Double Footling Breech Birth Adventure {Vaginal Hospital Birth}

“I am a chiropractor who specializes in pediatric and pregnancy chiropractic. I am certified in the Webster technique which is a special technique/analysis that helps balance a mom’s pelvic bones and ligaments via a chiropractic adjustment and also helps take stress/torque off of the uterus by finding trigger points on the round ligaments. Not only does it help mom feel and function her best but it helps baby get into the optimal position for childbirth. Ironically, my baby happened to be hanging out happily breech at 39 weeks pregnant.” – Crystal

I had been getting adjusted regularly (almost daily), doing inversions and breech tilts (spinning babies), visualization, ice/heat pack, playing soft music at my pubic bone, etc… BUT my baby boy really was enjoying sitting Indian style/cannon ball in my uterus! My care started off with Alpharetta Women’s Specialists midwife Janet and plans for a North Fulton Hospital waterbith as I had planned with my first son, Alex, who is now 2.5 years. I knew from my first labor and delivery that not all things happen according to the “birth plan” but never did I expect to be full term and not even know who my provider or hospital would be, let alone come to find out at 37.5 weeks that baby boy was not head down.

My midwife, Janet was pregnant and began transferring all her patients due around the holidays (my EDD is 12/23) to another midwife group. Unfortunately ISIS had a midwife whose son had died over Thanksgiving and could not take me, so I was transferred to North Fulton Women’s Specialists. I had one appointment there with the new midwife, Michele, and Dr. Mudugno (whom I saw a couple times at my post-partum checkups from having my first son with Diane Tandy a couple years ago). I was given the option to have an External Cephalic Version performed first thing Monday morning at the hospital in order to get him to turn. I was agreeable to this, seeing as how 1 or 2 out of the 3 OB’s at this new practice were not comfortable doing vaginal breech delivery and I would likely end up with a C section if he wasn’t turned by the time I went into labor.

At the hospital, prior to my ECV, I picked the brains of a nurse that had worked there for a couple decades. I asked if vaginal breech delivery was allowed/ever performed there. She said, not intentionally and hasn’t been done in a very long time. This is when I knew I had to get in with either Dr. Bootstaylor or Dr. Tate ASAP. By the way, the ECV was unsuccessful after two very painful attempts. The Terbutaline Sulfate given to me to relax my uterus, made the rest of my body a nervous wreck. Come to find out that it can cause tremors, tachycardia, palpitations, all of which were happening to me while my baby was getting pushed and pulled in-utero. Not fun! I’m also wondering if I had a mild/moderate allergic reaction because I am allergic to Sulfa drugs. Anyway…

Dr. Tate was booked solid and I couldn’t get an appointment with him until Thursday so I decided to have a consultation with Dr. Bootstaylor Tuesday morning to get his perspective and the diagnostics on this baby’s dimensions via an ultrasound. I was really impressed with all of the midwives at Intown Midwifery and Dr. Bootstaylor when I attended an Intown Midwifery Meet & Greet the prior week. It was confirmed that my baby boy was complete breech, weighing approximately 8.5 pounds based on femur measurement. Dr. Bootstaylor informed me that he will only deliver frank breech (butt presenting first) due to a couple risk factors of cord prolapse, feet coming first, etc. He said we can just wait and see if baby decides to change, I can go into labor spontaneously and then have a c-sect or schedule a c-sect for after 39 weeks. I knew I still had to talk with Dr. Tate and Thursday couldn’t come soon enough.

At my first appointment with Dr. Tate I loved the fact that he took the time (3 hours) to share with me all of the pros/cons of breech vaginal birth. He gave the most thorough informed consent that I have ever experienced and had me sign a few forms about what we discussed. Not too many doctors are willing to take the time to explain the risks, side effects, benefits and alternatives in this much detail. It was so important to me that I got all of the facts to make an informed confident decision. He did a head/body ratio analysis of the baby and my score was a 0.91. He said he is willing to deliver breech vaginally since anything under a 1.1 is ideal for this scenario. I was so relieved to hear this. This meant my baby’s abdomen was the same size or even slightly larger than his head at this point. So during a breech delivery if I am able to push out the butt/body/abdomen then I should have no problem pushing out his head, avoiding one of the risks of breech vaginal delivery, head entrapment. He also stated I had a “proven pelvis” which means I have pushed out an 8.8 pound baby with no complications in the past. My “homework” was lots of walking, sex and nipple stimulation! Sounds like work at 39 weeks pregnant! Lol!

Given my options and the probability of success for vaginal breech delivery I chose to go into labor spontaneously. My baby boy was in the complete breech presentation (he was basically sitting cannon ball/Indian style) at the appointment with Dr. Tate. I promised to call when either my water broke or my contractions are at 6-8 minutes apart every hour. I continued to get adjusted because, regardless if the baby turns or not, chiropractic care helps the body function at its best which I need for an optimal delivery!

12/17/12 7:25 AM Woken up from sleep by a contraction. I felt another about 5 minutes later. I began using the contraction timer I had downloaded on my iPhone the night before. Ironic that I felt the need to go out with my fiancé and 2 year old son as our last meal for a family of 3 the night before! I even took my 39 week pic in front of our Christmas tree and wrote this jingle/caption, “My Christmas Jingle: All dressed up and nowhere to go! It’s raining outside and I wish it were snow. 39 weeks pregnant and 1 to go? Alex is excited to meet his little brother and Santa Claus. Ho ho ho!”

After about 30 minutes of the contractions I realized they were consistently 5-7 minutes apart and I got in touch with my doula and my parents, letting them know what was going on. Since my first son’s labor was over 27 hours I thought I had plenty of time to labor through this first phase in the comfort of my home. My 2.5 year old son and fiancé were sound asleep in bed. I got up and began finishing up the laundry, packing the rest of the hospital bags, getting breakfast ready for my son and his overnight bags packed for the friend of ours that would pick him up from daycare. In this amount of time (2 hours or so) I was able to observe my contractions lasting about 50 seconds, every 5 minutes, consistently. My fiancé woke around 9 and I called Dr. Tate’s office at 9:30 to tell them my progress. I was surprised when they told me to go in to the hospital as soon as possible. I decided I would take a shower and shave my legs before I woke up my son to get him ready for daycare. I hardly felt the contractions in the shower so I extended my stay in there but once I got out, contractions hit me so hard that I began sweating through them, dropped to my hands and knees during them and had to recruit my fiancé for sacral counterpressure to alleviate the intensity. My son woke up worrying about mommy, grabbed mommy’s hand and said “I help you, mommy. I help you.” So sweet! I realized my contractions were getting more serious and productive when my son asked me to read him a book and I couldn’t read 3 words in a row because of the pressure and intensity. It was time to get gone! Lol! After I started saying, “Dear God, help us all.” (My mantra during Alex’s labor/delivery!) My fiance also started realizing we needed to have been on the road a while ago.

We made it out of the house around 10:40 and to my son’s daycare at 10:50… it was a quick drop and run because I was already feeling pressure in the birth canal. I remember my fiancé asking if we should just go to the hospital without dropping our son off at school. I was thinking, “Yes”, but my mind knew that he would probably have missed the birth due to our son not being able to be in the L&D room or just trying to get a toddler to cooperate in such a rushed scenario, so I screamed “Drop him…FASSSST!” As we approached Alex’s school, he began singing, “ Happy Birthday to you, Happy Birthday to you, Happy Birthday mommy, daddy, Robi! Happy Birthday to you!”. Kids are so intuitive! He knew how to make mommy feel better!

We had about 15 minutes to go to get to Emory University Midtown Hospital in the heart of Atlanta…Thank God it wasn’t rush hour, because it took us 25 plus minutes with the traffic we did encounter… and that was with Xavier running 2 red lights in midtown. I was so impressed and surprised by how calm Xavier was during this process. He is typically a type A, almost OCD personality that is very impatient. He showed a lot of calmness during this process which I definitely needed at this stage. It was 11:08, we were on 85 South and my water broke. I began to panic a little. I called my doula and had her call Dr. Tate. Xavier assured me “Just because your water broke doesn’t mean you are having the baby soon/now.” My body was telling me something else. I felt my baby boy slip into the birth canal almost immediately afterward. This whole time I was in the back passenger seat of our SUV, squatting on the floorspace hugging the back of the passenger seat with my head on Xavier’s shoulder, saying “Dear God, help us all!” Visual: I’m 6 feet tall and very athletic build. I don’t fit very well in a floor space of a car. You should have seen the pedestrians and other cars looking in at what the heck was going on in our car? Was that lady shot or something? Haha! Comic relief in between intense urges to push, and I think I did… twice.

11:16 Emory Hospital front entrance is a chaotic traffic jam of Marta buses and backed up valet service… 200 yards to the doors…! I could reach down and feel baby parts coming out of me and was going into shock not knowing if it was feet/arms/cord because it definitely was not a butt or a head! I needed someone to come and sweep me up and fly me to the moon, or at least the labor and delivery room! Not an option. Xavier yelled at a police officer directing the chaos that there was a woman in labor and to take the car…

We both got out and walked about 50 yards… I stole someone’s wheelchair and yelled… “Labor and Delivery… he’s coming out… NOWWWW!” The lady pushing the wheelchair was going about as slow as she could go in the hustling lobby while onlookers are yelling, “She’s in labor!” I decided she needed to see the severity of the situation so I outstretched the waistband of my yoga pants and she and I could see his feet/legs. After 2 other passengers in the elevator got a birds eye view of a woman with 4 legs, they will never again be the same!

“Stand back everyone!” The wheelchair pusher screamed. “ Here we come. Sir, get that door. And that one.” As she is racing me sitting sideways in the wheelchair to the labor and delivery room on the 3^rd floor.” The registration desk is trying to flag us down and get us to register! Really?! We pulled up to the first L&D Room and there he was, the angel of a Dr. that was off-duty but ready and willing to take on this delivery. A L&D nurse pulled out my waistband and said, we’ve got a baby coming out and it’s not a head! A nurse/doctor on each appendage hoisted my petite delicate (haha!) self up on the bed and ripped my pants off…

Dr. Horton did a couple maneuvers with the baby’s arm which was giving him a high five already inside the womb. I had already pushed my baby boy out up to his thighs upon arriving. Dr. Horton had to adjust baby boy’s arm and flex his head forward by some maneuver that I was definitely not expecting!

3 minutes after arriving at the hospital front doors, “I need you to PUSH!” fell on deaf ears in shock from my last 15 minutes of labor. Everyone in the room came together to encourage me, “PUSH Crystal!” and with one room-shattering, bone shaking scream… his head was out and baby Robi Xavier was born at 11:20AM, a strong and healthy 8.7lb, 20 inches long!

I was in shock and in love! I couldn’t believe how fast I had progressed, that I got to have a vaginal breech “Footling?!!!” delivery and that it all felt so efficient and natural and safe! That God really was watching over us, since Dr. Tate didn’t get notice in time, Dr. Horton was the next most experienced vaginal breech delivery doctor and he was almost “waiting” for me outside that room at that time (even though he was technically off-call and getting ready to go home for the day). So many OB’s may have pushed the panic button due to lack of experience, etc… but he was so calm and relaxed and ready.

The unmedicated labor and birth was night and day from my first labor and delivery and my son was wide awake and alert and nursed 3 times from birth to my post-partum room. I felt awesome and ready to leave an hour after delivering. The only weird side-effect was that my legs would not stop shaking like I was freezing cold, and it lasted a good hour, until after I delivered the placenta. They said this is a common effect from the effort of pushing out the baby. The most painful part of my experience was uterine contractions after delivery. When my son nursed, it would send shock like sensations down the inside of my thighs and legs and I got very nauseous several times.

This had to be one of the most adrenaline packed births ever! I’m sorry Dr. Tate was not able to participate due to my fast transition and regret that his OB residents didn’t have the chance to observe another fantastic breech vaginal delivery with him. But I feel grateful for Dr. Horton and blessed that he was calm and cool and had been trained in vaginal breech delivery. I feel grateful for Dr. Tate and his willingness to take on VBAC’s and breech vaginal birth with such confidence in himself but more importantly in the woman’s ability to birth naturally.

So, in my quest to avoid a c-section I met some wonderful providers, toured 3 different hospitals, and finally found the information, peace and clarity that I needed to make a confident decision to have a vaginal breech birth. If not for the experience of Dr. Tate with this and the gentle guidance and time that he took to give me all of the information I needed, I would have spent my last week of pregnancy worried about an eminent c-section rather than focusing on the possibility of a beautiful natural birth. C-section could be the end result any time in birth, but I would hope it is only in case of an emergency. If my body is capable of handling the labor and delivery of my child no matter his presentation, I am ecstatic that I found a provider who is comfortable with that and respects the body’s ability to birth! We are blessed to have a healthy and strong baby boy and happy, healthy and unmedicated mama mia! Robi Xavier is nursing like a pro already and has gained a pound and a half and an inch and a half all in his first week and a half! We are so blessed.

Crystal owns C’hi Chiropractic in Atlanta