Sarah’s Birth Story

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We received this birth story from Sarah and are happy to be able to share it with you! Please read on…

As my due date was approaching, I was getting really excited about having a baby (of course). I felt I had a lot of support from my care provider, South Community Birth Program, and was enjoying learning more about the process of pregnancy, labour, and birth. At a session with one of the midwives late in December, we confirmed (with ultrasound) that my baby was sitting in a breech position.  At this time, the midwife introduced me to the Best Birth Clinic, and briefly spoke about what to expect.

A manual version was scheduled, since I was already at 35 weeks. Several of my friends in the past year had experienced the same thing with their pregnancies, and I began to take the steps everyone recommended to try and turn the baby around. I had two weeks to see if I could turn the baby before the version appointment, so began doing everything I could.

Unfortunately, the baby did not turn on its own, or through my efforts. It really appeared to me that the baby had already ‘dropped’ well into my pelvis. I prepared myself for the manual version, as I had been warned from our friends that it was a pretty unpleasant experience. My partner and I also started to gather information on what it is like to deliver a breech baby, since I had mostly decided by then that, if at all possible, I wanted to try and deliver the baby vaginally. My instinctive reaction, and belief at this time, was that there was no reason a breech position should have to ‘automatically’ mean a caesarean birth.

The day before the version appointment, I had an ultrasound to check the position of the baby, and it was confirmed to be in the ‘frank’ breech position. The manual version was the next morning at the 37-week point. As well as my partner, one of my midwives was there with me. The doctor attempted to turn the baby, but gave up after three attempts. The process took less than a few minutes, since it quickly became clear that the baby was firmly planted, and was not moving. I mentioned that I was interested in trying to deliver vaginally, and the doctor and midwife let me know that the baby’s size and positioning made me a good candidate to try this if I wanted to do so. An appointment was set for a consultation at the ‘Best Birth Clinic’ a week later.

That night, at our regular midwifery meeting, I reviewed my decision with a midwife, and she offered to do a ‘stretch and sweep’, which we did. I was already at term, and the goal became to naturally encourage labour to begin before my ‘official’ due date. She mentioned that she could call me slightly dilated, that the baby would have likely been delivered before that date regardless!  I met my assigned doula that weekend, and her positivity and calm demeanor further encouraged me in my decision, she was a great match.

The following week, I had a highly informative and positive discussion with the obstetrician, Dena, at the Best Birth Clinic. She reviewed the recent research into vaginal breech deliveries and caesarian births, presented the possible risks, and discussed what the process would be like if I decided to try for a vaginal birth. I was already quite set on wanting to try, but still wanted realistic and balanced information from a reputable source in order to feel confident in my decision. It was clear to me that, no matter what I chose to do, there would be capable and understanding people there to support me. I indeed wanted to labour and attempt a vaginal breech delivery, so Dena examined me and gave me another ‘stretch and sweep’ at the clinic. She noted that I was ‘pretty much’ 2-3cm dilated at that point. This was a Friday, and she said that I’d most likely be delivering the baby sometime that weekend.  I was getting pretty excited, as things seemed to be moving quickly!

The next morning I woke up to a beautiful winter day, clear and crisp, with fresh-fallen snow visible across the North Shore Mountains.  I got out of bed, had a good breakfast and a long shower, then my partner and I went out for a walk.  My back was feeling a little sore, and I had what felt like cramps.  It’s an 8-block walk uphill to the nearest bakery, so at 37 weeks pregnant that in itself took a decent amount of time!  It was amazing outside, so it was a pleasure to get out in the crisp air and sunshine.  We took a few detours on the way back, to stretch the walk out for as long as I could handle.  We returned home, since one of the midwives was going to visit that afternoon, and I had a nap on the couch.

The midwife arrived at around 5, and we reviewed the current plan. She examined me, and gave me another ‘stretch and sweep’. She determined that I was about 3 cm dilated, and could really end up going into labour at any moment. We discussed what to do, at what point to call our doula, and how quickly we’d have to get to the hospital – the conditions being a bit different with a breech birth. She also informed me that I was GBS positive, which meant that if my water broke, I’d need antibiotics.

She began to pack up her bag and at that point I noticed that a gush of liquid had fallen out of me. My water had just broken! She confirmed that this was indeed what had happened, and my partner contacted our doula to let her know we were going to head to the hospital within the hour. Our midwife wished us good luck before departing.

My contractions started pretty much right away, and we began to time them. It was soon clear that they were becoming stronger really quickly, and were already pretty steady at 2-3 minutes apart. I got on the labour ball, and my partner started to massage my back. Labour was most definitely moving along quickly, and the contractions were pretty intense. I wasn’t in any pain, however, it just felt like waves of energy were rushing through me.

We left for the hospital about an hour and a half later, and I was admitted immediately into the assessment room. I ended up having a pretty large team with me in the hospital: besides my partner, there was the midwife on duty, my doula, a 2nd year midwifery student, and another midwife who had taken some of her own time to come to the hospital, since she had been my primary care provider during my whole pregnancy. It was simply amazing to have such a great team supporting me at this crucial time.

It took some time to get a private labour and delivery room, and by the time I walked over to one, the midwife said I was about 8cm dilated. We got our own music going in the room, and I continued to labour. The contractions were very strong, and I rode each one as the waves passed through me. Labour seemed to be progressing well, though I was completely lost in it at the time.

Since I was concerned about having to go for a sudden, emergency cesarean, I’d decided to have an epidural sited. I did not want any medication run through, as I was not having any difficulty with the contractions. Unfortunately, the anesthesiologist did not understand this, and he ended up beginning a dose of painkiller. My doula noticed this and notified my midwife. The obstetrician ended up coming in and having the painkiller taken out, but I had received enough of the drug to feel the effect. I stopped feeling my contractions, though they did continue after a short interruption. My midwife and doula suggested this was a good time to try and get a nap, so I did.

Slowly, my feeling returned and I began to ride through the contractions again. Another examination showed that I was at about 9cm dilated by this time, but the progress of dilation had slowed down. The obstetrician was concerned, as with a breech birth everything needs to progress well without any complication, in order for them to continue with the plan for vaginal delivery. He said he’d return after another hour or so, to check on my progress. My midwife and doula worked with me, basically ‘pulling out all the stops’ and asking me to try different positions and exercises to encourage the dilation to complete and move into the ‘transition’ phase.

After some time, the obstetrician returned, and the student obstetrician examined me: only the slightest progress had been made, he could say I was perhaps 9.2 cm dilated. Since the implications of this judgment were so important, I requested that the obstetrician himself check me again, since he was the person who had performed the check the previous time. His examination revealed about the same result. We had another discussion about what this meant. He was no longer feeling comfortable about the outcome, since the labour was not progressing as hoped. If it had been a ‘head-down’ birth, this would not be as much of an issue, but as it was, this was of concern. He recommended going to a cesarean instead, and, after determining that the options had otherwise been exhausted, I consented. We still wanted to continue to labour while the rest of the process was being put in place, and the obstetrician said that if some sudden progress was made, he would be open to reconsider.

We had about 20 minutes, and we were once again left in the room with my ‘core’ team. We tried a few more exercises and continued to labour, but in the end, there was no further progress. The anesthesiologist that would run the OR came in and discussed the process with me, I was transferred to another bed, and taken to the OR.

Everyone in the OR was extremely gentle, informative, professional, and understanding with me. It took about 15-20 minutes for them to prepare me for surgery, and my partner was then able to enter the OR before they began. He later let me know that he was quite nervous, and really concerned for me at this point. I felt mostly assured and calm – I was excited to meet our baby and told him so. He sat at my head, massaging my shoulders and talking to me, for the duration of the operation, which took about 30 minutes.

The worst part of the operation for me was the side effects the painkillers had – they make you feel cold, and you shiver uncontrollably. They were of course completely effective; I was not able to feel anything below my chest. It was also a little difficult that, once the baby was born, I wasn’t able to hold him right away. My partner watched his birth and let me know we had a boy once he was born. The obstetrician held him up over the screen for me for a second before taking our baby over to the pediatrician for the post-birth checkup. He was completely alert and crying strongly right away; I had been prepared for a baby that was born unconscious (apparently many cesarean-born babies are). My partner was allowed to attend to our baby for this whole time, and held him to his bare skin as soon as he was able to do so. While the surgery team stitched and cleaned me up, my partner sat at my head with our baby, and I was able to see him breathing and crying softly against my partner’s chest.

The midwife was present with me for the whole operation, and even took some amazing photos of the process – neither my partner nor I could possibly have done so, so I am grateful to her for her experience and assistance. It was great to have her in the room with me. She also made sure I got to keep my placenta – that it left the room with me.

As soon as possible (I was told it was about another 15 minutes), they removed the screen and I held my baby to my chest. He latched on and began to feed while they were wheeling me to the post-operative recovery room.  He was born, completely healthy, at 2:42 am, weighing 6lbs 14oz (about 3450g).

 

Power to Push asks: Did you build a birth plan?

No, I did not build an ‘official’ birth plan, neither before nor after I found out my baby was in a breech position. My reason for this is that, while I had a very strong idea of what I wanted, I also did not want to become rigid in my ideas about the process and outcome, I wanted to remain flexible as the situation changed. The best plan I could write would always need to be re-written with every new development and every new piece of information uncovered. I wanted to stick to the direction and the outcome I most wanted, but wished to remain open to finding the best path available under any present circumstance.

I knew that I wanted a vaginal birth, but understood where the option to have a cesarean has a definite medical benefit – where it is required. I wanted to use as little painkilling medication as possible during labour, and nothing that would expose the baby’s system to any drug, especially a narcotic, if at all possible. I definitely wanted to labour naturally and without being artificially induced (with oxytocin), unless absolutely necessary for some medical reason.  Outside of these more firm ideas, I remained open to finding the best way to accomplish the best birth possible. I believe that part of the reason the whole process was such a positive one for me is because I remained open-minded throughout the process, and had an amazing support team with me the whole way.

 

Power to Push asks: How did your experience of giving birth compare to how you had thought it would be? How do you feel looking back?

My initial vision of giving birth was to go into labour naturally, stay at home for as long as possible, have no pain medication, and deliver in water. But, as mentioned above, I always allowed myself to be open to what may come up during my pregnancy and the birth. I think even though what actually happened was quite different from what I imagined, the feelings conjured up when I look back are exactly what I wanted: calm, supported, excited, happy, and positive.  In the end, these are the important bits. Yes, recovery is taking longer now after my cesarean birth, but my son is healthy and so am I and these too are what matters.

As for looking back, there is one major thing I would have done differently. Throughout my pregnancy I felt a hard lump on the right side of my abdomen.  This lump continued to be felt on the right side and moved up towards my rib cage as my belly grew. I know now this was the baby’s head, but at the time I assumed it was his bum as surely if it were his head my midwife would have said something.  Over time I began to assume that lump was his bum until I was told he was breech at 35 weeks.  By then my pelvis was starting to ache because he had already dropped and was quite well wedged in there.  I wish I had said something to the midwives, or that his breech position had been ‘caught’ earlier. I feel this would have given me more time to try and turn him around myself, possibly allowed me to avoid a manual version, and deliver my baby vaginally.

Furthermore, as I understand, BC Women’s Hospital has a policy of not performing manual versions until 37 weeks. I am sure there are very good reasons for this, but I am wondering if it’s possible to try earlier in the pregnancy (the key being before the baby drops into the pelvis).

 

Thank you for allowing me this opportunity to reflect on my experience and share my story.  I would like to reiterate that the birth of my son was a very positive experience, and the team from South and BC Women’s were completely amazing.

- Sarah

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