Bijgewerkt: 9 apr 2020
Note that in this article Dutch protocols are mentioned. These might differ from other parts of the world.
Finding out about the breech position
When I finally reached 37 weeks of pregnancy, I was very happy. This meant I was allowed to give birth at home (with a midwife off course) if everything went as plan (this is rather common in the Netherlands, about 28% of the pregnant women give birth at home and optional. You could also you to a hospital if you prefer). I was born 4 weeks early so there was a possibility I would give birth too early too.
The days past by way too slowly and I reached the 40 weeks pregnancy landmark. Apparently, my little one was very comfortable in my belly and wanted to stay there a little while longer. As I passed the due date, I was checked more often by the midwife. If you want, it is also possible the midwife detaches the cervix from the membranes with the fingers when performing a toucher (stripping).
After the due date, I had two normal checkups with my midwife. They came to my house twice (as my mobility was severely affected) to perform a stripping. One of the checkups there was with an intern who did some extra measurements which were very fun.
All this, unfortunately, did not result in spontaneous labor and I had to go to the hospital at 41.3 weeks to check to the baby’s heart with a CTG. At first, not much interesting was shown (the baby did not move) and I received a glass of very sugary lemonade and one of the nurses shook my belly. This woke the baby up and she started to move a bit. Now a proper CTG could be made.
Next, an OBGYN made an ultrasound of my belly to see if there was enough amniotic fluid for the baby. As soon as the OBGYN put the device on my belly she saw that my baby was with her head up and her bum down.…. She was in a breech position……
My head went completely blanc…….
This was my second push toward the PPD.
The OBGYN was called to the OR but my boyfriend and I could stay till another OBGYN could come by to answer our questions. This took maybe 10 minutes which I needed to process the information I just got a little. What I was wondering the most was; How is this possible? I saw 4 different midwives in the last 2 weeks and all were certain the baby was in the right position for birth. I clearly remember one of them saying: ‘Yes, here you can feel her head and shoulders and this is her bum’. This was all not true. A different gynecologist came to us to discuss a new plan.
The first option was a C-section. I really did not want a C-section as it is a severe surgery that many people think too lightly about nowadays in my opinion. I only wanted a C-section as a last resort when either my life or my baby’s life was in danger.
As my baby was estimated to be on the small size I at least wanted to try a breech birth. This was my second option. If my baby did not announce itself earlier than 42 weeks of pregnancy I would be induced. As my OBGYN had done multiple breech births and was confident that it could be done when everything goes well, I also considered this.
My third option was to do an ECV (external cephalic version) and have a normal delivery. If this was successful I could have the baby at home so this was what I wanted to try first. She told me about the pros and cons (a direct C-section in case something goes wrong) and I would be called if there was a room available in one of the delivery rooms. After resting a couple of hours at home I was called and we went to the hospital.
The delivery rooms in this hospital are super nice. They want to give you a homey feel which I think they did a great job at. Something you appreciate at moments like these.
2 gynecologists would do the ECV. One would get my baby’s bum out of my pelvis and slowly bringing it up while the other would try to bring her head and shoulders down.
It felt really weird and my uterus cramped completely as soon they started. My little one was far down my pelvis already and was pretty stuck there which made this a difficult procedure. Both OBGYN’s were putting their full weight on their fists on my belly to try to make her change position.
This was very painful and apparently very scary to look at if I was to believe my boyfriend. Unfortunately, this was not successful which meant I was going to try to do a breech birth.
Pros and cons of a breech delivery
I did some reach about the pros and cons of breech birth and a C-section that I would like to share with you.
Short recovering period
Boost for baby’s immune system because the bacterial in the birth canal
High chance of success for breastfeeding
A short stay in the hospital
Next delivery will possibly be easier
Fewer risks during the next pregnancy
A strong feeling of power and confidence after birth.
Disadvantages of Vaginal breech birth:
Death rate 0,04 per 1000
Long painful procedure Higher chance of tearing and high blood loss
High chance of damaging the pelvic floor with incontinence of stool and urine
A higher chance that the baby might be injured (on its head or collarbone) because of the delivery
Higher chance of defects in baby’s hip development
Earlier sensation to push
The last part of the delivery is the most difficult as the head comes last.
Less damage to the pelvic floor
Often can be planed
Takes 30 minutes to an hour
A feeling of control over the birth process
Severe abdomen surgery
Long stay in the hospital
The scar tissue can cause internal organs to grow onto the abdominal wall
Death rate 0,53 per thousand
Chance of infertility Increase chance of miscarriage with next pregnancy
Can affect bonding between mom and baby
Lower success rate breastfeeding
Feeling of failure
If a breach birth is possible depends on a few factors like:
How many kids you have
Estimated birth weight
Circumference of baby’s head
Experience of your OBGYN
Even though it was my first, my baby was estimated 3kg/6,5lbs. Also, her head circumference was estimated at lower than average. I was also not looking forward to having a C-section as it is a severe surgery in which lots of my friends suffered from long after the procedure. I also wanted my baby to have the boost of its immune system through natural birth. My OBGYN left the decision up to me. She had experience with breech births which gave me confidence that I could at least try to do it.
Going to the hospital
The day of the ECV was hard on my belly and my baby. Apparently, this had been severe enough for my water to break the following night. We immediately called the hospital and we had to come in to check if it was indeed amniotic fluid. This was the case which meant I would leave the hospital with my baby in my arms.
Because of the breech position, my delivery had to follow certain protocols (for both my baby’s and my own well being) or they would do a C-section. This meant the dilation should progress about 1cm each hour. To achieve this a balloon catheter was used. This felt a bit painful but not too bad. Kind of like having an IUD placed. The filling of the balloon catheter felt more painful. Also because it made my baby uneasy. This is completely logical of course. I wouldn’t like it either if a big ball was pushed against my bum. This balloon catheter had to stay until it would fall out on its own.
The hospital had delivery rooms that gave you a very homey feeling that does not feel like a hospital. It also had a nice TV and a small fridge we could use (in the end we used neither but it was nice it was there).
After a couple of hours, the OBGYN that would do my delivery came to say hi. She also told me that she booked an OR. In case anything does not go as planned, they would have room for me there immediately. I was really happy that she would be with me during my delivery. Of all the gynecologists in the hospital, she was my ‘favorite’.
Even though almost nothing came of my birth plan, I am very happy that she did the delivery and it is still something I look back on positively. While the balloon catheter was doing its job, I was Netflixing and feeling the contraction becoming stronger. Every hour I was checked upon and we were left alone again. My boyfriend even went home to get some things (maxi cozy) and snacks.
After about 4 hours the balloon catheter was removed. I was dilated sufficiently but muscles prevented the balloon catheter from falling out on its own. When it was gone, it was immediately clear that the baby was bum down and that the delivery had to take place within 24 hours. There was meconium everywhere.
Meconium is normally excreted after the baby feeds for the first time. When a baby does this sooner, it indicates stress. This meant they would accelerate the delivery even further by administering oxytocin. This was slowly increased to make sure my dilation would process sufficiently. Because my baby was starting to have a more difficult time her heart rate was now constantly checked with a CTG. They also could see when I had contractions. Being hooked onto a CTG also meant I could not leave the bed anymore.
As the contractions began to be more severe I also did not feel like walking around anymore and was turning more in onto myself. About once an hour I was checked upon to see if the dilation was indeed progression according to the protocols. As I had been in the hospital for a while now, this meant new nurses would take over the shift. They came to introduce themselves which was nice. They were also a little excited as a breech birth is not something they see often.
My contractions became stronger and when the dilation was about 7 to 8 cm I started to feel the need to push. As the dilation was not sufficient yet, I had to breathe the contractions away. As you read before, an earlier sensation to push is one of the downsides of vaginal breech birth. The combination of the strong need to push and the very strong contractions was very difficult for me to handle. Up till now, I could handle the pain but this combination was so severe, I had to ask for painkilling. Luckily, I received this directly (morphine pump) and had to deal with only the need to push.
Each time right before a contraction I had to push the button to make the contractions less severe. This made me a little too relaxed and it lowered my heart rate low enough for the alarms to go off. This alarm reminded me to breathe, that is how relaxed I was.
The Breech Delivery
When the dilation was 8cm the gynecologist came to watch me. She would not leave until my baby was born. Also, the nurses came to prepare everything. The painkillers were removed as it was important to feel the contractions so I could push properly. You read everywhere that the last part of the dilation is the most severe. This is indeed how I felt it. The pain is extreme and everything goes through your mind. I mostly felt fear. What I mostly thought (at least I think I did not say it out loud) was: ‘I don’t want this anymore, I want that C-section’ and (What was I thinking doing a breech birth) but mostly ‘Oh my… soon there will be a baby… How am I to do this?’.
The remainder of the delivery I can not remember clearly. These are just shreds of memory put together.
What I do remember is that the OBGYN kept saying that I had to give it my all. She also did something that really hurt me. I screamed (as the pain was far worse than the contractions) and I remembered that one of the nurses asked the OBGYN if that really hurt that bad. Which she confirmed.
What scared me the most about this phase was that your body completely takes over control. As I am a control freak I find this very difficult. There was nothing else for me to do than go with it.
Towards the end, I felt my baby move back and forth in the birth canal. Very frustrating. At this point, I saw one of the nurses prepare a syringe. It turned out to be the sedative for the episiotomy. The sedative was administered during a contraction so I did not feel it. The episiotomy happened during the next contraction which I also did not feel but I clearly remember hearing it. Cutting with scissors will never be the same….
With the next contraction, her body was born. The OBGYN took her and twisted her to help her head being born. I had to keep pushing and a few seconds later there she was. She was immediately placed on my belly where I could clearly hear her breath. This is the only part of the delivery that I clearly remember. Everything else is a daze.
The nurses and gynecologists were very busy around me. Daddy had to take off his shirt and my baby was placed on this chest. I was rushed to the OR as the placenta was stuck.
I remember seeing all these strange faces. Something was placed over my mouth and nose which I did not want as I was still having contractions. I really did not cooperate but suddenly I was gone.
My next memory was sitting in a bed crying as I wanted to go home. Unfortunately, we had to stay in the hospital for a few more days. I luckily did not have to share a room and my boyfriend could stay with me if he helped with taking care of our baby.
I was still very weak because of the blood loss. Afterward, I was told I lost about 1,5 liter of blood. I did not see this but my partner did. He was very scared when they took me to the OR. Because of the blood loss, I could not stand on my own let alone walk.
All the care for my baby was done by the nurses and my boyfriend. The only thing I could do was feeding the baby. She did not latch on properly so I had to use a pump to give my baby my milk. This milk was given to her by finger feeding which my partner could do.
When I received a blood transfusion I quickly felt a lot better. The catheter was removed and a soon as I could go to the bathroom without help I was allowed to go home. The next morning we got to go home.
In the Netherlands, each woman who gave birth is entitled to about 40 hours of maternity care so when we were home, the maternity nurse came only half an hour later to help us. As latching on still did not go well we also arranged a pump at home and the maternity nurse arranged for a meeting with a lactation specialist.
Unfortunately, this did not help much. This only useful tip we received was kangarooing (lots of skin to skin contact). This was very nice and helped us relax. She also recommended an osteopath to check for blockages caused by birth. By now we knew she had reduced movement in her neck. She could not look to the left. This was probably caused by the fact that her head was in an uncomfortable position against my ribs. The doctor also gave a referral to a baby physiotherapist.
The first weeks after birth I cried about everything. ‘I had such a beautiful baby’, ‘my boyfriend was so sweet’ but also negative thoughts like ‘how am I suppose to do this on my own?’. Part of this is normal. This is called the baby blues and is caused by the rapid changes in the hormone system of women who recently gave birth. Usually, this stops after a few weeks. In my case, it became worse.
Read here about the story about my postnatal depression.