Mama, don't breech, I've been losing sleep...

But I made up my mind, I'm birthing my breech baby

My second rite of passage was an empowering one. This is my VBB Birth Story

It turned out around 34 weeks into my first pregnancy that my baby was breech & I had (diet controlled) Gestational Diabetes. Well it turns out I was “borderline” with GD a mere 0.1 point over the target – this meant I was labelled “high risk”. We saw an obstetrician around 35 weeks, I begged him to let me be on Midwife Led Unit (MLU) but his concern was that my baby was breech (my concern was wanting a vaginal birth).

Breech presentation is when your baby is not head down (cephalic – sometimes abbreviated to ceph) where they tend to be bum down (frank breech) and there’s also feet first (footling breech).

I was like “don’t worry I trust this baby will turn” deep inside I believed this, I used to talk to my bump and ask nicely for them to turn. Spoiler alert, it didn’t. I can say I’m lucky because I was given 3 options at my hospital:

1. ECV (External Cephalic Version) where they manually try to turn baby, has a 50% chance of working and I found out it could be a painful procedure (low pain threshold me did not fancy that)

2. C-section – what most hospitals automatically do and push women to (essentially I found out midwives no longer have the skills to support breech births, due to the Hannah et al's (2000) Term Breech Trial policy which said:

Planned caesarean section is better than planned vaginal birth

It’s a paper that made such an impact overnight and all breech babies started being delivered by CS as per hospital policy. The knock on effect is that now, midwives cannot practice the skills required for a vaginal breech birth. However there’s another side to this, this paper has been hotly debated for decades that the trial was flawed:

The philosophical debate as to whether midwives are equipped to support women requesting vaginal breech birth continues, yet midwives are deemed able to conduct a vaginal breech birth in an ‘emergency’ scenario. The International Breech Birth Conference (2012) prompted the discussion of how midwives can revisit the facilitation of vaginal breech birth as a normal birth phenomenon in the post-Term Breech Trial era.

3. Vaginal breech birth (he said they had one specialist in my hospital)

The conference delegates concluded that vaginal breech birth is indeed a safe option with strict criteria and experienced practitioners in place. However, a cultural shift is required in the midwifery community to re-skill and reinvigorate vaginal breech practice.

They automatically booked me in for ECV at 37+3, he mentioned he’d be away before then (how convenient for him). By the way I don’t recall agreeing to it on the spot, I didn’t even know what it was yet. Their fear surrounding breech position rubbed on me. I started to worry (which made my GD readings high). I looked into asking my baby to turn, doing BI67 acupressure point, desperately trying to make my baby turn, Spinning Babies inversions. I just remember doing an odd inversion in my living room and I never felt more stupid. So I got up, researched stats. I joined Breech Birth U.K. Facebook group and asked on the Hypnobirthing group about it, the likes of breech birth specialist midwife Mary Cronk and Hypnobirthing practitioner Katherine Graves herself said “breech is an unusual but normal” position, it’s not an emergency.

To be honest it was the stats that made my decision clear . Essentially perinatal mortality is 1/1000 ceph, 2/1000 breech, 0.5/1000 CS [Source: Green-top Guideline: Management of Breech Presentation]. I finally understood that whatever option I chose there was always going to be risks (including CS) and deep down I didn’t think they were too far off each other.

I did Hypnobirthing you see and had learnt a lot about birth physiology, I wanted a vaginal birth for two reasons. Firstly because once the baby’s lungs are fully developed and they’re ready, it’ll trigger labour to start. Secondly because I would pass down my microbiome to my baby (decrease the chance of asthma, type 1 diabetes, obesity and coeliac disease). At the final scan I had I remember clearly saying to my husband. “I rather have a vaginal breech birth (VBB) than do an ECV” I decided to stop trying to force baby to turn, trusted they were on the inside and were the only one who knows the best way out. I was ready to decline the ECV but my baby beat me to it. Arrived spontaneously one day before the ECV appointment.

Remember my hospital had one specialist? Of course the breech specialist wasn’t there when I went into labour (I think it was 11pm when we got there), after they saw my birth plan they told us:

“the doctor on call is not confident in breech deliveries”

I asked to talk privately to my husband, we looked at each other and said “if they’re not confident, we’re not confident” so we asked for a CS. The midwives came back to say “we didn’t mean to scare you, we’ll support you whatever you want” but as a first time mother I got scared. The thing is breech is not an “emergency” and in fact breech births tend to be a bit faster, luckily my CS slot kept being delayed due to real emergencies and because of Hypnobirthing techniques my body worked very efficiently and I ended up fully dilated. Once I felt the foetal ejection reflex (my body started to push on its own) that’s when I realised:

I don’t need them to be confident because I am!

All the positive birth affirmations I practiced came true “my body knows how to birth my baby, I was built for this, my baby knows how to be born”. Suddenly it wasn’t just wishful thinking – those affirmations made me believe and given me confidence I could do it and my body proved so there and then. So when they said “we’re ready for you c-section” I declined.

I had been left pretty undisturbed (thanks to noise cancelling headphones, I could point to them and say I can’t hear you. So they were forced to chit-chat to my husband) during the first stage of labour [click here for more on the stages of childbirth] in triage. At 9cm they rolled me to the labour ward and I accepted some gas and air. I told them straight “I’m not lying on my back” luckily the new midwife I got was not only respectful of our Hypnobirthing but suggested being on fours and later on a throne/squat position. The second stage (the pushing) was my favourite part I was so excited as I felt my baby descend I was smiling, sipping water and humming lullabies between surges. Baby and I were so in synch. When the baby is sliding down the birth canal, it felt exactly like having a poo, obviously different size but it was the same sensation. It was a feeling I knew, so I didn’t feel scared at all.

Looking at my yellow notes, several people came into the room apparently and registrar insisted on me lying on back and the midwife said no at the start. Unfortunately there was a time limit after the body was out, I knew deep down I needed one more contraction for the head to be born. This is when I felt they panicked. I remember the midwife telling me to really push, which I did. I don’t remember when but I was put on my back and they did a manoeuvre and got my baby out. It happened very quickly and a bit of a blur. I don’t even remember any of this happening to be honest. I was high in endorphins (body’s natural painkiller) at this point.

The consequences was that the forced purple pushing and the manoeuvres caused a 3rd degree tear, they injected for the placenta (when I had trouble breastfeeding it turned out I had retained placenta and this was probably the culprit on my low milk supply together with accepting an epidural in theatre), and sadly they cut my baby’s cord straight away and took her to resuscitation station – I dislike the term because she was fine, I knew deep in my soul my baby was well and remember thinking why are they panicking so much, calm down. She was born without crying and probably had fluid in her nose (this is a common thing with breech babies and just need a little help clearing that out, this is because being born head up the fluids can’t be squeezed out of their nose. If you place your palm in your chin and lift up to your nose, that’s what happens with breech births. Now if you place your hand on your forehead and slide it down, that’s how cephs are born, the fluid pours out rather than up). We had the most glorious skin-to-skin but only 45mins, which felt more like 15 minutes.

I’m so glad I invested in antenatal education, was able to advocate and take charge of myself and what I wanted. It was nice to have some midwives back me.

They did help protect my space and my wishes. You have to remember midwives do want to regain these skills, she thanked me SO much afterwards that I let her be part of it. And breech births are taught to all midwives, the only issue at the moment is that they can’t practice the skills if everyone is automatically having CS.

There are some hospitals here in the UK that are using OptiBreech to give training for midwives to regain those skills. They have alot of information on their website, check it out if you need to know if you hospital have specialist trained midwives for it there. And there’s also Breech Without Borders who also help educate both parents and healthcare professionals.

But the obstetricians and medical staff lack of experience on breech births and trust on a woman’s body showed. I wouldn’t be surprised that they had never seen one before, they panicked and caused more harm than good. I am the one who had to deal with a 3rd degree tear, had to go to theatre for stitches, had trouble breastfeeding by being taken away from my baby and having drugs in my body. I had a wonderful positive experience during my birth, but would say the postpartum wasn’t as much. Or it could’ve been way better. It still bugs me they denied my birth plan wish for delayed cord clamping, if my baby needed help breathing why on Earth would you cut their oxygen supply from my placenta? To use a manual machine to clear their lung? They could’ve done that with the baby near me.

Overall I never felt more strong in my whole life. I proved to them a woman can birth naturally even if their baby is breech. It set me up for a wonderful start to motherhood, last but not least I love this quote by Laura Stavoe Harm:

There is a secret in our culture, and it’s not that birth is painful. It’s that women are strong.