A Cesarean for Breech Baby, Jaundice and PND

At our 19 week scan, the sonographer found that our son, J’s, nuchal fold was more prominent than it should be. She also found the left brain ventricle to be larger than the other. These, we discovered, were soft markers for some chromosomal abnormalities, such as Down syndrome, and it may have indicated J having fluid on the brain.

I remember I picked up the scans on a Friday afternoon. My next appointment with my GP/ob was not until Monday and I had to work Saturday morning. The first thing I did when I got home with the scans was read the report (of course!). It had a lot of big words that I didn’t understand, and I did the worst thing possible. I turned to Doctor Google. I was in tears when Tobi came home. He said I was being silly, and there was no point in panicking and dwelling on this until we had heard it in laymen’s terms from the Doctor. I went into work Saturday morning, determined not to think about those horrible long words in the report. I stepped into the office, where the boss was sitting, to grab my keys and name tag, and the boss asked me (completely innocently) how I was. I took a deep breath and burst into tears! He took one look at me and sent me home. He is the biggest softy when he wants to be.

We were booked for another scan at the Women’s and Children’s Hospital in Adelaide at 22wks, just to double check the measurements. It was at this point it was highly recommended to have an amniocentesis to confirm whether J had any chromosomal abnormalities. Tobi was adamant it was not a risk worth taking. I needed a little more convincing, but with a 1 in 200 chance of miscarrying, it was not something I wanted to risk. We also agreed, that whatever the outcome, we would still want J, regardless. The doctor we saw also told us that a termination was still an option, right up until 26-ish wks, when “it would start to become a little difficult.” NO! NOT an option!

I felt devastated. I hated being in limbo, not knowing whether our baby was healthy, whether he would be ‘normal,’ or whether he would even survive. Tobi was my stronghold. He never wavered in front of me. He knew nothing was wrong and that we would have our perfect baby with us. I should have trusted him. I later found out from a family friend that he wasn’t ok, and had gone to him and completely broken down. I had no idea! He is so brave for being strong for me. He doesn’t need to be, but it is nice to have a rock to lean on.

For 10 weeks we continued on. I still worked, the world kept revolving. We headed back to Adelaide at about 32 weeks for another scan to check the measurements again and to see whether I could birth our baby back home, or whether (because of the possibility of fluid on the brain) I had to be in the city. There would still be the possibility of a chromosomal abnormality, but our local hospital would be more than capable of ‘handling’ that. The scan took forever. Two different people did the ultrasound. We then waited for the results.

They came back all clear!

There seemed to be no fluid on the brain. It was just a random thing that happened every now and then. The possibility of having a Downs baby, or some other abnormality flew out of my mind. I was just ecstatic that I was allowed to stay home and try for the birth I was so desperate for. Oh, and it was also at this scan that we found out baby was measuring nearly 5wks ahead of dates at 36+ wks!

A bit of history – my first son was posterior. I had always had in my head that I wanted a natural birth. I envisioned walking around, laying in the bath, nice warm showers, not birthing on my back… but after 3hours labour at home, I was crying to Tobi to take me to hospital. Within an hour of being there, I had screamed for the gas. NO, the pethidine. NO an EPIDURAL! I had just got the epidural in when the midwife leant down on the bed and said, “ah… I’ve just read your birth plan… ummm…” to which I replied “I don’t care, it doesn’t matter!” while still waiting for the epidural to kick in! Anyway, 18 hours later, and about 1 hour of pushing (and third degree tearing), we welcomed L into the world.

I was determined that I was going to have my natural birth one day, or that I’d at the very least, better myself. I research and educated myself on natural birth, and found myself a student midwife to help support me. From about half way through, J decided breech was the best position, and stayed there until birth. So I also researched (extensively) about vaginal breech births and had spoken about this with my midwife and OB. My OB was all for trying a vaginal breech birth, but wasn’t confident, and was recommending I see another OB as well to discuss options. I was to make an appointment with him at about 37 weeks. In the mean time I was spending a lot of time inverted or on my hands and knees to try and get him to turn. It must have been hilarious watching me!

On a Wednesday night, at 36 weeks and 2 days, I finished work with MAJOR cankles! It was hot, I know I hadn’t drank a lot of water and I had been on my feet at work for 9 hours that day. I took myself up to the maternity ward as I had never had an issue with swelling before, and it was starting to feel really uncomfortable all over. I was monitored and had my blood pressure taken, but all seemed normal, so was sent home and told to put my feet up. I was planning on finishing work that Friday, and was really looking forward to a week or two off before baby made his entrance. Later that night I thought I noticed some fluid leaking. But I wasn’t sure. I had no pelvic floor muscles left by that point and baby seemed to be sitting right on my bladder for the last 4 weeks, so I assumed it was just wee.

Friday, as I’ve finished work, I’ve noticed my pad is pretty soaked, so again, I trot myself up to maternity to get myself checked out. With my first son, my waters broke after the epidural was in, half way through the day, so I didn’t know what to expect. Tobi came up with me and we sat around for a while, while I was being monitored again. The midwives check the fluids, and yes, it was amniotic fluid. My pelvic floor muscles were better than I gave them credit for! Coincidentally my OB was on the roster that night and she came in to see me. She explained that yes it was my waters. They hadn’t broken, it was just my hind waters. As I had no contractions in the 2 hours I’d been laying there, the (more senior) OB might do an ECV if asked. This was one of my options, as a breech vaginal delivery was NOT a favorable option to most of the hospital staff.

Unfortunately, the OB who was on call, was not one of the local guys. He was an OB from Adelaide and he was driving down (5hours) and still ½ an hour away. He was not aware of my birth plans and didn’t seem to want to hear them.

I overheard my OB was on the phone to the visiting OB explaining my ‘situation’ and, bless her; she was such an advocate for me to have this baby preferably breech, or at least try an ECV. She came back in to see Tobi and I with a sullen look on her face. She reiterated that the other OB did not want to try and ECV, and it was far too dangerous to try a vaginal breech delivery. He had said to book an operating room immediately and prep me for a cesarean.

For the second time this pregnancy my heart dropped. Having a C/S was so far from my mind. For me it was a very last resort. I was devastated. I wanted SO bad to try a natural birth and this person I had never met had just stripped it away from under me. When he finally waltzed in, he sat on the bed and would not listen to a word my OB and I were saying to him. He would not do an ECV as my waters had broken and there was not enough cushioning for the baby. It was far too dangerous to have a breech delivery, it is safer to have a cesarean, especially at 36+4wks. I just wanted the option. I wanted to try. I wasn’t even in labor for God’s sake! The visiting OB stated his reasons, said “hmff” and put the consent forms on the bed. Through tears, I signed the consent for to be prepped for the operating room. To this day, hubby still doesn’t seem to understand why that was so hard for me. Why a cesarean was such a bad thing. For me, I think, it was more the lack of choice. This doctor who didn’t know me from a bar of soap, strode in, told me what to do and expected it. I did not like that one bit.

At some point I was moved from the delivery room I was in to the maternity ward across the hall. Tobi and I debriefed a little and let it sink in that we were going to meet our ‘troublesome’ baby finally! I then did a little panic because we hadn’t chosen a name! It was literally on the way to operating room when we finally agreed on the baby’s name. We didn’t bother thinking about girl’s names as we were almost positive that this baby would be another boy.

So I was prepped for the most relaxed ‘emergency cesarean’ they’ve had for a long time and I got wheeled away. The anesthetic seemed to take forever to work. I swear I could feel them pricking me with something the whole time they were testing. They ran ice over my belly (apparently) and then they were ready to start. Funnily enough, as they cut into me a massive gush of fluid came out all over the Ob saturating his shoes. That made me feel a little better (no fluid or cushioning left, really?). It felt so weird to be tugged and pulled at. My Ob explained everything as it was happening and Tobi took photos over the curtain. It’s cool looking back at the photos, I must admit! I had to have a longer cut than normal as J was footling breech and had his feet were well engaged. Finally they pulled him out and showed him to us. He was perfect. Jackson Eli was born!

They whisked him away to be checked and I started shivering. Tobi freaked out a little me shivering, but the anesthetist assured him it was normal. It wasn’t long before I was stitched up and moved across to a bed. Still in the operating room, I was given Jackson and we had some skin on skin time and (tried to) breastfeed in recovery.  I think he was born about 9:30pm (that sound horrible doesn’t it, that I can’t remember, without looking at his book!). We got back to the room and J was weighed at 8lb 15oz, or 4.04kg (I think!). The question was floated as to whether we thought our dates were right, but after a couple of days, the nurses all agreed, because of his mannerisms, that J was definitely early.

We had a rough few days. J ended up becoming jaundiced and was under lights. Thankfully he was able to stay the room with me the whole time. Because of his jaundice, he was tired and he struggled to attach properly. I was pumping and expressing like mad and using a syringe to drop colostrum into the side of his mouth while he sucked on my finger. I was determined for him not to have a nasal-gastric tube and he was not having formula. We continued like this for about 3 weeks before he finally seemed to get his latch right.

On day two, the visiting OB came in to see me. He looked at our chart and saw I had been expressing and syringe feeding J. He told me that it babies don’t in fact need colostrum, it’s pointless really. People in such and such a country don’t give it, that’s why milk can take up to a week to come in. So don’t expect your milk to come in until next weekend. My milk came in that afternoon, before 48 hours were up. Just let me mother my baby! Just to add to that, not long after he left the (horrible) midwife on duty told me that J had lost too much weight and needed a formula top up and nasal-gastric tube. I asked why? My milk hadn’t come in, it was less than 48 hours after birth, give us a break! She begrudgingly left saying well, if things don’t improve, we’ll need to do it by the next morning.

I don’t remember when, but somehow J ended up with a tube thing “just in case.” Tobi wasn’t around when they did it and he wasn’t happy when he came in and saw it. He was just about ready to rip it out himself. I was already doubting myself and would’ve agreed for the midwives to give him top ups if it weren’t for Tobi and my friend. Kylie came in that day, and had the same reaction as Tobi. Kylie was an ABA counselor in training and was just about finished her nursing degree. She checked our chart and my colostrum supply in the fridge and said that J didn’t need that tube in. That settled it for Tobi – he marched J down the hall to the nurses and demanded that the tube be taken out. Tobi isn’t one to be messed with. He’s 6ft+ tall and built solid. You wouldn’t want to say ‘no’ to him! J came back without the tube in.

A week after J was born, with his jaundice levels going down, we decided to leave the hospital. I was going mad, and the midwives and my OB told us his jaundice wouldn’t necessarily improve any faster in hospital, than at home. But they kept telling us, ‘just one more day, just one more day.’ By the Friday, we’d had enough, we discharged ourselves against medical advice and lo and behold, J was fine!

I was diagnosed with mild PND just before J’s first birthday. I think a lot of it has to do with his birth and the lack of choice I had. We are now talking about trying to conceive baby #3 and I am arming myself with even more research and knowledge. My OB and I are more confident and although I have still been recommended to see a senior OB, she and I seem to be on the same page more often than not and is more than happy to support a VBAC this time.