Unexpected Breech Birth

By Louise B

 
Waters broke at 2.30 am when I was 37+3. There was a pop, then a trickle - not a waterfall. I woke my husband 3 hours later at 5.30 am when I began to feel niggly - periody type pains. I rang the labour ward, spoke to the community midwife and we agreed that she wouldn't come out yet, there could well be a while to go (my first labour had taken 27 hours).

One hour later, 6.30 am, contractions quickly went into overdrive. I got my neighbour round to take my daughter and my husband rang the delivery ward and told them we needed a midwife as soon as possible.

Next 45 minutes are a blur of agony as I went from zero to fully dilated. I was leaning over the sofa with one foot and one knee on the floor. We didn't have time for dust sheets towels or any type of protection. The house was completely unprepared. The birth pool was left abandoned, only half blown up, as the contractions were coming one on top of another and I needed my husband to support me through each one, rather than man the pump!. Suddenly I needed to push. Still no midwife so my husband rang the labour suite again and urged to midwife to get here quickly. It transpired that the original midwife had gone to the wrong address. She never made it to the delivery. The labour ward despatched another midwife to attend to us, and that explains why it took so long for any help to arrive. I could feel the baby descending and everything down below was bulging. We thought my husband might be having to deliver the baby, although I was beyond rational conversation by then. Thankfully 15 minutes later, at 7.30 am, the midwife arrived. The pain was insane, but I was sooo relieved that I could finally push with confidence, and that we were safe. I knew we were close to delivering, and just the feeling of being secure helped bring the pain back under control and allowed me to productively channel it into pushing.

Two minutes later though, it all went wrong. I felt a plop, midwife took a look. Her words are ingrained on my memory, as is the sound of controlled panic / urgency in her voice. She said, “Oh God; it's a foot, it's breech, dial 999 NOW, get an ambulance, it's a footling breech. Tell them it's urgent”.

Then she told me I mustn't push, that every time I had the urge I had to pant, but whatever I do I must not push the baby out. So started the longest 15 minutes of my life waiting for the ambulance to arrive, in panic with the pain again, and trying with all my might to fight the urge to push for fear I was endangering the life of my baby.

The ambulance arrived and somehow I managed to find it in me to stand up, run to the front door, sprint over to the ambulance, clamber up the steps and collapse over the trolley as another contraction took hold. We blue lighted it to hospital which took another 15 minutes when I finally got my first whiff of pain relief. The ambulance had gas and air, but I wasn't able to use it properly as I had to give short pants, rather than long breaths. Still, it gave me something to concentrate on as I continued to fight the urge to push.

In my head I was thinking that they were taking me to hospital to give me a section, something I was desperate to avoid. Just as we arrived at the hospital I couldn't withold the urge to push anymore. To be honest I think subconsciously I thought to myself, that in order to avoid the section I was, at some point, going to have to push the baby out. Arriving at the hospital and knowing that help was close was perhaps the impetus I needed to let go, and give in to my body.

I pushed and another leg fell out. I felt like I was splitting in two. Still they were telling me to stop pushing. They wanted to get me out of the ambulance and rush me to theatre. The medical team were waiting outside to whisk me away. The midwife though changed her mind and demanded the medics come into the ambulance, saying the baby was coming and it was too late. An altercation ensued with the nurse trying to insist I was moved to the theatre. The message got through at last, the ambulance filled up and finally, finally I was able to push. Her body was half in and half out. I was still leaning over the trolley with my feet on the floor. I had a rough episiotomy and the doctor manipulated the head through the birth canal. At 8.24, 2 hours after the first real contractions, Harriet Rose was born.

She was rushed outside into zero degrees temperature (coldest morning of the year) and into the resus unit waiting for her just inside the doors of A&E. I curled up into a ball and went into shock, whilst they wheeled me up to delivery. I hadn't yet seen my baby.

Ten minutes later we were reunited. I had a physiological third stage and spent the next hour cuddling Harriet and delivering the placenta.

We left the hospital the next day. Harriet had a broken collar bone as a result of the breach birth but no treatment was required.

On the whole I am glad we went the homebirth route. Had I been in hospital I am sure I'd have been whisked off for an emergency section the second the foot fell out. It could well have been a crash section with a general anaesthetic and recovery from that, both mental and physical, would have been long and hard.

I am incredibly grateful to be spared that, to have had a natural delivery with very little aftermath - a fractured collar bone and a roughly cut episiotomy. From that point of view it was a very positive outcome.

However, during almost the entire labour I felt very unsafe and out of control; firstly because we were close to delivering her on our own and then afterewards because the breech was viewed by everyone as a BAD thing. I have struggled with the 'what ifs'. Had the midwife been just five minutes later, it would have been my husband discovering she was coming foot first and we would have been facing the prospect of delivering a footling breech on our own at home. I know it didn't happen, but it feels like we were just minutes away from a potentially very dangerous situation. On the other hand, I also wonder if I could have pushed the baby out at home. If the midwife had said, 'right, let's get the baby out' and guided me, then we might have had a very natural and positive home birth, rather than the panic-filled version that did happen.

The other thing that bothers me is that we didn't get a glimpse of her when she was born. She was whisked away immediately. She has a shock of dark hair, that neither of us were expecting and it threw us a bit. When we were reunited I kept wondering if she was really my baby. I know of course she was - she had a bruised bottom and feet for a start. But, still, it runs through my head. It's a shame that directly after her birth was the only time we were separated during the first few weeks of her life.

 

Four days after the birth I met with the midwife for a debrief. It was a useful conversation and happened at the right time in my recovery. Prior to that I was just grateful all was well, and wouldn't have asked the right questions. By day four, though, relief had given way to anger. I was angry that despite my desire to be in control and have a natural delivery, and my best efforts to secure that by aiming for a homebirth, it had transpired to be a labour characterised by panic and lack of control and I felt the midwife could help me understand why. The crux of it was why hadn't I been given the chance to continue labouring at home, with the medical team and ambulance waiting outside to intervene if need be. Why hadn't my body been allowed to do its job?

 

I accept the midwife's answers, and accept she acted professionally and within her comfort zone. She had never met me before, she walked in as I was pushing and hadn't been able to assess my labour and my progress fully. Most importantly, she was on her own with no back-up midwife on the way. If both baby and I needed help after the delivery, then she would not have been able to attend to us both. She felt that homebirths were fine in low-risk deliveries, but as soon as the labour ceased to be straightforward, she felt the best place to be was the hospital. I guess an independent midwife with experience of breech deliveries may have managed the situation differently. But, why would I have sought out that sort of expertise prior to the delivery? I didn't know she was breech!

Just one other thought ... all the midwives in the hospital were very positive about the birth and congratulated me on the natural delivery and telling me I had done well. In contrast, the two doctors I spoke to took a much more negative point of view and focused on the fact that an ambulance delivery was 'less than ideal'.

Louise


Note from Angela: Around 4% of babies are breech at term, and approximately 1 in 4 of these are undiagnosed until labour - so that means that 1 in 100 labours will turn out to be a surprise breech. Relatively few midwives are experienced in attending a natural breech birth; sometimes manouvres are necessary to free trapped arms, and breech babies are more likely to need resuscitation, so a midwife who does not feel confident would usually ask a mother to transfer in this situation. The possibility of a surprise breech is one reason to consider having an internal exam in labour, so that you have more time to think about your options and to transfer if necessary. For more breech birth stories and links, see 'Can I have a home birth if...?'

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