A young professional couple in their 30's came to our clinic for prenatal care in the early 1980's. After dealing with her tremendous nausea and vomiting was helped a great deal with Homeopathic remedies, her pregnancy went as normal as can be. Lovely couple, looking forward to their new child birthing at home.
She calls me one night and said she was sure she was in labor, described it and indeed I agreed to come quickly as it should like she was already close to transition. It was very cold and snowy that night in Anchorage.
I went over and she was sitting on the toilet. Her water bag had just broke right before I got there. As dad and I were setting up the room, in a very loud voice my client asked "Is it normal to have black stuff coming out of my vagina?" as was showing me the toilet paper with Black poop !
What does that mean, girls and boys?
Yes, frank breech baby.
This was my 2nd one by myself.
I had let them know I had only done 1 other breech and that was a surprise hospital birth, the surprise was I caught the baby with just mom and dad in the room. That baby had just slid right out.
We discuss the pros and cons, true informed consent, warning them of my lack of experience with breech. Parents and I pray about it. They decided to go ahead with the home birth. I call my back up doc give him the info, he said politically he needed to tell me not to do it and to transport- I explained that I thought she was going quickly and wasn't sure we would get there. I had brought one assistant who had never attended a breech birth, so I called an RN who has said she attended many breech births in huts in Viet Nam in the 1970's as I thought she would be able to help me. She only lived a block away and she got there quickly.
All was going well, mom was dilating quickly. and quickly got the 10 and was begging to push but I was taught to check cervix and make sure it was all gone before "allowing mom to push" I brought her bottom to the end of the bed.
His body started out as anterior and quickly rotated to complete posterior and I never saw this in the "text books" so I knew he had to turn. I gently rotated him to anterior position. Now I realized his arms were above his head, I waited for them to come out, but everything slowed down, all I could think of was to reach above his head, one arm was twisted behind his head, but ended up sweeping them across his chest one at a time to bring out his little arms to his waist. Wow, I thought ok any time he's just going to fly out.
I did at some point gave her a large episiotomy, mediolateral that required a hosp repair, it did give me more room to maneuver my hand but did nothing to bring him out. I let him dangle with hands off until again he was not moving out any further, He came out to his mouth and I realized his head was coming out asynclitic-off centered. All I could think was to get o2 on him so I had my assistant place the tube by his nose mouth. Now, all of a sudden I realized his head did not flex downward with his chin pointed downward on his chest. So he was trying to come out with his head not coming down correctly. I had a thought that popped into my head, either I read it somewhere or what, I asked her to hang on one more time as I was going to place 2 fingers in her rectum. She just wanted her baby out to make sure he was ok.
As I place my fingers I could feel his forehead coming out wrong, so I flexed his forehead downward so his chin now repositioned to his chest, I felt it release the trapping of his head and out he came.
I gave him a few seconds and knew he was stunned, he had a great heartbeat as he did through out the labor. I gave him a puff with the bag resuscitator and he got a big lung full of oxygen and cried. Mom and dad grabbed for him and cried with joy and anticipation.
I felt weary but joyous that he finally came out and looked great. His body was nice and pink but his head was pale white. The RN now started freaking out, saying something was wrong with him, and the fact his legs were folder up above his head. She quietly called the EMT's when she went into the other room.
By the time they got there the baby was nursing well, so parents refused a transport.
The RN continued to freak out, and mom started bleeding heavily as she forgot her own self and all her thought were on her baby,because the Rn had totally scared her. for her and the "baby". I told her I thought baby was just fine, but perhaps the RN knew something I wasn't aware of. I used everything to stop her heavy bleeding but as her lips now started to get pale, I told them I thought a transport was needed, as she was going to need an extensive repair. I apologized for having invited the RN, thinking she was going to be of help but instead in some ways showed me she didn't know much about breeches and said I thought she was fine we just needed extra help. That was the first time I transported for a PP hemorrhage.
We went in and I was greeted by my least favorite OB, He was an older German Dr with a heavy accent. He was quite scary, and bullied everyone. He asked me what happened and why did we stay home. I told him the truth. He lightened up and said well, lets see about her repair. He looked at baby and the color of his head and said" his head was fine, it had gotten squeezed and it would soon get pink. He got a Pediatrician to check him out.
Mom did end up loosing quite a bit of blood and was required to stay in the hospital for several days. I knew she was upset that we ended up in the hospital, so she allowed me to do minimal care for them. Both her and the baby's dad later thanked me for doing so much, they just couldn't get over being so scared by the RN. I was so sad, as I knew they might regret having a breech at home at that time. This boy is now a man and he should be about 30 now.
I almost stopped being a Midwife because of this birth. There was so many lies that came out through the hospital personnel, thus going through the community. I did much praying and re- evaluating the way I practiced.
Do I think all breeches are safe at home? No. Do I think all Midwives should be doing breeches? No. I think you have to have a strong trust that birth usually works just fine, women have unbelievable strength and that we should be ready for everything that could happen. For most of us that do attend breeches have chosen to do so, learning extra skills and are ready to do anything that is needed to have a safe birth. Know to transport when things aren't working, if you have the time. In my experiences breech labors are quite quick.
But I am a firm believer that most breeches can turn out just great out of the hospital. Do I think there should be a breech experienced person there to help? you bet! Do I do breeches now? Yes, but the parents are very well educated about the possibilities. I have done frank breech, complete breeches, a knee presentation about 60 miles from a hospital-that was a complete surprise. and many footlings some presenting in twins. Several 2nd babies turning complete transverse, and required maneuvering then to footling, All of these breech baby's have come out successfully and none of these mothers or baby's needed to be transported for problems.
My mom was a footling breech at home in 1933, with an old country doc on a kitchen table in Michigan.
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