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Where is the head?



“Where is the head?” I nervously asked the ultrasound tech at a last minute appointment. I was 38.5 weeks pregnant. “Up here” she tells me, pointing to the small bump nestled in my ribcage. I knew what that meant. Breech. I felt my stress level skyrocket. My midwives were telling me that heads and bums can sometimes feel the same, and at my last appointment she wasn’t 100% sure which way baby was sitting. So I was sent for a last minute ultrasound to find out once and for all. I’m glad I did. I was planning on a home water birth an hour away from the hospital. While midwives are trained to deliver breech babies, it is only in emergency scenarios. I left the clinic fighting back tears with my 21 month old daughter in tow and broke down in tears telling my husband the news over the phone. We knew that breech presentation would drastically change our birth plans. The water birth in the peace and calm of my own home would most likely become a cesarean-section, in hospital. The next call was to my midwife, Naomi. She calmly walked me through my options without trying to sway my decision. Option 1 - C-section (majority of breech births). Option 2 - try to flip the baby manually (unlikely an option in my case due to being so late in the game and low fluid levels). Option 3 - find an OB willing to deliver a breech baby vaginally. I was stunned that option three was possible here in Sudbury. I told her that I was willing to see if I was a candidate for a vaginal breech birth. I was transferred to the care of Dr. Vijay who, I was told, was one of the only OBs in Sudbury who would let you deliver breech when it is not an emergency. He assessed me and determined that I was a candidate for breech birth! I had had a previous successful vaginal birth with my daughter and my current baby was frank breech (bum down, legs tucked up). But the catch was that I had to deliver in the 24 hour window when he was on call. And that was two days after my due date…if baby would wait that long. Now came the big decision of what to do. I had a lot of questions. What would breech birth be like? Could my body do it? Was the bum bigger than the head?? What happens if baby got stuck? What were the risks for baby and for me? Should I just do the c-section birth? Was I crazy for even considering this?? I did a lot of research and spoke a lot with my midwife about birthing breech babies vaginally. I learned that most breech babies were born vaginally until around 20 years ago where a flawed study recommended c-section was the preferred method for delivering these babies. And so the skill was lost. I learned that there is no difference in complication rates between vaginal and cesarean section deliveries of breech babies. Overall I learned that it was a safe option for me. But I was scared and I wanted to talk to someone who had been through it. And surprisingly one of my good friends had birthed her baby breech in Winnipeg a few years before. I called her up and she walked me through her experience. That was so helpful for me because I was able to start visualizing what it would look like. Not going to lie. I was terrified. Something about the thought of pushing out a butt first gave me the shivers. But I had made my pros and cons lists and decided that if I could deliver naturally, I would! And so I told baby to hold on and wait until Dr. Vijay went back on call. And he did. On January 28th, 2018 at 8am sharp we arrived at the hospital for a final assessment. And Dr. Vijay said I was favorable for a trial of labour! He talked us through what it would look like and his recommendations. I’d be started on Pitocin to get labour going and then he would come back after a while and break my water. I’d deliver in the operating room. He recommended getting an epidural because he wanted me to be as relaxed as possible for a smoother delivery and because I’d have additional pain from the physical manipulation needed to help baby out. This caught me off guard because I hadn’t had an epidural with my daughter and hadn’t planned on it with this labour either. I had time to think it through because an emergency c-section on another mother delayed the induction until the afternoon. When we arrived back at the hospital we had the induction started quickly. I had been having contractions on and off all day so I knew my body was ready. Before long I had strong contractions for 45 seconds, two minutes apart and they held steady! Because of the induction I was tethered to the heart rate monitors and the IV. This restricted my movement a lot. I hated that. It felt so clinical. But I was still grateful that I was in labour! I used the ball or squatted during contractions for the next hour. It got more intense and my husband paged my midwife to come (she wasn’t “running the show” but still was coming to support me). I had told her before of my plan not to have an epidural but I was wavering on that decision when she arrived. On my hands and knees on the bed during a long and strong contractions I made it known I was considering that epidural! Naomi came over and simply asked, are you sure? I told her no, I wasn’t. So she suggested I try the shower for a bit. That was exactly what I wanted, the hot water felt so good. But unfortunately for me that was short lived. The nurse couldn’t get a good enough reading on baby’s heart rate and so I was hauled back out to bed. I was checked at that point and they paged Dr. Vijay who had gone home for supper and he bustled in shortly after to check my progress. Almost immediately after he checked me I felt my body ready to push, and they were not ready. They knew I delivered my daughter very quickly so I was told “NOT TO PUSH” as they quickly rolled me down the hallway to the brightly lit operating room and I was transferred onto the tiny operating table in the middle of the room. There was quite the audience. The doctor, a medical resident, two midwives, four NICU nurses, and my husband. I didn’t really notice any of them, I was so focused on what I was doing. I was fighting the urge to push and it made the contractions so painful that I asked for laughing gas to take the edge off. Eventually I couldn’t hold back anymore and I looked at my midwife for permission to push. It went so fast. I only had to push three times. Second push the bum was delivered and with a few quick maneuvers by the doctor his head was delivered on the third and final push. When people ask what it felt like, I just say…basically like delivering two heads! I learned after the fact, that I had had an episiotomy. My baby was placed on my belly and my husband announced we had a beautiful baby BOY! The NICU team left after they were satisfied there were no complications. And after I was stitched up I was transferred back to the much-more-cozy room where Noah got his newborn exam and we had our first breastfeed. The only thing that surprised me was his head shape. It look as though he was wearing a permanent bike helmet…like the ones you see in the Tour de France! (It eventually rounded out but took about six months!) It was over. We had DONE it! I felt like a rock star. I delivered my son breech! I trusted my body to relax and open enough. I trusted that I had done my research and chosen the best birth for us. I felt so grateful for a doctor who was trained to deliver breech babies (so rare) and that Noah waited until his on-call day. And I was just so grateful that it was a positive and safe experience for everyone. I was empowered. I had never felt so strong. One of the reasons I was able to muster the courage to choose a vaginal breech birth was because I had a friend tell me her story. And so I hope by telling mine someone might feel empowered to choose this birth too, if it is right for you. It takes courage to go against the norm but…it was totally worth it.