Midwife-Assisted Footling Breech Hospital Birth

Early on in my pregnancy I had done a lot of research and reading and thinking and I was strongly considering the idea of a homebirth. I was doing my ante-natal care with a team midwifery practice out of a public hospital that supported this. The midwife assigned to me was really supportive of this choice and I would also have my mum there who is a midwife of about 35 years experience and attended many breech births. However, a fibroid I had that was 9cm and was not just on the surface of the uterus but had grown into the myometrium (the next muscle layer). This meant that I was no longer a suitable candidate for home birth due to the risk of a bleed. So we had no choice but to opt for the delivery suite. As I got further along in my pregnancy and my baby was still breech, I was doing moxibustion and acupuncture to try and encourage my baby to turn. None of this was working so at 36+3 weeks I consulted an obstetrician about having an ECV. I was booked for a scan at 37 weeks to ensure all was ok with the baby and scheduled for the ECV at 37+3 weeks. When viewing the baby on the scan, it was very clear that she was in the frank breech position with the head up under my left ribs and her feet up under my right ribs with the bottom well down into the pelvis. We went ahead with the ECV but baby absolutely refused to budge.

On Tuesday morning, 20/12/11 I was 39 weeks I woke up with pretty bad hip pain but didn’t think too much of it as I’d been getting that most mornings for the previous week. I knew my sister in law was coming around with my niece and nephew and my other 2 sisters in law (also pregnant and due 13 days before me and 5 days after me respectively) were coming around for a bump photo then I was going to go shopping with Mum.

Mum ducked by around 11am so she could be there when my niece and nephew got there and noticed the pain I was having. By this stage I also had some mild period like pains coming and going but figured that although it might be related to labour it would probably just be a sign of things getting ready to happen in a week or 2. Mum said she thought it might be early labour but it could fizzle out so just manage the pain. So I took 2 Panadeine and muddled through my sister in law and the kids being there then Mum left and I dealt with my other 2 sisters in law coming for the photos. By the time they left at 3pm the pain was really uncomfortable so I rang Mum and asked if she would come pick me up and take me to her place for a bath. I prepared everything just in case and rang Dan (my husband) at work to let him know where I’d be.

I got to Mum’s, got in the bath and the relief was amazing. The pains were still coming very irregularly when Dan arrived. I went for a walk down the backyard and then sat on Mum and Dad’s back deck with Dan. They got closer together and more intense so I got back in the bath. The pains eased and got further apart again but by 6-6:30 they had established a fairly regular pattern of 4 minutes apart. Mum had examined me on the Monday and I was 3cm dilated and she debated whether or not to examine me again in case I hadn’t gone any further and got disheartened. She did, and I was 5cm. (Yay!) We rang my midwife who had been my primary prenatal caregiver and told her what was happening and she said she’d get things prepared and ring back around 8pm to see how things were going. I went for another walk and the contractions got stronger and closer so I got back in the bath for relief.

My midwife rang back at about 8:45pm and said she wasn’t on call so to text her when we decided to go up to the hospital. Mum had rung delivery suite earlier in the day and asked the midwife in charge of that shift if the only delivery suite room with a bath was free… it was and they said they’d hold it for us as long as possible. It got to around 9:30pm and we were thinking that, even though I was coping with the pain in the bath at home, if we didn’t go then we risked losing the room with the bath and it would be better to go up and get settled while I was still reasonably comfortable.

I got out of the bath and between there, getting dressed and getting to the car I had about 3 contractions in 5 minutes. We got up to the hospital and got out of the car and it took ages to get up to delivery suite as I was having contractions every 10 steps I took. Someone walking past as we were in the hospital foyer asked if I needed a wheelchair and Mum said, “Nope, she’ll be fine”, then asked if I wanted the lift or the stairs. I said, “F*** the stairs”. It was pretty funny.

We got into the room and I had to do some monitoring and have my first dose of IV antibiotics for GBS. Once my waters broke, I had been told by the obstetrician who had attempted the ECV that I would require constant monitoring. This meant that until then, I could be in the bath as long as I wanted but after that I would need to be out. My midwife negotiated that I would be able to spend 15 minutes every hour back in the bath with her monitoring the foetal heart rate every 5 minutes. All good…

So once initial monitoring was done, I got in the bath. I had to get Dan to help me in as it was really deep and I couldn’t get in without feeling like I was going to fall. Dan sat up on the edge of the bath behind me and I leaned back against his legs. One of the obstetricians who Mum had organised to back me up for a natural delivery came to examine me and said I was about 4-5cm. She apparently then went out to the desk that she didn’t think I would do very well and would probably need a c/s. After about half an hour, (around 10:30pm I think) I asked for the gas. I was seriously considering all pain relief options including epidural at this point but figured I should start with something a bit less drastic and see how I went. I asked for it to be increased twice throughout the labour and by the time I stopped using it I had gotten it up to a level just a bit above 50/50.

Around 12 or so I started having contractions that didn’t really feel like they were completely going in between and at the end of some of them I was having an uncontrollable urge to push. At this stage my waters still hadn’t broken so Mum and my midwife decided to let me stay in the bath as I was coping quite well where I was, especially with my midwife coaching my breathing through every contraction. At 12:35 the urge to push became consistent and far more intense on every contraction. Suddenly I felt a really odd sensation and I said, ‘Something just came out.’ Mum looked and got this stunned look on her face. ‘It’s your bag of waters Laura and it’s still intact…wow…that’s really rare!!’ I reached down and had a feel and it was the weirdest feeling. Kind of like a really soft water balloon. After a couple more contractions they burst. They decided to let me stay in the water just a little longer as I was still coping reasonably well.

Mum said they could see contractions coming before I could feel them as the amniotic fluid would start gushing. A couple of contractions after my waters broke I pushed again and felt something else come out and I said so. As the amniotic fluid settled, Mum and my midwife were watching to see what it was. There was silence… Apparently at this point Mum and Nancy looked at each other and Mum mouthed, ‘Oh shit!’ I asked what it was and Mum said, ‘Um, 2 feet.’ I looked down and floating in the water were these 2 little feet facing the same way as mine…she was spine to spine. I said, ‘Shit, that wasn’t supposed to happen.’ That image of those feet in the water is something I will never forget for as long as I live. Apparently bub had decided to do a little manoeuvring since the scan I’d had in preparation for my ECV and stuck her feet down. Another midwife was in the room at this point and Mum told her to double buzz for an obstetrician as was required but they were all busy in theatre so Mum said, ‘Righto Laura, you just have to do this. Get out of the bath.’ I was thinking, ‘Is she bloody kidding me??? There is no way I can get up out of this thing that I was lowered into in the first place.’ So they let the water out on me. Mum then told the 3rd midwife to call for someone from NICU which I panicked a bit about but Mum quickly reassured me that it was protocol for breech babies.

I ended up getting onto all fours and pushed a bit more and the baby came out up to the thighs. They got me standing and tried to get me to get out of the bath but I just didn’t have the strength in my legs and was worried about hurting the baby so I got 1 leg on the side of the bath and pushed. This time, she came out up to her chest and as she did she rotated herself so she was no longer posterior. On the next push she was pretty much all out except her head and arms. Mum and my midwife both had hold of her body and Mum reached up to pull the arms out but before she could I pushed again and after just 6 hours 5 minutes of established labour and only 23 minutes of pushing, at 12:58am her head came out.

She gave a little cry, Dan cut the cord and the guy from NICU took her to the trolley and checked her over and said, ‘I’ve just wiped her off Lorraine, there’s nothing wrong with her, you can give her back to her mother.’ I was asking what it was and Dan looked at me crying and said, ‘It’s girl!’ I sat on the bed and they gave her to Dan to give to me and I fell in love in an instant! I was in complete awe of her and couldn’t believe that I had made something so beautiful and perfect.

Charlotte Mackenzie weighed 3800g (8lb 6oz), 53.5cm long and had a head circumference of 35cm.

If they had known about the feet before I went into labour, I would definitely have been booked in for a c/s. Instead, I ended up with a natural birth with only 2 minor grazes that didn’t even need stitching. Mum and my midwife think these are likely to have occurred as she rotated. It was an entirely midwife attended birth with no obstetrician in attendance, apart from the initial exam when I first got to hospital.

One thing I didn’t expect from all this is how much more I would fall in love with Dan. He was absolute gold from start to finish. He gave me everything I needed before I even knew I needed it. When the water in the bath was too hot and I started to overheat he wiped my face with a cold cloth until I cooled down, he had a cup of iced water ready at the end of each contraction because my midwife had told me to make sure I drank after each contraction as the gas was really drying on the mouth. He’s pretty quiet and didn’t say much but when he did it was, ‘You’re doing so well,’ and, ‘You can do this,’ and, ‘Come on Laura, push!’ I couldn’t have asked for anything better. I also have to say, I knew my Mum was good at her job and she’s been doing it a long time, but now I appreciate just how good at it she is. Her and my midwife were both brilliant and made a fantastic team and I’m not certain that things would have gone as smoothly as they did if it had’ve been any other combination as they both understood, accepted and worked with my wishes.

I didn’t get my homebirth and I didn’t get a water birth the whole way, but I got near enough to it and I got absolutely everything else I wanted that was within my reach to get. I honestly could not have asked for a more positive and beautiful experience to welcome my baby girl into the world.