head down (vertex) before the 37th week, and only 3 to 4% stay breech.  (We found out later that if the baby had never been vertex and remained breech at 30, 32 and 34 weeks the greatest probability was that the baby would remain breech.)  At 34 weeks I sought out and began a variety of non-invasive methods of turning the baby, including acupuncture (moxabustion), chiropractic (Webster technique), lying with my butt in the air, playing music and Denis talking to my lower belly, doing somersaults in the swimming pool, ice packs on the baby's head, and everything else we could think of.  The general vibe that I was getting was that a breech baby was a very unfortunate occurrence.  A web search produced all sorts of horrors, from mothers lamenting their virtually forced c-sections to articles from mainstream medical sources suggesting that babies are breech due to congenital abnormalities, and calmly stating that a pre-planned cesarean was the safest way to deliver a breech baby.  When we went in for a position-check ultrasound, the attending doctor came to our room to give us her condolences – it was as if our baby, instead of being in an unusual or variation of normal position, were damaged goods.

At week 35 our midwives admitted to us (after repeatedly avoiding the topic) that if we were to remain in their care our only option would be a scheduled c-section.  I had a hard time coming to terms with this; we had chosen out-of-hospital midwifery care in the understanding that we were employing the services of women who would honor our choices, hold our interests above the fear of liability and advocate for us in the event of a variation from normal necessitating consultation.  I realized that if the baby didn't turn I would be abandoned within weeks of my due date and given no option but what I consider an overused and invasive medical procedure. 

I turned to the two guidebooks of my pregnancy, Ina May Gaskin's Spiritual Midwifery and Sheila Kitzinger's The Complete Book of Pregnancy and Childbirth.  Both authors presented breech as a normal variation and a viable presentation for a natural birth.  Surprised by the discrepancy between the opinions of the authors I trusted and the midwives I thought I could trust, I started to seek out alternative opinions. 

I found a way to the contact the midwife who had been present at my little brother’s birth and the woman who was to become our guardian angel, Debra O'Conner, who agreed to consult with us on our options.  The news was a huge relief: in order to have a natural birth, all we had to do was cross the border of Washington State.  There were midwives in Vancouver, BC and in Portland, Oregon who routinely caught breech babies. I could even go to the “Farm” in Tennessee.  I called the Andaluz Waterbirth Center in Portland and explained my situation, expecting to have to pass through a barrage of questions before they accepted to see me.  Instead, I was immediately given an appointment and treated as a normal client.  It felt good to have found support after a month of insecurity. 
The next week we met with Jesica Dolin from Andaluz and set up a birth plan.  Because Denis had to work and I didn't want to go to Portland without him, we decided to drive down while I was in early labor and get a hotel room (Oregon state law prohibiting breech in birth centers) where Jesica and her colleagues would meet us to catch the baby.  They would set up a birthing tub for us at the hotel, and we would have a two-day postpartum stay at Andaluz in order to recover before the drive back to Seattle.  Looking forward to the road trip, I made copies of all the Leonard Cohen and Johnny Cash that I could find, and I made special voyages down the candy aisle upon our weekly grocery outings, loading up on all the junk food that I had avoided for the past year. 

Around this time I got copies of the two seminal works on breech that Debra had recommended: Breech Birth Woman-Wise by Maggie Banks and Benna Waites’ Breech Birth.  These two texts, which defend a woman’s right to a natural breech birth while even-handedly enunciating the risks and benefits of procedures such as the elective cesarean and external cephalic version, were my primary focus for the next three weeks.  I read about all the possible complications of breech birth (cord prolapse, head entrapment, oxygen deprivation, etc) and was delighted to learn that these risks all but disappeared when a breech birth was accompanied by a “skilled” birth attendant.  In fact, the reason that breech birth was considered so risky was more due to inexperienced practitioners, i.e., “unskilled”, or who were insufficiently trained and who would take to pulling on the baby (causing him to startle, his head and arms jerking up, and him getting caught in the mother’s pelvis) or using forceps or a vacuum to extract the baby and severely injuring the child in the process.  Online I read birth stories of women who were both well and poorly attended, and learned from these women’s accounts as well.  One mother described having a physician reach inside of her to push her healthy, descending baby back up into the womb so that he could perform the cesarean he had been taught was “safer” for breech birth.  I had the pleasure of talking with one of Jesica’s past clients, Sarah Ericson, who had her breech twins and her following baby with Andaluz and whose experiences left me confident that we had chosen an amazing midwifery team (Sarah’s birth story is available on her blog at http://geoffrie.wordpress.com/sarahs-birth-story/).  But most importantly, I was in the process of learning what could potentially go wrong and how to avoid these complications.  Denis and I wanted to be sufficiently informed to be able to responsibly make our own decisions, and not blame someone else should the birth take an unfortunate turn.  From the research I had done, a natural birth was still the safest and healthiest way to have our baby. 

In the week 35 ultrasound, Bruno was frank breech – he had his feet up by his face, in the easiest of breech positions to push out.  As my due date approached I began to feel kicking down low in my pelvis, a sign that he was potentially footling breech – with one foot hanging down below his butt.  This was considered the hardest breech presentation, since the hanging foot could slip through my incompletely dilated cervix, giving me a premature urge to push (and I could bust my nuts trying to push my baby out when I wasn’t fully dilated).   By this time I had read enough to know that this wasn’t such a worry: barring cord prolapse, which was less of a risk if I labored lying down, I could resist the pushing by panting through my contractions. 

At week 37 we went in to a hospital for external cephalic version.  We figured that we would try everything, so that we would not have any regrets in case we ended up with an emergency cesarean.  We agreed to the procedure on two conditions: that I not have to take tocolytic drugs (also used in case of preterm labor, they relax the uterus and prevent contractions); and that the OB who would do the ECV had a record of few complications (she supposedly had none, but we were not actually shown any statistics).  The procedure consisted of two adults manhandling the outline of my baby through my belly, using massage oil and intermittently monitoring his heart rate to make sure he wasn’t in distress.  Needless to say, the procedure was unsuccessful – the OB and her assistant pushed the baby halfway around, and as soon as they let go his head popped back into place.  They were sweating, but Bruno’s heart rate was fine.  In retrospect, ECV was an unnecessary risk and it was ridiculously painful, but I felt proud of my son for being so persistent in maintaining the position in which he preferred to be born.   

At 40 weeks I was 2 cm dilated and 90 to 95% effaced.  I had been having contractions every evening for around two weeks and all facts pointed to a fast labor.  I had been doing labor preparation treatments with an acupuncturist, Patrice Hapke, which I feel were instrumental in the ease and speed of the birth.  Though I was told by all parties concerned that Bruno would be quick to slip out, I wasn’t worried in the least.  I had read that first labors lasted around 10 to 15 hours, and I was convinced that Denis and I would have plenty of time to finish packing the car, get the snacks out of the fridge, pick my mom up from West Seattle, and enjoy our last few hours as a couple together on the drive down to Portland. 

On the morning of the 17th of August, a week after my calculated due date and the day that the ultrasound folks had set for Bruno’s birth, I woke up to some bloody show.  I called Denis at work to let him know, since from what I had read there was a large chance of labor starting within the next three days.  That night my dad cooked us dinner; the same Pad Thai recipe that he had made for our neighbor years ago on the night that she went into labor with her second daughter.  My dad jokingly swore that this was a foolproof  induction method: that night the neighbor woke up so far along in her labor that, by the time her husband called my mother over to help, the baby’s head was already crowning and my mom had to help her take her underwear off so that the baby could come out.

Around 8pm I started having the usual contractions, coupled with a strong desire to go to the bathroom.  My dad had left, and Denis started timing the contractions.  They were about 10 minutes apart and stronger than the other nights, like menstrual cramps.  Around 10pm they jumped from 8 to 5 minutes apart.  I knew that I was in labor, and Denis called my mom, Laura, to ask her to come over.  My last desire was to get in the car, even to drive the twenty minutes to West Seattle.  I was pushing to poop but couldn’t get anything out, so I asked for Laura to bring an enema.  I remember being very frustrated at not being able to poop. 

By the time Laura arrived, barely half an hour later, my contractions were three minutes apart.  I was in the bathtub with the shower beating down on my belly.  This felt great; I couldn’t imagine getting out of the tub.  My grandmother was driving up from her home in Eugene and had already reserved the hotel room in Portland.  Jesica was getting everything ready for our arrival.  Laura came into the bathroom and timed my contractions.  Realizing that they were so close, she asked Denis to call Jesica and ask whether or not we would be able to come down.  Jesica agreed that we probably wouldn’t make it, but we could call her any time we had a question and she would accompany the birth by phone.  I was very relieved at being able to stay in the comfort of my own bathroom.  We started to fill up the tub, but by that time I had left the shower running for so long that there was no hot water left.  Denis and Laura took turns boiling water to bring to the tub.  We soon gave up on the boiled water, since I would have another contraction whenever it was poured in.  

I labored lying down in the tub from 11:30pm to 2:30am.  We had Leonard Cohen playing at top volume in our little apartment, at my request.  I could reach inside and feel the membranes poking through my cervix, and inside the sack something that felt little and bony.  At 12:30 my water broke, and soon Denis and I could reach up and feel him.  We still weren’t sure that he was footling, but as he descended we could feel his toenails, which left us with little doubt.  We were very gentle when we touched him, so that he wouldn’t startle and get his arms caught.  Because of the hanging foot I had an incredibly strong urge to push with each contraction, so I would pant through them as much as I could to avoid him descending too quickly.  The bath water was filled with strings of meconium like little worms swimming around with me. 

When the contractions started getting really heavy and I felt like I couldn’t bear it anymore, I remembered the birth stories from Spiritual Midwifery where women would describe the tantric connections they formed with their partners while in labor.  I asked Denis to look into my eyes during the contractions; I would tell him “now” when one started and we would start staring at each other.  We probably looked like lunatics but I was feeding off of his energy and this got me through the thick of the labor.  It felt great to have him so present with me and to be able to transmit a bit of the tremendous energy of the contractions to him. 

At 2:30, after Laura helped check that I was fully dilated, I got out of the tub at Jesica’s suggestion.  An entire foot was out, and after a quick push sitting on the toilet, the leg followed.  Then I got on all fours in front of the bathtub and took it nice and easy so as not to tear and also so that I would have some energy to push him out quickly if need be.  I had read that you have a maximum of five minutes in which to get a breech baby out once you can see their bellies and umbilical cords, since at that point the head is in the pelvis, compressing the cord and cutting off oxygen.  So I tried to push his other leg and his butt out as gingerly as I could, but I ended up giving one big push and all but the crown of his head slipped out.  Denis, who was behind me, says that all of a sudden he found himself sitting there looking at his son’s face.  Both Denis and Laura were entrenched in the idea of “hands off the breech” (an adage repeated by Mary Cronk, Maggie Banks, and anyone versed in breech birth) lest the baby startle,  but at this point no harm could be done so my mother guided my hand to Bruno’s butt and helped me catch him.  Then Denis and my mother lifted Bruno up to me, and I leaned back against Denis to check him out and let him breastfeed.  He let out a little conversational cry and latched on almost immediately.  I looked in a book later, and his Apgar was at least a 9.  After about ten minutes he opened his eyes and looked back at us. 

He was born at 2:48 am on the 18th of August, 2009.  Around an hour later we were sure that Bruno had recuperated all of his blood from the placenta, and I was ready to get it out.  His breastfeeding had stimulated more contractions but I was tired and had no urge to push.  The contractions were weak by then, so I would try to guess when they came and then push while tugging on the membrane that was hanging out.  After a few minutes I got the placenta out into a bowl, and Jesica told us to get some tooth floss to tie around the cord.   Denis cut the cord and we got back into the bathtub to have a wash. 

My grandmother, who had driven straight from Eugene to Seattle, arrived at 4am and sat in the bathroom to help me wash off her great-grandson.  He was covered in vernix; he had it stuck in his ears for days and I would pick it out and spread it on his newborn rash.  

We were so elated that we only got a couple of hours of sleep.  The birth was much more than we could have wished for; such a simple and majestic event.  Afterwards we got to curl up in our own bed and look at our new baby and laugh.  I felt like a superhero and I couldn’t wait to give birth again. 

That afternoon we took him to a doctor for a well baby checkup.  He weighed 7lbs and was 21 inches long and perfectly healthy.  A couple of days later Denis sautéed the placenta for us, because eating the placenta helps speed the healing process.  As I write this, two weeks after the birth, we are all in top shape and enjoying our new family. 

I would like to thank my husband and my mother for their splendid performance as stand-in midwives, my grandmother and Debra O’Conner for providing the love and support that made Bruno’s birth such a tremendous experience, and I would like to thank our midwife, Jesica Dolin, for gracefully rising to the challenge of her first breech-by-phone birth.