Breech Birth at 43 Weeks

Savitha Kopperla Breech Birth

Of One Brave Mamma, and her Breech Birth Story at 43 weeks complete!

Rewind: Feb 2015:

I helped her birth her footling breech baby girl naturally. In that pregnancy, she got so fed up with the routine hospital care, that for several months she went off the “check up” grid, until she and her husband found out about Healthy Mother online. They came to us in search of a waterbirth at week 33 – and as I do the check up, I find that the baby is breech. We send her home with positions and exercises, and ask her to come back the next week for Lamaze classes, and the following possible ECV. At 35 weeks and few days, her bag of waters breaks, she comes in to see us, and as I talk about pros and cons of a footling breech vaginal delivery, she asks for some time to decide. Meanwhile contractions pick up, and she wants to go ahead with birthing her baby naturally. Of course, I facilitate that baby’s birth, and am in awe as baby is born – yes, her 2.5 kg baby girl is born breech naturally, into my waiting hands.

Fast forward: 22nd Jan 2017

This is her due date for her second baby. This pregnancy she has been under our care from the beginning. There is a level of comfort and understanding of her needs that is wonderful, and for her we provide her the honest familiarity that she seeks! We spin out dates. But we know that she has irregular cycles. So we counsel and ask for the NT scan, which can be an early excellent indicator of due dates. But for some reason the sonographer is unable to do it properly on 3 different occasions. So it remains not done. TIFFA scan- parents defer it. So with ZERO scans in this pregnancy, we just think she will follow a similar gestational age pattern like last time! So far, so good.

By week 28, and then 30, this baby remains breech too! I have been monitoring with a hawk’s eye as Mom wants a waterbirth this time! So starts rounds after rounds of exercises, #SpinningBabies positions, homeopathics and everything else that I can think of and offer. And, Mom does what she needs to do.

Meantime, her Hemoglobin falls sharply. I help Mom focus on nutrition and supplements.

Week 34:

I try an External Cephalic Version (ECV). Baby turns! Mom is happy and so are we.

Week 35 – 36:

I get a call late at night and then early the next morning. Cough and cold. Sounds simple enough? But, no. It is a full blown respiratory infection, and mom is so breathless that she cannot speak. I tell Dad to take her to the nearest tertiary care hospital as she needs a different level of care. The first hospital that she goes to wants “empty her uterus” (another way of saying C-section) without even determining what is wrong with her respirations! I facilitate her shift to another hospital, which provides her much better care, gets her respiratory infection under control. But even there, everyday she gets multiple doctors and multiple scans, saying her baby is breech. And since her respiratory infection is responding to treatment very slowly, they tell her that the best plan of action would be to “get rid of the baby”  (another way to say C section) and then keep treating Mom for her infection. I get a call from her. “I am able to breathe well without oxygen, and they only want me to accept a C-section. And they are not doing anything except scans”, she says. I speak to her doctor in that hospital, and she chalks out her plan, and says that in case Mom does not agree, she will shift her to our Center. I say okay, we can manage. Nothing for a few hours, and later that night parents are standing at our Birth Center. She has stood her ground. She wants to birth with me, and has gotten herself discharged. We hug silently in the hallway. I monitor her and her baby. Speak with my back up ObGyn. And send her home with instructions to come back in 3 days, after the current set of Meds are done.

Week 37-39:

Learning to deal with a baby that dances in her Mom’s womb

Flip flop. Flop flip. My goodness.
This baby may have the makings of an acrobat.
She tests my skills of palpation, version, Rebozo, belly binding .. first breech, and then finally seems settled in a sort of oblique, but head down position! I tell Mamma that perhaps the contractions of labor will align her longitudinal, so she can move into Mom’s pelvis. I talk to her about coming in immediately to the Center if her bag of waters breaks, as her baby is floating high above the pelvis.

Week 40-41:

Routine check ups – Nothing is “routine” about this pregnancy

At 40 weeks and 2 days, as she comes to the Center, for a check up. This baby has now been inside her Mom 4 weeks more than her older sister. We had assumed that Mom would have her baby by now! So we talk. Mom has zero signs of labor. I tell her that she will have her baby soon, and that she should continue to work hard to get her baby to descend into her pelvis. We give her a script for getting a Doppler Scan done next week, at 41 weeks and 3 days.

Week 41 to 42:

Labor? Dates? Baby Position? Nothing is what it seems it is!

41 weeks and 3 days:

Perfect Doppler and Biophysical Profile.

Placenta is Grade 1 (Really, at 41 +3? But, remember she has a very irregular cycle?!!) And, wait there is more. Her baby is TRANSVERSE!
Midwives Crystal and Kiran are doing antenatal care that day. Crystal counsels Mom about pros and cons of waiting, choice of planned C-section, risks to baby if water bag breaks, etc. I know what Mom’s answer is going to be. “I will wait”, she says. I recommend homeopathics, soaking in the Water Tub to relax her uterus and Rebozo on hands and knees to bring the baby into a longitudinal lie – breech or head down. Not across the belly. Kiran and Crystal work with her. It works to some extent. Mom goes home.

Week 42 to 43:

This baby needs Touch, Talking, Singing and even the power of a Birth Circle

By now, I see Mom in the clinic daily. Spend time with her. Try gentle but firm repositioning. We have long talks. Run Non stress tests daily. Baby is perfect!

42 weeks and 5 days:

I work with her again.

Water Tub, Rebozo, and with gentle yet firm touch, and some singing of my favorite holy song, bring the baby into a full breech position, so at least the baby’s bum is directly above Mom’s pelvic inlet. I co-consult with my lovely Ob Dr. J – Hoping she will not tell me that my head needs a full examination for insanity! Waiting at 42 plus 5, with a breech baby, with zero signs of labor. She knows me a tad too well, respects my reasoning, respects Mom’s wish, checks her on scan and tells us that the placenta is still young. Grade 2. So, that’s plenty encouraging. Thank you, Dr. J. What would I do without you as a back up?

I think Mom is now more close to 42 weeks or even 41? Not 43. But we will never know exactly. What matters is that baby is healthy. Mom is healthy. Parents are more than ready to wait. And so am I.

I bring Mamma back into my office and that late evening, I teach her some more movements and work with positions to try and help her baby to descend. Pelvic tilts against the wall, forward leaning pelvic tilts with a semi squat, slow cat camel, duck walking, pelvic tilts in full Squat, and finally a military crawl position with pelvic tilts. This is hard. But, Mamma does every one of it, with grace and good cheer, no complaints at all! She is so determined, this Mamma.

And today, we have another wise presence in our midst. #Sister Morningstar, an Elder Midwife and Cherokee mystic from the US, who has come to visit with me, and her innate wisdom and calm presence are so very welcome. As I talk and reason midwife to midwife, she talks also to the Mamma. Mom is feeling some discomforts, back pain along with increased interested belly tightness. Sister teaches Dad some comfort measures, including how to apply counter pressure to Mom’s back. Mom feels instant relief. Things are feeling calm.

Sister and I plan and set up a bit for our BIRTH CIRCLE, which is set to happen the next day. And then, these wonderful parents are willing to take us to their Pyramid Meditation temple. At 8:30 pm at night! We drive over. Mom, Midwife and Elder Wise Woman Midwife sink into deep meditation. It feels divine.

42 weeks and 6 days:

Power of “Speaking Her Truth” in the midst of a protective circle of Women in a beautiful, magical Birth Circle

Sister Morningstar leads us into a powerful Birth Circle. Talking Stick in hand, Mamma talks about her previous birth, and speaks her truth – “What I want for this birth, is to hold my baby immediately after her birth, skin to skin”

“May it be so”, “Tathasthu” we the circle of women say. She hears her baby via the Fetoscope, smiles and feels very calm and connected. As we sing “Precious child of the Universe, come on through” everything feels nearly ready. Mamma has some more calming talks with Sister for a bit. And it is going to be a Full Moon night. :) Come baby, Come.

43 weeks:

6:55 am. I get a call.

Brownish water leaking since 6 am. Contractions are 10 to 15 mins apart. I tell them to come to the Birth Center immediately. But over the next half hour contractions suddenly pick up and are 5 mins apart through the entire drive!

7:40 am. At the birth center now. Contractions are every 2 to 3 mins now. We ask permission to check internally and find that baby has moved down beautifully into Mom’s pelvis. Still -2 station, but a far cry from floating!! And, wait: Mom is 8.5 cms dilated! Sometimes feeling pushy. We encourage her to go on her hands and knees, and tell her to blow through most of the contractions so her baby can descend fully as her cervix opens up.

10 mins into that Mom wants to lie down on her back. Intense pressures now. She is pushing. For a while all seems well. And then, baby’s heart tones are not optimal. 1 contraction. Then the next. Then the next. Lower and lower each time, and taking longer than we would like to recover. I go out of the room for a minute to make calls for backup support. Crystal is there in the room with the mother, as is Vijaya kumari. Sangeeta is there too. Both nurses are not only good support but have also worked in the NICU. We start Mom on supplemental oxygen. And encourage her to go back on hands and knees. That does the trick. Baby is back to sounding great.

By now, Sister Morningstar has arrived, and sits in a corner, holding calm, holy space. Gentle strains of classical flute is playing as per Mom’s choice. She is pushing. She is vocal.

Her perineum stretches beautifully, as the baby’s bum “rumps”. Contraction. One leg out.

Contraction. Another leg out. Contraction. One arm out. Contraction. This time I have to wiggle her a bit to get her other arm out. “Is it a boy or a girl?”, asks Dad, who has been supporting Mom so amazingly at the other end of the bed. It is a girl, we say. The baby is sitting on my hands now. I am telling Mom that her baby is pink, she is moving her hands and legs a bit, and the cord is pulsing and sending blood to baby.

2 mins over. Mom is not feeling any contraction. The head has to still be born. The cord is beginning to go white. We know she has to push her baby out. Crystal tells her to do so. But Mom says that she is not feeling anything. Concern now building up. I decide to connect with Mom. I ask Crystal to hold the baby’s bottom as I go over to the other end of the bed. I tell Mamma how good she has done. How her baby needs to come, Now. And that she can do it. She can give one mighty push to bring her baby out. She looks at my. Nods. And pushes with everything she has. Her baby is born!

Relief. But baby needs help to breathe. We set into motion. Cord still intact. Sending blood and oxygen to baby. Crystal gives a couple of breaths through bag and mask. I dry and stimulate. 1 minute plus, heart beat is good. Another 30 seconds baby has taken some breaths. She is pinking up rapidly. I keep talking aloud so Mom can hear that her baby is doing okay. Next baby opens her eyes and by 2 mins she is breathing well. Not much of a cry yet, but she is fine.

I pass the baby under Mom who is still on her hands and knees. She lifts up her baby and as we help her to lie down holding her baby, the baby lets out a loud cry, as if telling her mamma “there you are, Mamma, I was looking for you”

Beautiful pink baby.

All 3.5 kgs of her! She is 1 whole kg bigger than her older sibling at birth!! Ecstatic Mom, and teary Dad and more teary midwife. “You did it, Mamma” I say. And she says “We did it”!! 

Baby breastcrawls in a bit, latches and feeds beautifully. Mom is amazed. The “truth” that she spoke with the talking stick in her hand, at the Birth Circle has come 100% true!

Today, as I speak with her, Mamma says that she wanted that natural birth for her daughter. She felt that if her baby could not make the small journey through her to the outside, how would she be able to make more challenging journeys in her lifetime? Such a wise, strong, brave Mamma.

She also said something I would want every Mom to hear: “So many of our generation have lost the opportunity to experience the true power of natural birth. At least if we all try really hard, we may do enough to let our next generation experience birthing the way it was meant to be”.

Yes, Mamma. Yes. May it be so. Tathastu.

~ Vijaya Krishnan

Vijaya Krishnan is a Certified Professional Midwife (CPM), and the co-founder and Director of Healthy Mother Sanctum, Natural Birth Center, and the leading official Lamaze Certified Childbirth Educator (LCCE) in India. She is a graduate of the Midwifery Program from National College of Midwifery, USA. She is the most sought after Independent Certified Midwife in India and an an expert in Normal Birth. Vijaya has been inducted as a Fellow of the Academy of Certified Childbirth Educators (FACCE) in recognition of the outstanding work she is doing to bring about positive, sustainable change in birth practices in India. She is also the Chapter Leader of ICAN (International Cesarean Awareness Network), and runs the Healthy Mother Breastfeeding Support Network in Hyderabad. She is a prolific author and her publications have been published in Midwifery Today, Journal Of Perinatal Education, and online in MIDIRS as well. Over the past 2 years, she has lectured widely and run workshops on Gentle Birth Practices at Universities and Medical/Nursing Colleges in India, to sensitize the key care-providers into adopting these practices widely.

2 Responses

  1. Amanda Noelle

    Amazing inspiration! I’m 39 weeks breech and felt so encouraged reading this 🙏

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