Breech Births - A Lost Art

We at From Belly to Baby were thrilled to receive the following letter, which is in fact a birth story, from Mme. Maloney. Here she shares her recent experience, having a frank breech birth at the Monfort Hospital just before Christmas. Congratulations!

The Birth of Ms. Abigail Elizabeth Maude Béo by Samantha Maloney

In the beginning, the only complication in my pregnancy was finding a midwife. I had a hard time finding midwifery care in Québec, so most of my prenatal care was done in Ontario. When I finally got a call back from La Maison de Naissance, I was relieved. I wanted a homebirth and they said they might be able to provide me with one. Turns out, we live one kilometre and a half too far from the hospital for them to do a homebirth. I could still have midwifery care at the birthing centre which, to me was still better than the hospital.

At 36 weeks, my midwife at La Maison de Naissance brought to our attention that our baby was breech. More seriously, she informed us that it was probably too late to turn her and if she didn't turn that we would have to schedule a cesarean section. This news, as you can imagine, came as a harsh shock to Daniel and I, and we didn't take it well.

They scheduled an ultrasound and a version (a technique used to manually turn a baby on the outside) but we were still hopeful that our baby would turn, so we decided to try other methods such as acupuncture and chiropractic care. When we went back to La Maison de Naissance for our next appointment they told us that it was too late for exterior methods to work and urged us to go for the version because if we didn't go or if it didn't work then our only other option would be a scheduled cesarean because no one in Québec has the proper training to deliver a breech vaginally.

So we went to the hospital for the version. When it didn't work we decided not to go back to La Maison de Naissance because we didn't believe that the only way I could deliver this baby was by cesarean section. It sounded like a last resort for an emergency situation. I felt great through my entire pregnancy and I still felt great. The only thing wrong with my situation was my care providers who were not experienced and skilled to try delivering my baby the way she was. To us, this was unacceptable.

We had heard about a midwife in Ottawa who had a high success rate in turning babies so we decided to seek her out. We went to her house for a version. She was able to turn the baby into a transverse position but then had to turn her back because her heart rate didn't cooperate. She talked to us about the politics of breech birth, given that in Ottawa, very few midwives or doctors have ever seen a breech birth, let alone know how to deliver one. She also said that it would be hard for her to help us because we were Québec residents but that she would at least try to turn our baby a second time. She gave us information about breech birth so that we understand the risks involved with delivering a breech vaginally and the added risk in doing so in a community in which it is rarely seen.

Here I was, a week away from my due date with no solid idea of what I was going to do when I went into labour. Most professional people I talked to were saying I was incapable of delivering my baby vaginally. I felt so discouraged although my true belief remained there was nothing wrong with me or my baby and that I was fully capable of birthing my baby the way my body was made to.

The second version attempt was yet again unsuccessful. It became inarguable that my baby was just not going to turn, and it was going to be a struggle to have this baby naturally within the current medical system. Along with the midwife, we planned to labour at home and deliver at the hospital. We were overwhelmingly relieved that someone was on our side and supporting us. We could then relax and prepare for my pregnancy to end and our labour and birth to begin.

Arrangements for a consultation were made with an obstetrician who would let me try to deliver vaginally. That same day, our van broke down and we missed the appointment. The following day, our midwife called to tell us that she had fallen ill and would not be attending our birth. She also informed us that the obstetrician who was skilled and experienced in vaginal breech birth was on call back-to-back the following days. Our midwife suggested we go for a consultation and have the obstetrician break my water. That was a bizarre concept for me to get used to but I told her I would sleep on it and make a decision the following morning. I went to sleep that night while watching the full moon rise high in the sky. Then at 5:30 am, I woke up with mild contractions.

I woke Daniel up and we lay awake in bed watching the full moon shine in our window and light up the whole room. Daniel's dad was planning on coming to bring us to the hospital for our consultation, so we relaxed and waited. By 9:00 am we were heading to my sister-in-law's home in Ottawa. From there, I called my midwife to inform her that my contractions had started and labour had begun. She was thrilled and gave the hospital a head's up. She suggested I try to labour at home until contractions got more regular, closer together and stronger.

We timed the contractions with the help of my sister-in-law, who had given birth to her baby 9 months ago. When contractions got closer together and more intense, we drove to the hospital while our midwife found another midwife who could come and give support.

When we got to the hospital, the nurse already knew we were coming and said; "oh, you're the breech" and wheeled me into triage. There, the nurses started preparing a saline drip in case of an emergency to which I refused. However, the doctor told us flat out that if I refused the drip, he would not deliver our baby, so we then agreed. He told us that normally he would insist on using an epidural for this type of birth because "it would make his job easier," but because he knew we were so opposed, he would keep it handy in case I needed it. Then he did an ultrasound to make sure that our baby was the "right" type of breech (frank or bum-first), and the "right" weight and had the "right" head circumference for a breech to be "possible." Then again he told us that if any of these things were "wrong" then he would not deliver our baby. That's when the midwife arrived.

It was instantly relieving to have a midwife there to provide me with extra confidence in what I was about to do. My labour was getting stronger and stronger when the midwife brought a birth ball. I tried rotating my hips while sitting on the ball and trying hands and knees on the bed. I found low moaning to be helpful and calming during contractions.

Then the doctor arrived to check my dilation. He thought I might be ready to push, but I was only 8 cm. That's when he urged me not to push if I felt the urge because I wasn't fully dilated and the baby's head could get stuck after the birth of the body if the cervix wasn't fully open. He then suggested I try the bath to relax.

The urge to push was so intense that my body actually tried pushing on its own. Denying my body of this was the most difficult thing I have ever done. I breathed through my contractions and was able to fight off pushing.

Then finally, I was fully dilated. The doctor insisted I lie on my back for the pushing, which was uncomfortable to say the least, but was the only way he knew how to deliver a breech. The baby's body has to dangle in order for the head to tuck (flex), facilitating it to come out after the body is flipped over onto the woman's body.

I pushed using two handles on the side of the bed to pull my whole body down. This was very helpful. When her buttocks started to show, I kept feeling it retract back so I thought I should hold each push then push harder to gain progress. The pushing took only 40 minutes which I am told is very quick especially considering the type of birth this was.

At 5:09pm, my sweet Abigail was born to this world without a hitch. It was the trip of my life and I would do it again in a heartbeat.

Miss Abigail Elizabeth Maude Béo was born on December 13th, healthy, pink and looking around to see all who greeted her. Tears of joy and beautiful smiles were present in the room.

This was my very first vaginal breech birth and I was delighted to have been part of this amazing team. ~

Geneviève Gagnon RM

Sages-Femmes Prescott-Russell