Beautiful Breech Birth (Part III)

Illustration by Richard Wilkinson.

Read Part I Here || Read Part II Here

When we arrived at the hospital they brought us into L&D room 7.  J looked at me and said, “Seven, that’s a good number.”  I agreed.  I always take seven as a good sign and mentioned to J that this was the very room my last clients birthed in.  That moment was the calm before the storm.

The nurses come into the room in a flurry.  Sign this. Wear this.  Lay here.  Tell me this.  We need blood.  Saline lock.  Hold still.   This will hurt.  Spread your legs.  Spread them wider. Just Relax.  It was a shock to the system.   The first nurse checked J’s cervix, she didn’t wait for the contraction to end.  This hurt my heart.  In fact, it made me angry.  J screamed from the pain of the rough exam. The nurse was obviously frustrated and told us that she couldn’t find the position of the cervix.  “It’s posterior. I can’t even reach it. You need to hold still,” she said, as she pushed her fingers even deeper into J’s vagina.    My client is literally clawing at the sheets and gasping for breath.  I placed my hands on J’s face and asked her to look at me.  J opened her tightly clinched eyes. I said, “Would you like her to stop?  You can ask her to stop.”  J shut her eyes again.  I said it again, “J, you can ask her to stop.” For some reason, J did not ask her to stop.  In my heart, I wonder if I did enough.  As a doula, I cannot make requests or demands beyond what my clients have already expressed.  I was waiting for J to give the word and she didn’t.  I’m still confused by this.   Immediately, another nurse, seeing the situation, promptly stepped in and asked the  other to stop and that she would check J’s cervix in a moment after the contraction ended.

This was nurse Ryan, and she was a wonderful and knowledgeable L&D nurse.  She respected my laboring  momma and had a special revere for natural birth.  Beyond that, she was even experienced with vaginal breech birth.  She gently came to J and reassured her, spoke respectfully to her and then took a very tender approach with her as she checked her cervix, no patronizing words or angry movements, just pure and simple kindness.  After the exam, Nurse Ryan let us know that J was 9 centimeters dilated, 100% effaced and baby was zero station, her cervix, was anything but posterior.  As she left the room, she smiled at all of us and said to J, “You’ve done a fantastic job of laboring.”  Our first bright moment in the hospital.

I look out the window, and I see the sky tumbling down buckets of rain; like God opened the faucet of heaven and left it running while He walked away.  I hoped that Dr. Cummings was on his way soon.

Just then, J yells out, “Whooooa, my water just broke.”  I buzz the nurse and let her know.  I’m talking J through another contraction when Nurse Ryan comes in.  She checks J’s water.  There’s meconium.  In most cases this is a cause for concern, however, since baby Sofia is breech, it’s quite common.  Breech babies have their bottoms sitting on the cervix and the meconium collects and stays on the bottom almost like dredges of a pond.  When J’s water broke, the meconium immediately was expelled because of the position of the baby.

Nurse Ryan check’s J’s cervix again.  J is complete.  Just then, J looks at me with an all too familiar expression I’ve seen before on other laboring mothers and says, “I need to push!”  Of course, she can’t push until the OB is present.  But this is okay, I was taught that it’s best to assume with breech births that there is a cervical lip present and to have mom pant the baby down through her initial urges to push.  This is a preventative measure, it allows us to be absolutely sure that the cervix is 10 centimeters dilated – making certain that baby’s bottom wont be pushed out before momma is complete.

We are told that Dr. Cummings is not here yet, but will be here as soon as he can.  In the meantime, J must pant through her urge to push.  I begin to lead J in breathing techniques.  My face is near hers, I’m crouched to her eye level,  I have my hand on J’s forehead and she and I begin breathing together as I nod my head in rhythm with the slow-paced breathing, saying out loud, “Puuuuuuuh, (pushing out your breath as you do this) puuuuuuuuuh. Puuuuuuuuuuuh.”  J holds her husband’s hand tightly and breathes with me as she looks intently into my eyes.  F is also sitting on the bed and he begins breathing with us as well.  There we are, all three of us, puh, puh, puuuuuuuhing through J’s urges to push, with Nurse Ryan sweetly looking on.

Another nurse comes into the room.  She lets us know that Dr. Cummings is stuck in traffic and has made arrangements with another Dr.  to deliver the baby.  None of us say anything.  I look at J and she looks at me and then I see it in her eyes – a strong determination that she would not push out her baby until Dr. Cummings arrives.  And that’s exactly what she did, for over an hour, in total, J panted through her urge to push, breathing her baby down when finally Dr. Cummings walks into the room.

Seeing his face come through that hospital door was a huge moment of relief for all of us.  He looked at J and said, “I knew you would be strong enough to wait for me to come.”  He quickly examined J and then confirmed that it was time to move.  Dressed in scrubs and with our masks on, F and I follow the circus of nurses and technicians down the hospital corridor into the OR.  J is leading the party, wheeled away on her bed like she’s the float of the breech parade and we are all in tow behind her.

The OR  is buzzing with movement as we lift J from one bed to the operating table.  The anesthesiologist is waiting in the corner. When attempting a vaginal breech birth, it is policy for moms to move to the OR when it is time to push.  Should any emergency happen and a cesarean is necessary, then everything is already in place for immediate action.

Dr. Cummings gives the word that J can start pushing.  With one of my arms holding J’s leg back and the other holding up her head, and her husband on the other side doing just the same, J begins to push.  With her very first push we see the little baby butt cheeks crown.  Another two pushes and the bottom has completely emerged.  Dr. Cummings places a warm wash cloth over baby Sofia’s bottom, to prevent meconium from getting all over him.  Breech babies tend to get all their poo squeezed out of them during birth, this is quite normal.  Another two pushes and the legs and trunk emerge.  J is incredibly strong.  I’m literally holding her with all my might, my muscles are quivering as she leans against me for leverage during the force of her pushes.  J is pushing so hard her torso starts to rise off the bed.  I gently speak to her,  “Keep your chin on your chest. Bring your bottom back on the bed.  That’s perfect, you’re doing an incredible job. I can see your baby, she’s almost here.”  J is pushing with all her might, and the shoulders emerge.  Now it’s time to push out the head.  With one strong, long push and with the gentle guidance of Dr. Cummings, baby Sofia’s head emerges.  J pushed out her breech baby in ten minutes flat, mostly due to the fact that she panted her baby down for over an hour.  We immediately hear that beautiful newborn cry and Dr. Cummings lifts up the baby to show momma her sweet girl.  J says with relief, “It’s finally over!”  “Actually, it’s just starting.”  Dr. Cummings says.  We all laugh and smile.

After being up for more than 34 hours, by this point I am overwhelmed with emotion and I start to cry.  F is crying as well and he wraps his arms around his wife.  Dr. Cumming tells J over and over, “You are a star! You are a star, J!”  The nurses take the baby over to the warmer and begin to check over her to make sure everything is fine.  F goes to be with his baby during the exam and I’m standing near J.  She is crying and she looks up at me and grabs my hands to her face and begins to kiss them and says, “I could have never done this without you. Thank you, thank you, thank you.”  Of course, I’m crying even more by now.  I lean down and kiss J on the forehead.

We look up and see that F is now holding his sweet girl.  The room suddenly becomes quiet as he sings a simple lullaby to his daughter.  She stops crying immediately and looks straight into her daddy’s face.  F brings Sofia to her mother and J holds her daughter for the first time.   I step back to give this new family some space.   This moment is worth a thousand words and a million songs.  It is the sacred space of new parents with their new child and it feels as though the whole world has stopped for them in honor of what has just occurred.

Baby Sofia is born after 20 hours of labor at 6:20 in the evening.  Welcome to the world precious girl!  It was a privilege to assist with your birth!

Read Part I Here || Read Part II Here

Tags: breech birth, Doula & LCCE, Natural Birth