I thought I must write how truly useful the breech study day was.
I remember saying to my colleague how I wish I could witness a breech birth. Little did I know how soon this would come true!!!
The day after attending the study day my wish came true. I work in a hospital where breech babies are born by caesarean section. Well, I was assigned to care for a 20 year old primigravid lady. I performed one examination and I found the cervix was 2-3 cm dilated, cephalic ?ROP. I moved her to one of our larger rooms to mobilise. Anyway, she started displaying the typical signs of progress – distress and spontaneous pushes, purple line etc. I just waited for the vertex to appear at the introitus!!!! Her membranes were intact and could be seen advancing. They exploded at the perineum – clear liquor!!! then, I saw a white presenting part and I thought, no it can’t be a bald head. Then I thought, perhaps it’s a face presentation. I could not believe my eyes when I saw the tiny anus!!! I informed the woman of the surprise and asked her to turn over onto all fours (she was already on the floor where she had thrown herself during transition!!) I waited a moment for the baby to descend (good by stealth!!) and then pressed the normal call bell as I could not and did not want to press the emergency buzzer knowing full well what would happen. I did not realise just how quick a breech birth can be. It was over in two minutes and thanks to Mary and Jane, I remained calm and sat on my hands. It was beautiful. The co-ordinator panicked and pressed the emergency bell and did not come near us – by which time the woman had birthed her beautiful daughter.
Thinking back I can clearly see the mechanisms of the birth. Sacro-anterior presentation, extended breech. The legs were born spontaneously followed by abdomen, a nice juicy cord and the arms were born so quickly I have no idea where they had been!!! The head came quickly – it was well flexed so I just supported the baby under the shoulders as Mary and Jane had described with the mother in the ‘exaggerated prayer’ position. Mum had an intact perineum to top it all off and I am chuffed!!! Perhaps the best bit of all, was the entrance of the doctors – you should have seen their faces. The woman was on the floor and I had pushed the bed to a corner. I had to laugh at their reaction.
Well, I cannot thank you enough – God was watching. Had I not attended the day I would have handled it very differently. Many thanks for this beautiful opportunity – I’ve finally seen and ‘assisted’ (or rather didn’t) a vaginal breech birth!!
I would like to take the opportunity to thank you all for a wonderful day – A Day At the Breech. I went away feeling that maybe I had not been a midwife for the last twenty years but from now on I am certainly going to become one. I qualified in 1985 and trained in a very medicalised consultant unit.
In recent years I have worked hard within the unit to ensure birth is normal against much opposition. The study day has encouraged me not to fear some situations and to gain courage and determination to practice.
I admire your commitment to women and the profession. You are all certainly with women and are all passionate about the profession.
Thank you again. I am looking forward to my first breech birth
First of all a big thank you for all of you who organise the inspiring and informative ‘Day at the Breech’ but a special thank you to Jane Evans who came out to a planned breech birth last night to support Jacqui and I.
Jacqui and I attended one of your study days maybe 3 years ago and had booked ourselves on another one to refresh our memory, unfortunately Jacqui couldn’t come due to a birth, but I went and was really spell- bound. I remember Brenda saying that she wants us to leave the day really excited and boy, you three succeeded!
Already half way through the morning I thought who might/could have the next breech baby and thought of H whose baby had been breech at 34 weeks and I knew she had been trying acupuncture, moxabustion and inverse positions. Thirty minutes after that thought H phoned reporting that she just had her 2nd acupuncture session during which the baby turned to transverse and then back to breech again. We had just covered the steps that could be taken prior to deciding where and how to have the baby. I asked H if she thought the baby wants to turn and she said yes s/he wanted to but couldn’t. H felt strongly that she wanted to give an ECV a go and Jacqui arranged this with a consultant at H’s local hospital. The ECV was booked for today.
I saw H last Thursday discussed what happens during an ECV and stressed that she did not have to have it and could change her mind at any time if it didn’t feel right – memories of Brenda’s story about her 2nd baby resurfaced. I was struck by the fact that H kept saying that she doesn’t think EVC will work, that she hates the thought of going to hospital but she still wanted to go ahead… She felt strongly that if the baby stayed breech she would stay at home and was supported by this by her husband R. I explained that the lovely, skilled and ,yes, famous Jane Evans had volunteered to support us. I left her a copy of the Benna Waites book.
Yesterday evening H phoned me reporting mild contractions and more pressure in her bottom – prior to that the breech had been free! I suggested to observe and to phone again if any changes. I wondered if we were dealing with ‘engaging pains’ or a trial run often experienced by multips. What contradicted that was the fact that she was alone with her toddler – her husband a 3 hour train journey away and her mother needing to come from several hours drive away. I therefore thought it prudent to alert Jacqui with whom I work in close partnership and Jane who said she would be available whenever.
An hour later H rang again contractions now painful and desperately trying to get O the toddler to bed. I offered to come and asked Jacqui and Jane to make their way there too, there is always a possibility a breech might be quick and H had a 10 hour labour last time…
When I got there H informed me that she could still breath! Her main focus was to get O to sleep it was by now 20.10h. I brought my equipment in, noted the electric heater I had requested as H’s house is often very cold. I spread a soft matt out for her and when Jacqui arrived 10 minutes later we made tea waiting for H to return. Which she did: she was contracting 3:10 moderate. On abdominal palpation the baby seemed RSA 2/5 palpable and on reflection with an extended head.
Jane came 1/2 hour later and helped us set the room up after some life affirming hugs!!! Still no sign of grandma or dad!
H’s contractions now came 4:10. Jacqui decided to read to O so that H could concentrate on her labour she was kneeling on the mat with a small beanbag and a cushion in front of her.
Around 21.30h H’s mum arrived and H seemed greatly relieved and contractions seemed to get a bit stronger still. The baby’s heartbeat had been good throughout with a lot of reactivity.
Around 22.00h H’s waters broke lots of clear liquor and a reassuring FH. Pale red line was rising, H got slightly more vocal but nothing expulsive yet.
Around 23.00h H’s husband arrived and sat by her head end he seemed calm but somewhat surprised to see H in such strong labour – as far as he was concerned that was the practice run as H had never updated him!
It was probably 20 min after he arrived when contractions got more expulsive (times were kept by the lovely Jacqui while I was able to massage H’s back
– I so love the way we work together). Of course H had manoeuvred herself to an area with little space but both Jacqui and Jane managed to perch and squeeze in – Jacqui was taking lots of pictures and Jane was right behind be able prompt direct when necessary. I realised quite early that something pointy was distending H’s perineum and in the recesses of my mind the Mary’s slides of the knee presentation resurfaced and sure enough a very chubby thigh came down followed by a calf and foot, next contraction the other leg
– I think then the pelvis and it was great to see the juicy cord as the chest came into view the baby had been wriggling a few times too the arms came with great ease and then it was hanging there. What an extraordinary sight – even after all the pictures it seemed so strange Jane then suggest that H should push a bit more for the head I tried to perform a ‘Smellie Veit Manouver’ and discovered more cord round the neck and for a split second thought about looping it over the baby’s head – a no go with a breech I discovered. I flexed the baby’s head from behind and had just found the cheek bones when hey presto the baby emerged a little shocked admittedly but seemed to recover quickly and just showing her the bag and mask seemed to do the trick – she was no shrimp.
Weight 4300g or 9lbs 10oz H/C 37cm. The cord had been tightly round the neck twice.
After wards we speculated about the possible outcome of the ECV and H’s wisdom to labour beforehand!
I also thought had H had a caesarean everyone would have said it could never have happened vaginally: extended head with cord round it twice (the cord was incredibly long more than 50cm!), the birth weight and the h/c and of course the knee presentation according to Jane 1:6000!!!
It was truly amazing to witness, I am sure there is so much more to say especially when we look back at the pictures and debrief with Jane, but I just felt compelled to write it all down while it was fresh and say thank you to you all!!
Lets keep up the fight to keep these options open for women.
Needless to say H is over the moon too….
Elke and Jacqui