Our Quest for a Natural Breech Birth in California (aka Breech Birth and the War against the Mother)
A summary of our experience in having our breech baby vaginally, with minimal intervention.
When we found out that our baby was in the breech position at week 37, the face of the midwife waxed pale. 'You'd better schedule a trip to the hospital... today... to try to have her turned.' Every midwife had confused her position, even after a series of ultrasounds. During this one, they caught it.
The turning procedure is called an ECV... External Cephalic Version, as opposed to the antiquated Internal Cephalic version, where the practitioner would reach into the womb through the vagina and pull down a head or a foot... whatever they could reach. It is suggested if the baby is discovered in the breech position after week 36. They also mention that the baby could turn at any moment, even during labor. That wasn't much of a help in this context, because most hospitals in the US will only deliver a breech baby via a Cesarean section, so you'd never find out if the baby was about to turn just prior to labor.
Why does every breech birth automatically trigger a Cesarean section ? Safety of the mother? Liability for the hospital? Well, that remains to be seen. They both come with inherent risks, but in my opinion the C-section induces far more trauma to the mother and infant. Since I work in trauma release, I see this regularly, though it probably does not show up in studies, as it cannot be measured in the short term.
That day, we checked into Sutter, Santa Rosa to have a go at the ECV. A tall blonde female OBGYN, with hands that were larger than mine, tried her skills. My partner C. declined the spinal anaesthesia, so she had to meditate and bear the pain, while trying to loosen her abdominal muscles as much as possible, so the procedure had a chance. Contraction would restrict what could be done, even for the most skilled practitioner. The practitioner tried to turn her counter clockwise, and when that wasn't working, she tried to turn her clockwise. A lot of the procedure centered around digging in just over the pubic bone, and trying to dislodge the leg or foot or whatever was lodged in there, presumably the reason she wasn't turning. There was the risk of the pressure actually inducing labor, which was frightening, because that meant a trip to surgery for the emergency C-section.
They kept checking the heart rate in between attempts. It held strong, thundering through the machines. There were a few times, when the heart shrunk to a distant echo, and vanished entirely. C. lied with her eyes closed while I gripped her hand, and we waited with baited breath for the heart rate to show up again... the abstract 'swish swish' we grew to know and love over various trips to the hospitals.
Whenever I see the ultrasound screen, I see dark imagery. I hoped it wasn't some sort of ominous portent.
The ECV didn't work for us. A midwife at the Santa Rosa Birth center had said that every patient they'd sent to this woman so far had had a successful ECV. I guess we were the first that didn't.
We went home a little disheartened, in something of a daze. C. was so sore she could hardly walk. She's embodied, and therefore, sensitive. The baby wasn't moving much, either. After every ultrasound, she would go off the grid, not stirring for days, so we worried about how this more intrusive procedure might have affected her.
After a few days, we shook off the catatonic stupor and rushed to schedule every practitioner we could find (and afford) that might be able to turn her. There were chiropractors, a renegade midwife who advocated natural vaginal breech birth, a moxibustionist / acupuncturist. Everyone was as helpful as they could be.
The acupuncturist gave me a box of moxibustion to bring home, and I held that little ember near C's little toe, where the nail bed meets the flesh on the outer edge, like holding a candle up for dear life in a black night. I would get bored with the reality, and drift off into a trance. I wasn't sure it was working, and I'd drift in and out of consciousness. Ouch, she'd shriek. Hot. Hot! Once, she felt the warmth rise up the right foot into the womb, and the baby kicked wildly. Most times, we couldn't elicit a response. It was more the joy of practicing an ancient, primitive art.
I was railing against the whole medical establishment, with their sinister apparatuses, with nothing but an ember.
C. had a dream where she had a glass of wine. When she woke, she said that she was able to accept that the baby was breech, and that she probably wasn't turning.
Now it was up to us to figure out how to birth her.
The situation appeared bleak at first. C. was in a state of shock, having this baby inside of her and nowhere to birth, without invasive surgery. So it was up to me to do the research and see what could be done. I am, by nature, strongly inclined to holistic healing, and against intervention in most cases, so I was being challenged left and right.
I stumbled on a video on youtube of a vaginal breech birth facilitated by Stuart Fischbein, and it seemed like no problem.
Dr. Fischbein is located in LA, California, and can be found at http://www.birthinginstincts.com/
The video really eased my mind. I'd read about the routine vaginal breech births performed by Ina May and her crew on The Farm in Ina May's Guide to Childbirth, but there was something about the video that made it real.
A midwife at The Birth Center in Santa Rosa saw our downcast expressions after the failed ECV, and she encouraged us to look into other options. She said there were a few places where vaginal breech births were performed. There was a hospital or two in San Francisco, about an hour and a half from us, that reportedly offered the service. When we called them, they said they were booked through January, and our due date was at the end of December. The birth center put out referrals to everywhere we could find, to see if that would somehow streamline the process.
I emailed Dr. Fischbein. He replied right away. He was the first one who seemed to empathized with and understood our predicament. His simple response brought tears to my eyes. He said we could come down, for a fair but significant financial investment (which we could not then afford), but he advised me to look up Dr. Anette Fineberg in our area, and to see what she was up to.
I found that she was working out of Sutter Davis, about an hour and a half from us, and that they offered more holistically oriented birthing services. When we called them, they advised us that they didn't accept our insurance, Medi-Cal, but that the Davis Community Clinic did, and their policy was to transfer mothers to the Sutter Davis birth center for breech births.
It seemed a long shot somehow, because our date would have to align with one of the doctors on duty who would deliver breech babies. Again, most hospitals automatically revert to a C section when the baby is breech. C sections are fine, when they are life-saving, however are they automatically necessary in the case of breech presentation? No.
The day before we could make it out to Sutter Davis, a seasoned midwife I found, who had performed 67 at-home breech births successfully, came to our home and spoke to us about how routine this process really was. I'd written her a desperate email. At this point, it is illegal for a midwife to oversee a vaginal breech birth in a home, so her visit was more informative than anything. She brought us a bag full of resources on breech... books and DVD's, and that really helped. She raved against the lunacy and cowardice of the system. 'Out of the 67 breech births I've done, only 1 required a C section, and that turned out fine.' She slammed the policies of the hospitals. From her perspective, a vaginal breech birth was as natural as any other birth, and hospitals were only afraid of it due to perceived liabilities. It had nothing to do with the welfare of the patient / mother. She really inspired us to pursue the natural option, as it is no longer legal in California to perform home breech births without a doctor present due to potential complications.
Anyway, as soon as the Davis Community Clinic got my email, they called and we made an appointment for the next day. We drove out, registered through the clinic, and within the hour we were able to meet Dr. Annette Fineberg. It seemed almost miraculous, after so many grueling setbacks. We were free to birth at the center within a few hours after arriving. C. was evidently a perfect candidate. She was tall and healthy and had had a baby before, vaginally. Since we were something of an emergency case, they streamlined the process for us, which we deeply appreciate! And instead of looking at us with dread when we mentioned the breech position of our little one, they seemed excited.
'Oh we love breech births around here,' our midwife assured us. 'They are so exciting, and they make our day.'
I looked over and saw C's whole body soften. There were tears in her eyes. I was relieved to have found a corner of sanity in a world gone mad.
Dr. Fineberg was approachable. She, too, talked about vaginal breech birth as though it were completely routine, and with a passion. She was actually excited to work with us. Her smile kept beaming through. She showed us the birth center, and we were relieved to see birthing tubs, and electric candles, and other accoutrements for the comfort of the patient. Were we inching back toward our birth center ideals?
(Later we discovered that she was featured in Mama Sherpas, a documentary about birth and the rise of C-sections, by the makers of The Business of Being Born, a documentary that C. and I watched earlier in the pregnancy).
We began to get a confirmation of our sense that something was seriously amiss in the standard presentation of breech births as some sort of dangerous procedure.
There are a few (rare) instances where a breech birth might present complications for the mother. For instance, if the placenta is underneath the fetus and arrives first (placenta previa). With modern diagnostic tools, the position of the placenta is simple to ascertain, so there is really no threat in most cases. 3%-5% of babies are breech at the time of delivery.
We hung out in Vacaville, near the hospital, for a few days after meeting with the doctor and seeing the birth center. When we realized that the baby may not be coming quite yet, we decided to drive back tp Sonoma County and pack up a few things.
A day later, at 2:22 on December 22nd(12/22), C woke me up, and said we'd need to leave early in the morning. I was sleep deprived, and seriously running low on energy. I nodded, and fell back asleep. We left early to beat the traffic. I tried not to drive over any bumps. We stopped in Vacaville so C. could have a shower and relax, and then called the birth center, and let them know what was going on. 'Head over', the midwife on call said. 'It's ok if you arrive a little early.'
When we arrived, the midwives and nurses were receptive, giving advice and trusting C's intuition. She labored in the tub for an hour and a half, while I sat beside the tub and dabbed her head with a towel, while she growled and moaned. During contractions, she didn't want to be touched, and they respected that. Between contractions, I reached out to dab. After an hour or so, Dr. Fineberg arrived, and she asked C. a series of questions, which were mostly responded to with inaudible sounds. I tried to interpret as best as I could. Sometimes I just shrugged.
I felt like I was on weeks of very little sleep. I was struggling to keep my wide open, so I didn't miss anything. It was a struggle to keep them open at all. Like C, I just wanted a place to land and rest after so much stress to my system.
While the birth center at Sutter Davis does a beautiful job of balancing the hospital atmosphere with the atmosphere of a traditional birth center, they do normally relocate the patient to the operating room when a breech birth is imminent, just in case there are any complications. We didn't want to deal with that transition, and slow the momentum. C. stayed in the tub as long as possible, and by the time the baby was about to come, it was too late... they moved us over to the bed a few feet away. The ideal would have been to birth in the tub, but that was not considered safe, due to the potential for bleeding and not being able to tell how much blood there was in the water.
After she moved to the bed, and got on all fours, the baby slid right out. She turned out to be a footling. This was supposed to be the hardest to birth, but as Ina May has written, 'they just slide right out.' I saw the little purple toes, and the foot flexing. C. asked me to come up by her face to support her chest, but whenever another body part revealed itself, Dr. Fineberg summoned me to the rear to celebrate celebrate. C's daughter M. watched the whole affair with wide open eyes and her jaw on the floor, while a friendly midwife narrated the whole affair to her.
The left foot came out first, and it was twisting around, feeling the air for the first time. Dr. Fineberg asked M. if she wanted to touch it, and she declined, shaking her head vigorously. The foot was sort of gray, but turning pinker all the time. It seemed that with every breath, groan, scream, a body part came forth. It was astounding. The whole pushing process must have taken about thirty minutes (though I confess I had no concept of time at that point). As the left leg dangled, Dr. Fineberg asked C. to glance down at it. That seemed to have a profound effect. C. didn't know what to think, at seeing her baby coming out backwards, and at the same time, it was her first glimpse of her new baby, so it was a powerful motivator.
The left leg was dangling, and then the butt, and the right leg started to come out. Soon, the torso was out, and the legs and head were still not showing up. It was surreal seeing the baby, a new human life, dangling there, with the whole body protruding except the head. Mostly, Dr. Fineberg hadn't intervened at all before. At this point she reached in, put a finger in the mouth, and gently loosed the chin.
Then the baby came out. The cord was around her neck twice, loosely. Our midwife leaped out and unwrapped it, narrating her every move. They handed the little one to the mother, between her legs. C. rubbed her back vigorously, and became a ferocious guardian. She was tired but sharp; no drugs were used in the birthing of this baby.
Rose was born at before noon on Dec 22nd, 2016.
After they wiped her down, they handed her to me, and I held her in my arms, awestruck. She looked at me, wide-eyed, as they cleaned C. up and turned her over onto her back so that the baby could find her way to the breasts and suckle. It was one of the happiest moments of my life; so still and present, with tears in my eyes, absolutely astounded at those eyes, a sort of mirror, that were gazing into mine. It felt like part of me was suddenly coming alive, or on line, with this little life force. I could see in those eyes ablaze, a torrential, ancient soul. They looked like a deep gray.
Afterwards, a few of the midwives came up, and said that that was the most beautiful birth they'd ever seen; a perfect breech birth.
I was so proud of C. She always astounds me, and I'm continuously humbled by her. She's the most powerful female I've ever met.
There she was; 7 pounds and 9 ounces.
All of my naive notions about the natural process of birth were tested. I was forced to walk the delicate line between the natural, at-home water birth that we'd fantasized about, and the sterile pharmaceutical-laden hospital birth, contraptions and interventions at every turn.
We all came out more alive than ever.
I want to thank the people that made it possible, esp. Dr. Annette Fineberg., Dr. Stuart Fischbein, The Santa Rosa Women's Health and Birth Center, Sutter Davis Hospital, and the courageous midwives that guided us.
She thanks you as well:
Love and Flow,
#breechbirth #naturalbirth #vaginalbreech #holisticbreech #breach