Monday, July 20, 2009

The Home Water Birth Breech Delivery of Liam

By the time I received the surprising news that I was pregnant with my fifth baby, I had given birth to two of my babies in the hospital completely medicated and to the other two in the hospital without any medication. I had learned a lot about my body, mind, and spirit, and what they are capable of. I had worked with a doula to achieve the natural birth I had always wanted, and I had even started the process of training to become a birth doula myself. At the time I was reading everything I could get my hands on about pregnancy and birth. I felt like a sponge. I had discovered a deep passion and I was soaking up every bit of information I could.

In my studies I had learned about the option of home birth. It was something I had never considered before in my life because I didn't know until then how safe and wonderful it could be. I knew then that I had some options I had never even thought about with my previous pregnancies. I had always been interested in water birth (giving birth in a tub of warm water), but it was not an option in the hospital because of the policies in place. Even after the birth of my fourth child I had felt a sense that something was still missing from my birth experiences. I felt that home birth would fill that void. As I thought about my options, the idea of a water birth at home gave me great peace. The peace I felt surprised me, but I welcomed it. I prayed about planning to birth my baby at home, and that resounding peace filled my soul. That peace stayed with me throughout my entire pregnancy. I never felt fear about my choice to birth at home.

Along my journey I had been blessed to meet people with wonderful skills. Through his work in massage therapy, my husband had gotten to know a midwife who specialized in home birth, and had been working in that field for 15 years. I called her and we started meeting regularly for prenatal visits and monthly forum meetings at her home. She did all of the clinical work that my obstetrician had done at the prenatal visits, but she also offered emotional support that I had never experienced with a birth care provider before. Over the months my midwife and I developed a close bond and friendship that I had never expected. I was able to meet all of her birth attendants (all trained birth doulas who were either midwifery apprentices or midwives themselves), and to familiarize myself with the people who would be at my baby's birth.

I went to my obstetrician's office three times in my pregnancy for various medical tests that my midwife didn't offer (such as an ultrasound). I knew which medical screenings and tests I wanted and didn't want, and I knew my reasons for choosing them or declining them, and I felt informed and comfortable in my decisions. I felt that I got the best of both worlds on my own terms.

My children had already started to become familiar with birth terms and concepts from the many times I read about and talked about pregnancy and birth with my friends. My older children had started asking me questions about what the terms meant and I answered their questions in simple ways that they could understand. They were interested and I decided to use that curiosity to teach them. I didn't know whether I wanted my children to witness the birth, but I knew I wanted them to be prepared for it. I didn't want them to be scared and I hoped they would understand what was happening whether they were present in the room for the birth or not. I wanted them to understand what we were planning and why, especially because it was so different from what most people in our society do.

As the baby's due date came close, my husband and I worked to organize our home to avoid unnecessary clutter and chaos. We tried to foster an environment of peace and love. It was difficult at times with four rambunctious children, but we worked together, prayed often as a family and worked hard to turn the moments of chaos and confusion into bonding times in changing those moods into positive moments.

I had several days of early labor, spread out over more than a week. The contractions were mild and I could walk and talk through them and go about my day. I started to feel very anxious about having my baby, and at times I got frustrated when the contractions would stop for a day or so. My mood was all over the place. I had never experienced such violent mood swings before, and my husband was a life saver in helping me calm down. My midwife assured me that the mood swings were a symptom of the hormonal changes my body was experiencing while preparing for the birth. What was good for labor was hard on my family. I tried to used this time to make peace with myself and resolve any emotional issues that came up.

While driving to my midwife's home for a prenatal visit the day before the due date, I was thinking about having my children witness the birth. I had been hoping to birth in the middle of the night while everyone slept. For the first time I felt a strong desire to have them there. I felt it would be a special bonding experience for our family, and I decided I would like to have my two oldest children at the birth. I decided to see how labor played out and go with the flow, with the hope that they would be able to be there.

At the visit my midwife checked my cervix and found I was dilated to a 1 and my cervix was soft. She did some things to try and help stimulate labor naturally, and she was able to help stretch my cervix to a tight 3. We discovered that the baby's head seemed to be in front of the cervix, rather than on top of it. It was not lined up properly. She recommended some positioning (such as knee-chest) to try to move the baby out of his position and encourage him to move into a favorable position by alternating the downward and upright positions. I used these positions over the next few days, hoping the baby would move where he needed to be for labor to progress well.

About four days after the due date, my midwife brought the birth tub to our house and we set it up in our bedroom. My midwife checked the baby's heartbeat and the kids all got to hear it, with grins and wide eyes. She also checked my cervix and found it was dilated to a 4, almost a 5, and 80% effaced. After she left, my contractions gradually started to build in intensity and frequency. It was evening and I was cautiously hopeful that we would have a baby sometime that night or the next morning. I stayed busy doing things around the house, doing whatever I could think of to prepare and keep my mind off of the growing pressure. I called my midwife to let her know what was happening, and she suggested I go for a walk and call her back if things changed. I walked through the neighborhood around midnight and the contractions started coming every two minutes. I could still walk through them, but it was becoming less comfortable to do so. I called my midwife and she started on her way to our home.

My midwife arrived and my husband helped her set up her things as I moved about the house doing what I could to help and get comfortable. She checked me and found my cervix was at a 5. I was completely calm, able to move about freely as I wanted to. I had my birth ball in our front room, and would lean my torso against it in a kneeling position during each contraction. I was using focused breathing through them at this point, but was managing well without needing additional support. Our 18 month-old fell out of bed and woke up, and I held her as I labored for a while. We all decided to lie down and try to rest while my contractions were so manageable, and get her back to sleep. By the time the contractions were strong enough to wake me I was focusing intently on breathing through them, and my little one was asleep. She was placed back in her bed and I got into the birth tub. At some point my midwife checked me again and I was dilated to a 7. She called her attendant to come assist.

As I stepped into the warm water, the pressure seemed to completely melt away and I felt instant relief. My husband sat behind the tub as I leaned against the back of it. He held my hands to support my arms, and pressed some acupressure points to alleviate the pain. It worked wonders. It seemed to me that my contractions were slowing down and much less intense, and my midwife assured me that I was still having them, but feeling them much less because of the water. Between contractions we chatted and enjoyed each others company, and during contractions I closed my eyes and focused while my husband held me and pressed the points on my hands. The next time my midwife checked, I was dilated to a 9. We were elated, and anxious to have a baby! She stepped out to talk with her attendant and my husband and I talked about how this was the easiest birth by far, and how wonderful it was to be at home and for everything to be so calm and comfortable.

When my midwife came back in to see if it was time to push yet, she found that my cervix had started to close back up! I was back to a 7, and my cervix was swollen and hard. We were perplexed and disappointed. We had no idea why my body had gone backwards. We talked about our options. If I had energy we could try some things (like walking and going up and down the stairs) to get things going. I was tired, and we all decided to lie down and try to rest. My husband laid down behind me to press on my sacrum during contractions to help relieve the pressure in my back. It felt good to breathe deeply in and moan as I exhaled, and I slept between the contractions. My water broke a little bit when I was in bed, and my midwife broke it the rest of the way for me.

The kids started waking up and the midwife's attendant helped them get cereal and keep them busy for a little while. I sat on the birth stool to encourage progress and allow gravity to help. My husband pressed on my sacrum and my midwife applied counter pressure on my hips. My children helped by placing their hands on me or stroking my feet. We soon realized that our littlest one was upset and confused about why mommy couldn't give her attention. We called grandma and asked her to take the kids, but the oldest two wanted to stay and help. We promised to call them back home when the baby was ready to come out. I got back into the birth tub in an upright position and my husband pressed on my back.

It was only about 20 minutes after the kids left that my midwife checked me and found I was at a 9. We called the kids and the older two came home. I was finally able to push, and my kids stood at the side of the tub while my husband sat behind my head and supported my back. It felt good to stretch my body out as long as I could and arch my back. The urge to push wasn't as strong as I remembered it being with my other births, and I had to will myself to push harder than the urge.

With the first really good push it felt to me that the baby's head was about to come out, but it went back in. My midwife asked me to stop while she cleaned some stool out of the water. She soon realized it was meconium from the baby and wondered why there was so much of it. When she checked, she found that it wasn't the baby's head that was about to come out, but his bottom! I sensed worry in her face and her voice as she announced that the baby was breech, but I wasn't worried. I knew my baby would be fine and I waited to be instructed on the next step. My midwife told me to stop pushing and was about to have me get out of the tub. She later told me that she thought she should have me on the bed so she could help manipulate the baby to come out. Her attendant quickly stepped in and said “No, it's alright, let's just keep her here and keep going”.

They instructed me to push and don't stop; just keep on pushing! I forced myself to push harder than my body wanted to as the baby's bottom came out, then one leg, then the other leg. As my midwife reached to help the baby I heard the attendant say “No. See how he's kicking? He's doing just fine!” I closed my eyes, focused and kept on pushing, and they told me his torso came out, then one arm and then the other arm. I felt every movement as the pressure eased with each body part that came out. Then, as my 6 year-old describes it, the baby “put the feet and the hands on the bum cheeks and pushed his head out!”

My baby was out! They immediately lifted him out of the water and placed him in my arms. He was beautiful and perfect, and I just held him against my body in the warm water. The midwife had me hold him above the water with his face down and he immediately spit out the fluid from his lungs and took in a big breath. He let out two little cries and instantly started to pink up.

My husband and midwife described to me how the baby had kicked his legs in the water while I was pushing, and moved his body to help wiggle his way out. I didn't realize until I talked with my kids later that he had actually used his arms and legs to leverage himself against my body and help get his own head out. My kids had the best vantage point, and had seen the process better than my husband, who had been sitting at my head. My midwife herself had been amazed. She didn't have a lot of experience with breech babies, but her attendant who was there had experience birthing more than 20 breech babies, including 3 of her own grandchildren. The attendant had known exactly what to do. It was good for me to be in the water and allow the baby to feel the weightlessness similar to the womb and be able to manipulate his own body in ways I never would have imagined possible. I was immediately grateful I was at home in the tub.

A second attendant had arrived sometime around the time the baby was born. I held my baby as I was helped out of the tub and onto the birth stool to deliver the placenta, which came out in one push. The placenta was then wrapped in a chux pad and placed at his feet while I held him. We were helped into bed and snuggled for a while and enjoyed each others company with my husband and other children while the midwives cleaned up. I had no concept of time, but it was a while later that the midwives came back in and clamped the cord. The kids put on latex gloves and our oldest son got to cut the cord. The midwives inspected the placenta and explained it to the kids. They then weighed the baby at 7 pounds, 15 ounces. I was given a cayenne drink to minimize bleeding and told to drink as much as possible.

I had a small tear, and my midwife stitched me while her attendants examined the baby near me on the bed and went through the long checklist, making sure everything was good. The baby was completely calm as they checked him, and my husband held him. The baby's legs were straight up with his feet by his face because of the way he had come out of the womb, and it took some time for him to let his legs down. One of his hips had been dislocated during his birth, and the midwife suggested that my husband do some craniosacral therapy on him to help his hip. He was given an APGAR score of 9/10 and measured at 21 inches long (once his legs were down).

I don't know what would have happened had I been in the hospital, whether or not they would have wanted to do a cesarean section due to the strange pattern of labor or the fact that the baby was breech. My labor with this baby was different than with my other children. There was no clear pattern to me. The contractions did get more intense as things progressed, but they stayed fairly far apart, and I never felt I experienced a clear transition stage. Even the urge to push was not very strong compared to what I had felt with previous births. I wonder how much the baby's position contributed to these differences. Despite the strange labor, the whole process was very peaceful and beautiful for us. My husband and I both felt calm through the whole thing, even with the surprises that came up, and we are both very happy we made the decision to have this baby at home.

We're not sure why we didn't know the baby was breech beforehand. The midwife is still wondering if she could have detected it earlier. When she had checked me earlier in labor she had noticed that the “head” didn't feel normal, but thought what she felt was the molding of the crown in the cervix. I don't fault anyone for not knowing he was breech. We didn't know, but God knew, and provided us with what we needed to handle it. My husband and I feel that everything happened as it should, and we are thrilled to have our beautiful, healthy baby.

16 comments:

  1. What a beautiful experience! That's such a miracle how he just knew how to do what was necessary to get himself out! How great to show how baby and mother really do work together during birth. :) Congrats!!!fe

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  2. You're so right Jamie :) Something I learned in my doula training is that when a baby is coming out head first, it actually uses its legs inside the uterus to help push itself out. A friend of mine told me that she felt her baby kick inside of her as she was pushing the head out.

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  3. I read this on my iPhone to my husband while he was driving us to my mom's tonight. Great story! Thank you so much sharing so many details. Cheers and congratulations!!!!!

    Kristen

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  4. I am expecting twins in April. I am 21 weeks pregnant and I am considering a homebirth with my twins. One of the twins is Breech, so reading your story gives me confidence to have a homebrith. Thanks for sharing!

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  5. Such a beautiful testament of God's love for us and the importance of trusting Him!

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  6. Thank you for this wonderful story! I also had a surprise breech at home in the water, also entirely successful. Thanks for spreading the work that vaginal breech birth doesn't have to be something to fear.

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  7. Beautiful and inspiring story! Who were your midwives? I'm finding it's hard to locate a midwife with experience delivering breech! We had a C-sec for our last one that was breech and I'd like to avoid that this time around. If you could email me their names, that'd be awesome! Thanks!! tinkgna@gmail.com

    -Natalie

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  8. I want to start by telling you that homebirth is a wonderful thing and I think it can be done by first time moms with breech babies. I also want you to know that I am NOT trying to scare you. But - I am a first time mom, with fantastic, educated midwives and I had my first baby at home in June. He was breech, which we were pretty sure about beforehand, his head got trapped, he suffered a lack of oxygen and was declared brain dead. He lived 4 days on a ventilator in the NICU.

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  9. Dear Anonymous,
    Thanks for sharing. It must be painful for you although you support home birth still. ((hugs)).
    Would you consider sharing more so mothers could learn more?

    Can you describe the birth. What do you think went wrong? Did your midwives have much experience with breech babies?

    Barbara

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  10. Anonymous,

    I've been trying to think of how to respond to your comment, but I can't find any words that seem fitting. My heart breaks for you, and I'm so sorry that was your experience.

    It's hard sometimes for me to share my birth experience when I know that other women haven't had such a wonderful breech birth. Some face surgery because of the baby's position, which I feel is often unwarranted. There are so many reasons for why obstetrics are the way they are today, and I personally wish we had more qualified professionals to support vaginal breech birth so that it wouldn't have to be a hospital or home decision based on the situation.

    The truth of the matter is that birth is unpredictable. We can do everything within our power to prepare and plan, and things can still go completely different. This can happen in the hospital as well as at home, and even under the best of care. Death is a part of life, and a part of our experience, but I wouldn't wish it on anyone.

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  11. I found this blog via a post on Facebook. What a beautiful baby!!!!!! Absolutely gorgeous!!! I had my first home birth two weeks ago and loved it!!! My labor was really weird too! The contractions were sporadic the entire time and only got stronger never closer together. I wanted to have a water birth, but I never had a clear transition either and went from a five to pushing less than fifteen minutes later! I was just about to ask to get the pool ready when I felt I needed to push! My baby wasn't breach but its fun to read that other people's labors were as strange and unpredictable as mine! It proves that you can't expect anything predictable in labor!!!!

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  12. Thanks Krista!

    I asked my midwife later about the lack of a clear transition and whether that was because of his position. She said she thinks it's actually a home birth thing, because in attending home births she's noticed there's a much smoother labor progress and generally no obvious transition period.

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  13. What an amazing experience! So happy to have discovered your blog. I just gave birth to my second baby boy four weeks ago. We discovered he was breech only at the time I was ready to push. It ended in an emergency cesarian birth. It was a crazy experience, one I'm still healing from, and I trust that it happened as it should. I feel grateful that there are mama's out there like you who are sharing your experience and wisdom. Thank you. Here's a link to my totally unexpected birth story: http://freespiritknits.blogspot.com/2010/10/our-birth-story.html

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  14. I love that he pulled his head out :)

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  15. Awww what a beautiful birth story, thank you for sharing!

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  16. Incredibly cute how your daughter described her baby brother :) with his hands and feet on your bum cheeks! Loved this birth story. I had two of my own children at a birthing suite and home birth all without medication.

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